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Of all Indian Health Service areas, the Aberdeen Area has consistently had the highest infant mortality rate. Among some tribes in this area the rate has exceeded 30/1000 live birth and half the infant deaths have been attributed to Sudden Infant Death Syndrome, a rate four to five times higher than the national average. The Indian Health Service, Centers for Disease Control and Prevention, National Institute of Child Health and Human Development, and the Aberdeen Area Tribal Chairmen's Health Board collaborated to investigate these high rates with the goals of refining the ascertainment of the causes of death, improving cause-specific infant mortality rates and identifying factors contributing to the high rates. Ten of the 19 tribes or tribal communities, representing 66% of the area population, participated in a 4-year prospective case-control study of infants who died after discharge from the hospital. Infant care practices and socio-demographic, economic, medical, health care, and environmental factors were examined. The study included parental interviews, death scene investigations, autopsies, neuropathology studies, medical chart abstractions, blood cotinine assays, and a surveillance system for infant deaths. Controls were the previous and subsequent infants born on the case mother's reservation. From December 1, 1992 until November 30, 1996, 72 infant deaths were investigated. This report describes the study methods and the model employed for involving the community and multiple agencies to study the problem of infant mortality among Northern Plains Indians. Data gathered during the investigations are being analyzed and will be published at a later date. The following is appended: (1) Reduction of Infant Mortality Recommendations for Parents. [This study is also supported by the Centers of Disease Prevention and Control (CDC) and the Tribal Chairmen's Health Board (AATCHB).] (Contains 2 tables.)

Author(s): Catherine E. Ford [sup.1] [sup.6] , David Coetzee [sup.2] , Jennifer Winston [sup.1] , Carla J. Chibwesha [sup.1] , Didier K. Ekouevi [sup.3] , Thomas K. Welty [sup.4] , [...], Objectives We investigated whether a woman&apos;s role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d&apos;Ivoire, South Africa, and Zambia. Our exposure of interest was the women&apos;s role (active vs. not active) in decision-making about her healthcare, large household purchases, children&apos;s schooling, and children&apos;s healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00-2.89 all p < .05). However, associations between decision-making and antiretroviral use-for both mother and infant-were generally not significant. An exception was active decision-making in a woman&apos;s own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services.

CANCER AND CANCER RISK FACTORS AMONG NORTHERN PLAINS INDIANSA pragmatic definition for epidemiology is the study of diseases and health problems as they affect groups of people. Why do we need epidemiologists in Indian Health Service? The main reason is to provide information for action to media, tribal communities, health professionals, and individuals. This information is used to design and evaluate interventions to improve Indian health to the highest possible level, which is the goal of Indian Health Service (IHS). I will review some of the cancer prevention and control interventions being conducted in the Aberdeen Area Indian Health Service.The Aberdeen Area IHS serves 80,000 Indians who are members of seventeen tribal groups living in four states: North Dakota, South Dakota, Iowa, and Nebraska. It is an isolated area with severe transportation difficulties.Several years ago, I worked on a report for Congress called "Closing the Gap" or "Bridging the Gap," on the differential epidemiology in various areas of the Indian Health Service. We reported on a number of different health conditions, including cancer, utilizing age-adjusted mortality rates. Overall, Indian people are at less of a risk of dying from cancer than United States all races, but there are some areas, notably Alaska, Bemidji, Billings, and Aberdeen, where the rates of death from cancer are higher than the United States all races (figure 1). In Albuquerque, Phoenix, Navajo, Portland, and Oklahoma areas, the age-adjusted cancer mortality rates are considerably lower. In fact, the Navajo have about half the rate of death from cancer as the United States all races.

A study was conducted to evaluate and investigate the coverage of nevirapine-based services to help prevent the spread of mother-to-child HIV transmission in 4 African countries. Results indicated that only 51% of HIV-exposed infants received the required dosage of nevirapine in these countries.

The Cameroon Bapist Convention Health Board implemented to prevent mother-to-child transmission of HIV-1 into routine antenatal care, achieved high uptake of rapid HIV testing and posttest counseling on the same day, implemented routine uses on peripartum single-dose NVP for HIV-positive mothers and their infants in collaboration with the National AIDS Program is described. Consistent training and programmatic support contributed to rapid upscaling and high uptake counseling rates.

Native American women who drink alcohol during their pregnancy may be increasing the baby's risk of sudden infant death syndrome (SIDS), according to a study of 33 SIDS babies and 66 healthy babies of Native American women in the Dakotas, Nebraska, and Iowa. Putting two or more layers of clothing on the baby also increases the risk. On the other hand, visits by a public health nurse decreased the risk.

Research was conducted to examine the maternal and prenatal factors associated with prenatal alcohol use in American Indian women. Participants consisting of 177 Northern Plains Indian women were asked to answer self-administered substance-use screening questionnaires. Results indicate that women who drank during pregnancy were more inclined to smoke cigarettes and use drugs. Therefore, women who drink during their pregnancy should seek counseling for better insight into multiple risk behaviors.

Hantavirus pulmonary syndrome may be a serious and even fatal disease in the United States among both children and adults. Although rare, pediatricians should suspect the syndrome in children with typical symptoms of fever, headache, nausea, dry cough, and rapidly progressive pulmonary failure and fluid build-up, especially if the children have been known to come in contact with rodents. A 14-year-old boy who died of hantavirus pulmonary syndrome had mild symptoms at first. He died on the third day of symptomatic illness, with complications of heart failure and fluid in the lungs. He had handled live and dead rodents in the six weeks prior to his illness while at a summer youth camp in a semi-rural town in South Dakota. Diagnosis of hantavirus pulmonary syndrome may be accomplished using enzyme-linked immunosorbent assay (ELISA) blood tests or by reverse transcriptase-polymerase chain reaction (RT-PCR) amplification of hantavirus from frozen tissue., ABBREVIATIONS. HPS, hantavirus pulmonary syndrome; ELISA, enzyme-linked immunosorbent assay; IgM, immunoglobulin M; RT-PCR, reverse transcriptase-polymerase chain reaction; IgG, immunoglobulin G; PBS, phosphate-buffered saline; optical densities at 410 nm; HFRS, hemorrhagic [...]