By Matt Leingang
The Cincinnati Enquirer

Premature births among African-Americans drove up the number of child fatalities in Hamilton County last year, according to a report to be released today.

A total of 145 children in the county died in 2003, up from 138 in 2002 and the second-highest total since the report began eight years ago. The record is 153 in 1998.

While the report did not specifically look at child deaths in other Ohio metropolitan areas last year, Hamilton County's overall infant mortality rate for African-Americans is believed to be among the highest in the state.

Experts continue to struggle to understand why.

The Hamilton County Child Fatality Review Team documents the cause of death of all children in the county 17 or younger. The goal is to identify causes that may be preventable.

The majority of child deaths in 2003 - 75 percent - were from natural causes, a category that includes prematurity, medical disorders and infection.

But prematurity is where the story lies. Of the 64 infants dying from prematurity, 56 percent were African-American. This is disproportionate to the percentage of African-Americans in the county's overall population (23 percent).

"There are a lot of programs in Hamilton County that do outreach and provide prenatal care and other support services, but we never seem to make a dent in this. It's really disconcerting," said Patricia Eber, executive director of the Family and Children First Council and chair of the fatality review team.

Racial disparity in childhood deaths has been an issue nationwide. But data from the Ohio Department of Health shows how severe the local problem is.

For example, the overall infant mortality rate for African-Americans in Hamilton County was 19.5 per 1,000 live births in 2001, the latest data available. For Cuyahoga and Franklin counties, it was 13.2.

"Those cities (Cleveland and Columbus) have the same risk factors that we do, and it's just amazing that our problem is so much worse," Eber said.

Risk factors include poverty, lack of prenatal care, maternal smoking, substance abuse and poor nutrition.

Last year, Eber's group began using a $300,000 grant from the Ohio Department of Health to try to reduce the gap. The program, coordinated by Healthy Moms and Babes, a nonprofit organization in Cincinnati, links high-risk African-American mothers to prenatal care coordinators.

But it is too soon to know if the program is making a difference, Eber said.

Cincinnati Children's Hospital Medical Center also has a program called Every Child Succeeds, which sends nurses and social workers to the homes of first-time mothers - many of whom are teens.

In terms of deaths that could have been prevented, the fatality team reviewed 53 cases where the cause of death was either unintentional injury, homicide, suicide or undetermined.

Of these, 51 percent were deemed preventable.

For example, inappropriate sleeping arrangements were linked to 12 infant deaths last year. Eber said infants should always be placed in cribs and not in adult beds or couches, where loose blankets or pillows can suffocate children.

Other preventable deaths were linked to traffic accidents, drownings, poisonings and a handgun.

The team emphasized the importance of:

• Wearing seat belts.

• Close supervision of toddlers and infants.

• Taking seriously threats of teen suicide or violence.

The team includes representatives of the Cincinnati Health Department, the county coroner's office, the Cincinnati Fire Department, and Children's Hospital.

E-mail mleingang@enquirer.com