This study examines whether 72 infant deaths in one urban neighborhood in one year could have been prevented and if so, how. The neighborhood was targeted for a Maternal and Child Health Block Grant demonstration project because of its combination of low income and high rates of unemployment, teenage births, and infant mortality. Using a replicable set of decision rules, a committee consisting of a practicing obstetrician, a psychologist, and a social worker-epidemiologist used linked birth and death certificates to determine whether each death might have been prevented using available resources. Our criteria were designed to be somewhat conservative, in that no death was ruled preventable unless the evidence available from the birth or death certificate suggested that an available resource had clearly been called for and had not been used. Our results indicated that 25 percent of these infant deaths might have been prevented through the provision of maternal or infant transport, adequate prenatal care, immediate medical care, or alteration of the family environment. Each intervention is discussed in light of the particular circumstances of the neighborhood and current financial and political limitations.
Child Health Services Decision Trees