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Odds of infant death higher in remote villages than in rural hubs and cities, research shows

Kyle Hopkins

Alaska Native babies in small, remote villages die at twice the rate of Native infants in cities, according to new research from the Alaska Native Tribal Health Consortium.

Epidemiologists for the statewide nonprofit estimate that the odds of a child dying before his or her first birthday increase by 3 percent for every 10 miles the family lives from a regional hospital. The findings for 2006-2010 showed no significant difference, however, between death rates among Native infants in hub cities like Bethel versus larger cities such as Anchorage and Fairbanks.

Senior epidemiologist Carla Britton presented the findings Monday at the five-day International Epidemiological Association summit in Anchorage. The conference gathers public health experts from across the globe to discuss the latest research on preventing illness and death.

The safest way for babies to sleep is on their backs, alone in their cribs, doctors say. Toys, blankets and even bumper pads might increase the odds of suffocation. Other risk factors for infant sleeping deaths include:

-- Exposure to secondhand smoke.

-- Sleeping in the same beds as people or pets.

-- Caregivers who are very tired or under the influence of alcohol and drugs.

The number of babies dying before 12 months of age has long been a public health concern in Alaska. The mortality rate for all Alaska infants ranks about in the middle of all states and has dropped sharply since 1980.

Among Alaska Natives, however, the rate of 9.2 deaths per 1,000 live births remains roughly 50 percent higher than the national average. Native infant death figures leveled off and possibly increased slightly between 2006 and 2010, the most recent period studied. The research identified the child's hometown based on the mother's residence listed on birth certificates.

A mother’s health, access to quality medical care and poverty all influence the child's chances of survival. The Tribal Health Consortium research compared infant death rates in villages that are accessible only by boat or plane to cities and hubs with regional hospitals.

“We observed an 80 percent increase in the odds of death for infants whose mother's residence was reached by air or boat compared with those whose mothers lived on the road system,” Britton wrote in a presentation prepared for the conference. The mother's hometown did not significantly affect survival rates for non-Native infants, the research found. 

The precise causes of the disparity in urban and rural and Alaska Native and non-Native death rates is unclear.

“It could be any number of things and we haven’t necessary drilled down,” said Stephanie Birch, section chief for Women’s, Children’s and Family Health at the state Public Health Division.

“Housing is challenging in some of the Bush locations, so having room enough for a crib or pack-and-play in housing where you have a number of people living in one location has been challenging," she said. 

Some cases involved alcohol or a guardian accidentally smothering a child, she said. 

Birch is a director of the Alaska Infant Safe Sleep Project. That state effort was launched in 2010 after researchers studied the 53 cases of Sudden Unexpected Infant Deaths -- an occurrence that was sometimes previously classified as Sudden Infant Death Syndrome or SIDS -- and asphyxia that occurred in Alaska between 2005 and 2007.

The researchers found that at least 25 of the 53 deaths were preventable. Nine or more of the babies were sleeping beside an impaired person. Half of the deaths involved inappropriate bedding.

 

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