The contribution of infectious diseases to infant mortality in Alaska.

BACKGROUND: Based on death certificates to determine cause of death, current research suggests that infectious diseases are less important causes of infant mortality than in the past. METHODS: To determine the contribution of infectious diseases to infant mortality and the sensitivity of death certificates for identifying infectious disease causes of death, we examined information from multiple sources for a population-based sample of infant deaths that occurred in Alaska during 1992 through 1994. RESULTS: We collected information for 181 of 272 reported infant deaths and identified 48 infants for whom an infection was a primary (n = 15), contributing (n = 12) or suspected (n = 21) cause of death (infectious disease-related infant mortality rate, 2.2/1000 live births). Of these 48 deaths 27 were associated with a maternal peripartum infection and 15 were associated with a postneonatal respiratory tract infection. A specific organism was identified for 15 of 29 infants who died during the neonatal period and for 5 of 19 infants who died during the postneonatal period (including 2 with coagulase-negative Staphylococcus and the rest with a variety of other organisms). Death certificates identified an infectious disease as a primary or contributing cause of death for 19 infants (sensitivity, 40%) and reported a specific organism for 4 infants. CONCLUSIONS: Infectious diseases caused or contributed to a high proportion of infant mortality in Alaska during 1992 through 1994. Death certificates had poor sensitivity for identifying infectious disease-related infant deaths.