Epidemiologic Notes and Reports A Technique for Rapid Epidemiologic Assessment -- Nevada

In an effort to obtain information on perinatal health that could be useful in guiding local public health programs, a limited-sample birth survey was conducted in Clark County, Nevada, during 1981. By telephone interview, a public health nurse queried 200 women who had delivered babies 2-5 months previously. The first 100 interviews, conducted in May and June, involved mothers who had delivered in January and February, 1981; the remaining 100 interviews, in August and September, were with mothers who had delivered in June and July. Only mothers who delivered single, live-born infants were considered. The public health nurse searched local telephone directories for numbers to match the names and addresses of 1,271 mothers listed on birth records, found 425 numbers, and then attempted to telephone each mother. Of 201 mothers contacted, 1 declined to be interviewed.

The questionnaire used was a 1-page, standard-grid, modular form that could be administered in approximately 20 minutes. Questions sought information on such prenatal maternal activities as smoking and drinking habits and previous contraceptive use; the birth itself; and various postpartum maternal and infant events, such as illness and feeding choices.

Preliminary analysis of data obtained by the nurse indicated that 80 (40%) of the 200 mothers interviewed reported that they and/or their infants had had 1 or more infectious illnesses (as defined by the mother) during the first 30 days after delivery. Reported maternal illnesses were compatible with the following diagnoses: genital infections (11), respiratory infections (12), gastrointestinal illness (10), skin pustules/boils (8), mastitis (8), and cystitis (5). Illnesses reported for infants included skin pustules/boils (23), eye infections (32), respiratory infections (19), gastrointestinal illness (14), infection of the umbilical stump (5), and other (8). Although some of these conditions were self-limited, 27 mothers and 56 infants received physician care, usually including antibiotics.

Fifty-seven (28.5%) of the women reported smoking a total of approximately 234,000 cigarettes during their pregnancies, averaging 4,100 cigarettes per pregnancy or 15 per day. The neonates of these 57 smokers averaged 6.9 pounds, approximately 0.9 pounds less than the 7.8 pounds average birth weight of infants born to 143 mothers who denied smoking during pregnancy.

Although 102 (51%) of the women avoided all alcohol consumption during their pregnancy, 98 reported drinking 1 or more types of alcoholic beverages. The following beverages, in varied amounts, were consumed: beer (44 women), wine (72), and distilled spirits (38).

During the pregnancies under consideration, 188 (94%) women reported taking multivitamins; 87 (43.5%), Tylenol*; 55 (27.5%), iron; 51 (25.5%), Bendectin*; 30 (15%), calcium; 24 (12%), antihistamines; 17 (8.5%), aspirin; 16 (8%), penicillin; 12 (6%), other antibiotics; 8 (4%),sleep medication; and 9 (4.5%), other medications.

Thirty-eight (19%) of the mothers reported exposure to diagnostic X rays during pregnancy: dental (23), chest (8), abdominal (3), pelvic (3), wrist (2). Three had occupational exposure to X rays.

Fifty mothers (25%) reported use of ultrasound imaging for management of their pregnancies, and 11 (5.5%) mothers (6 over age 30) had amniocentesis. More than 90% of the infants had been screened for metabolic defects.

Almost one-fifth of the women in this survey had their infants delivered by Cesarean section. For the 162 (81%) women who delivered vaginally, the average hospital stay was 2.1 days, hospital costs were $1,386, and the obstetrician fee was $817. For the 38 (19%) women who had Cesarean sections, the average hospital stay was 4.9 days, hospital costs were $3,767, and the obstetrician fee was $1,200.

None of the 200 birth certificates reported any congenital malformations. However, 21 of the mothers reported the following defects for their infants: cutaneous birth marks (6), congenital dislocation of the hip (3), feet turned in (4), feet turned out (1), cleft palate and lip (1), umbilical hernias (1), other hernias (1), urethra too small (1), sunken chest (1), ptosis of eyelids (1), and skin tags (1).

Breast-feeding was begun by 136 (68%) of the mothers. When they were contacted 2-5 months after delivery, 38 (19%) were still breast-feeding.

Of the 200 women interviewed, 191 (95.5%) had used contraceptives at some time. Of the 9 who stated they had never used any contraceptive before their recent pregnancies, 2 of these had since used contraceptives, and 1 other (a diabetic who delivered an 11 pound 8 ounce infant) planned to be sterilized soon. Overall, 30.5% of the 200 mothers and 16.5% of the 200 fathers had either been sterilized since the recent delivery or were planning to be sterilized. Sixty-eight mothers (34%) reported having had a total of 89 prior abortions; 35 of these were stated to have been induced. Reported by OH Ravenholt, MD, Director, Clark County Health District, Las Vegas, Nevada; Office of the Centers Director, CDC.

Editorial Note

Editorial Note: The Nevada birth survey demonstrates that certain types of potentially useful public health information can be obtained in a cost- and personnel-effective manner by a limited-sample telephone survey. Limitations to such a survey include: 1) only persons with telephones who were home during the day were included in the sample; hence, persons selected and contacted were not fully representative of the entire population, and 2) the small numbers limit the kinds of analyses that can be done. This type of survey may, however, allow rapid epidemiologic assessment of local situations, trends, and attitudes useful in planning local health programs and applying limited resources to the most essential areas. Also, the response rate in this type of survey is ordinarily high. In the Clark County survey, only 1 of 201 women contacted declined to be interviewed. In addition, the single-sheet, standard-grid questionnaire is relatively inexpensive to produce and administer, and data can be easily extracted.

One important finding in this survey was that postpartum infections remain a frequently perceived problem among Clark County mothers and their infants and deserve more intensive surveillance than ordinarily provided. Since newborns and mothers usually are discharged from hospitals before incubation periods for most microorganisms have elapsed, special surveillance and feedback of information to hospitals is essential for effective control of nosocomial infections among these 2 groups (1).

Data on the exposure of pregnant women to alcohol, drugs, radiation, and smoking can be used to improve educational programs. Smoking, now the most prevalent preventable cause of death in the United States, and a foremost cause of reduced birth weight (2), is still widespread in this study population sample despite all evidence that "the risk of spontaneous abortion, fetal death, and neonatal death increases directly with increasing levels of maternal smoking during pregnancy" (3).

References

1. Ravenholt RT, Wright P, Mulhern N. Epidemiology and prevention of nursery-derived staphylococcal disease. N Engl J Med 1957;257:789-95.

2. Ravenholt RT, Levinski MJ, Nellist DJ, Takenaga M. Effects of smoking upon reproduction. Am J Obstet Gynecol 1966;96:267-81.

3. Office on Smoking and Health. The health consequences of smoking for women. Rockville, Md.: US Public Health Service. Office of the Surgeon General, 1980. (US Dept of Health and Human Services). *Inclusion of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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