Antenatal Risk Reduction: Effectiveness of a Community Based Public Health Initiative in Syracuse, New York

This thesis undertakes the evaluation of a multifaceted community intervention, the Syracuse Healthy Start Initiative, which aimed to reduce rates of infant mortality, particularly among African American women in Syracuse, New York. Analysis of the research literature confirms that preterm delivery and low birth weight are major causes of infant mortality. The project targeted interventions to causes of preterm/low birth weight, in four areas of risk: nutrition, smoking cessation, maternal stress and bacterial vaginosis infection. Utilizing a conceptual framework of cumulative risk and a case-control study design, a retrospective chart review was undertaken which reviewed all the preterm/low birth weight deliveries during 2000-2001 in the project area. Each project intervention was analyzed. Interviews with fifteen women who delivered singleton infants in the project area were also conducted Using a semi- structured interview guide women were queried specifically about smoking habits, nutritional status, stress during pregnancy and infection history The quantitative data was subjected to a simple descriptive analysis and then to a logistic regression analysis controlling for any confounding The effect of race was also analyzed. The interviews with postpartum women were transcribed and subjected to a thematic coding procedure described by Maykut and Morehouse (1994). The results indicate a significant association between preterm/low birth weight delivery and women who were positive for bacterial vaginosis but not treated [OR 2.48 (95% Cl 1.23-5.86)]. This was the only intervention that reached significance. Major themes in the qualitative analysis highlight the complexity of women’s lives and the existence of cumulative risk in each case. The role of BV treatment was also apparent among the interviewees. The results of this evaluation support previous work which demonstrates the relationship of BV infection and preterm delivery. It is suggested that a targeted BV screening strategy which combines risk assessment with prevalence information should be considered.