NPM 3 - Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU)
ESM RAC.3 - Number of steps of the CDC's LoMC process completed in order to design and align the Alabama Maternal Regionalization System Guidelines with the national criteria for the maternal levels of care
After ADPH completed its collaboration with AlaHA focused on infants delivering at the appropriate level of care, a new collaboration began with AlaHA to focus on LoMC. A workgroup was formed with staff representing the delivering hospitals and AlaHA to explore how the team would strategize the implementation of regionalized risk-appropriate maternal care. AlaHA encouraged hospitals to complete the LoMc tool. With LoMC defined, facilities identified and addressed gaps in capabilities and personnel to align with national standards. Regions and health systems were then able to examine the capabilities of their facilities and define criteria for care locally allowing for designated transfer of care based on risk.
The SPP held a meeting in Montgomery in June 2024 at AlaHA where results were given to each hospital and levels were discussed. Very few hospitals were at the level they considered themselves- largely affecting Level 2 and Level 3 hospitals. UAB and USA Women’s and Children were the only hospitals that were truly the level they considered themselves to be with UAB at Level 4 and USA at Level 3. There were discussions on maternal transfers and obstacles that were causing them not to be at the level according to LoMC. It was reiterated that the appropriate care level for patients should be driven by the medical needs and not limited to or governed by financial constraints (hospitals agreed financial constraints were an issue). Each hospital representative present was charged with going back to their hospital and doing a deep dive into what it would take to obtain those levels. The hospitals have had a year to look at what they would have to do to obtain their considered level. The next meeting is in June 2025 for hospitals to discuss any progress that has been made, what obstacles they are still facing, and a general look at the health of their maternal landscape.
NPM 5 - Percent of infants placed to sleep on their backs
ESM SS.3 - The proportion of mothers enrolled in the Cribs for Kids Program who self-reported that their infants are using the cribs for all periods of sleep at the home setting
During FY 2024, 1,389 pregnant women were enrolled in the Cribs for Kids Program. Surveys asked participants about crib usage when the baby is 2-3 weeks of age and again at 6-8 weeks. The ESM measure assessed crib usage among infants at 2-3 weeks of age. Approximately 13.2 percent (n=183/1,389) completed a survey regarding crib use when the baby was 2 to 3 weeks old. In terms of crib use, 72.7 percent (n=133/183) selected either always or almost always for their baby. Of those who completed the survey, the primary racial groups are as follows: 53.0 percent (n=97/183) were black, on-Hispanic, 31.1 percent (n=57/183) were white, non-Hispanic, and 12.6 percent (n=23/183) were Hispanic. Looking at the survey respondents’ valid address information, 68.9 percent (n=126/183) of the survey respondents resided in an urban county, while 31.1 percent (n=57/183) resided in a rural county.
During the last 2 months of FY 2024, the Cribs for Kids Program implemented a better tracking system for completing follow-up with participants concerning the completion of the first and second surveys. To increase the survey response rate, the Perinatal Health Division planned to incorporate diapers as an incentive for survey completion starting FY 2025.
Ongoing activities in Alabama to improve birth outcomes and reduce morbidity and mortality:
Fetal/Infant Mortality Review
Regional FIMR nurses continue to present de-identified case summaries to our RPAC case review teams for discussion. These teams are made up of professionals from law enforcement, medical providers, social workers, coroners, DHR, and AMA. The teams discuss the cases, the contributing factors, and make recommendations to prevent similar tragedies in the future. The region-specific recommendations are brought to the cross-sector CATs for implementation. The FIMR team has transitioned from a state created reporting system to the national FIMR data base.
State Perinatal Advisory Committee
SPAC brings together professionals from across sectors in the perinatal domain statewide at quarterly meetings where guest speakers provide information related to perinatal topics, relevant state agencies give updates regarding services to pregnant women and infants, and one perinatal region is spotlighted to give updates on trends they are seeing in fetal/infant deaths and the implementation of community initiatives.
Breastfeeding
WIC breastfeeding staff and PHD staff work closely with community partners to identify resources that support breastfeeding families and to find new ways for connecting families with those resources. FIMR partnered with PRAMS to identify issues related to breastfeeding. The Wellness Coalition and FIMR partnered together to create a resource guide that provides information to families about the benefits of breastfeeding. The guide has a QR code that can be scanned to launch the PHD website where they will be able to find more information and resources that are available to them.
Collaborating Partners and Initiatives for the MCH Populations
Count the Kicks
Count the Kicks, developed by the non-profit organization Healthy Birth Day, Inc is on a mission to improve birth outcomes through programming, advocacy, and support while reducing racial disparities that persist. Count the Kicks helps save babies from preventable stillbirths, prevents preterm births, and improves outcomes for moms. CDC lists a change in a baby’s movement as 1 of its 15 urgent maternal warning signs. Count the Kicks is an evidence-based stillbirth prevention program that provides educational resources to health care providers and expectant parents. In conjunction with the parental education, Count the Kicks offers a free kick-counting app to monitor the quantity and strength of a fetus’ kicks beginning in the third trimester. This hallmark tool is available in 16 languages.
In CY 2024, 136 health care professional and community workers placed orders for Count the Kicks educational resources. Through these orders, there were 45,401 Count the Kicks materials such as brochures, app reminder cards, and posters mailed out in Alabama. In May 2024, 98 health care professionals and community workers attended a Count the Kicks webinar. During CY 2024, there were a total of 1,890 website visits from pregnant moms.
In Fall 2022, Alabama became the first state (aside from Iowa) to promote Count the Kicks in dental offices. Since the initial year of launch, the OHO has continued to promote the campaign, sometimes initially with skepticism, but always ultimately being embraced by the providers. The momentum of the OHO efforts has continued to generate nationwide interest and implementation. In a recent email from Healthy Birth Day, the OHO was informed, “We are adding 11 states in the next month, making a total of 17!!! Mainly, thanks to you!”, bolstering the fact that medical-dental integration is a testament to put the mouth back in the body.
Success Story
Due to ADPH sharing the word about Count the Kicks, he ACHNs are promoting it through maternity care social workers. In January 2024, a network social worker shared the app with a first-time mom and noted that the app has been known to help prevent infant deaths. Together they downloaded the app and walked through how to use it. The following week the new mom reached out to the social worker and noted that fetal movements had dropped causing concern. With social worker assistance, the mom was seen by her doctor within an hour and was scheduled for an emergency C-section as soon as she got there. The umbilical cord was wrapped around the neck and if she had not noticed the decreased kicks, neonatal demise would be evident. Thanks to an attentive mother and the Count the Kicks app, the baby’s life was saved.
Babypalooza
In 2024, Alabama held Babypalooza events in three of the largest cities: Birmingham, Mobile, and Huntsville. For the second year in a row, FHS was a sponsor for Babypalooza. There were over 7,500 in attendance. The OHO educated attendees on the importance of oral health during pregnancy, having potential implications in terms of preterm births and low birth-weight babies, both of which can contribute to infant mortality. The attendees were informed and educated on Count the Kicks in an effort to promote awareness of consistent movements of an unborn child during pregnancy as it relates to possible distress of the child and stillbirth potential.
Staff from the PHD presented education on safe sleep, the benefits of breastfeeding, the importance of prenatal care, birth spacing, and information about eligibility for a free crib through our Cribs for Kids Program. Attendees were also awarded incentives for participating in an educational game whereas large dice-shaped cubes were rolled, revealing questions for parents about the different topics for which they received education.
Alabama Perinatal Quality Collaborative
The ALPQC has continued their work with hospitals and providers to implement AIM Patient Safety Bundles on hypertension, postpartum hemorrhage, and hypothermia in neonatal infants. The ALPQC was able to build on the AIM Patient Safety Bundles by piloting the Postpartum Bracelet Project in eight delivering facilities. The purpose of this project is to help doctors, nurses, and other first responders recognize the potential for post-pregnancy related health conditions preventing maternal deaths through education, recognition, and intervention. The PHD staff serve on the steering committee of the ALPQC. Staff from the ALPQC serve on various workgroups and committees lead by ADPH.
March of Dimes
The PHD staff are participants in the MOD workgroups on policy, services, and support related to substance abuse disorders for pregnant women and new mothers.
Increasing Access to Prenatal Services
Labor and Delivery services were temporarily paused at a delivering facility in rural Marengo County in May 2024. Those services were expected to resume September 1, 2024, but they have yet to do so. Forty-three delivering hospitals remain in our state's 67 counties. According to the OPCRH, only 15 of the 54 counties currently considered rural have hospitals providing obstetrical services. At least 25 Alabama counties do not have obstetricians, gynecologists, family-practice physicians, or nurse practitioners who deliver babies who work in those counties.
ADPH Public Health District Initiative
East Central Public Health District
The East Central District continued its Infant Safe Sleep Outreach and Education Project. The district MCH coordinator spoke at conferences, community events, Children’s Policy Council meetings, and agencies to promote safe sleep and Count the Kicks. The district MCH coordinator also continued to partner with the Wellness Coalition to maintain lactation rooms and baby depots in Lowndes, Macon, and Montgomery Counties. The depots are a one-stop place where parents and caregivers receive information on healthy babies and healthy moms.
Jefferson County Department of Health
JCDH operates the FDO Program with the goal of improving pregnancy and birth outcomes for women and infants in Jefferson County. FDO is a comprehensive patient-centered program designed to educate and support expectant mothers from the first trimester of pregnancy through their child’s first year of life. FDO promotes early access to prenatal care and connects families to beneficial community resources. The patients served by FDO consist of high-risk pregnant women, their infants, and maternal partners. Emphasis is placed on low-resourced, low income, under-insured, uninsured, and minority patient populations. FDO works with Connection Health to provide CHWs to achieve the program goals. CHWs provide the day-to-day monitoring of each participant in the program. In previous studies, it was shown that the western area of Jefferson County accounted for 66 percent of burn injuries, 55 percent of bicycle injuries, and 57 percent of poisonings admitted to COA. With the use of Zip Code mapping, it was determined that the majority of FDO participants live in western Jefferson County.
FDO Program participants receive a baby safety shower in their third trimester of pregnancy. The goal of the Baby Safety Shower is to increase client knowledge on infant safety, thereby reducing the number of childhood injuries and improving infant mortality. Each shower is planned as a special event for the program participant, one supportive person, and all children under the age of 5 in the household. Baby Safety Showers are held quarterly at JCDH and last approximately 2.5 hours. During the Baby Safety Shower, JCDH staff, community partners, and first responders deliver presentations covering a variety of infant health, injury prevention, and safety topics. Participants receive education on safe sleep, breastfeeding, fire safety, gun safety, personal safety, car seat safety, stress reduction, and oral health. Also, at the conclusion of the shower, participants take home safety-related items.
At enrollment, FDO participants complete a demographic questionnaire that includes questions about infant and childhood injury risk factors currently in their homes. Also, before entering the Baby Safety Shower, participants complete a pre-test to determine baseline knowledge of injury prevention and childhood safety. When showers are held in person, simultaneous interpretation is utilized for participants with LEP. Printed information is also provided in Spanish.
Depending on the number of participants, as well as attempting to maintain cost effectiveness, some showers were held in person whereas others were held via Zoom in 2024. Break-out rooms were utilized when the FDO Baby Safety Showers were held via Zoom. This allowed the LEP participants to participate at the same time with an interpreter present. Preparation for the in-person and virtual Baby Safety Showers included helping participants with creating email addresses to receive information about the Baby Safety Shower. This assistance was provided to 90 percent of the Hispanic clients.
In 2024, there were a total of 3 showers and 29 maternity clients participated along with 42 guests. Since July 2018, when the first Baby Safety Shower was held, there have been a total of 22 Baby Safety Showers with a total of 268 maternity clients and 203 family members participating.
Touchless distribution drive-up was held at the local health department in order for the participants to receive the “in-kind” gifts. The safety items distributed in 2023 were Dreambaby® Household Safety Kits, diapers, safety tubs, and Graco® Pack ‘n Play playards. The Graco® playards were donated by the IMPACT Family Counseling Cribs for Kids Program. IMPACT also provided safe sleep information and demonstration during the shower. Diapers were provided by the local diaper bank and feminine products were provided by the Junior League of Birmingham.
One month after the Baby Safety Shower each participant completes a post-test to evaluate knowledge and retention of safety education provided at the shower. In 2024, the pre-test score range for each question was 48 - 100 percent, and after the shower, the post-test score range was 94 - 100 percent.
Finally, when a participant has completed the full 18-month FDO Program, a face-to-face evaluation is done by the CHW in the home. This evaluation includes questions about the of use of safety related items and safety knowledge received at the baby safety shower. A 6-month post-graduation phone interview and evaluation is done by the program administrator or designee to ensure sustained safety adherence. This evaluation assesses safety knowledge and collects data on any preventable injuries sustained at home since safety shower participation.
Mobile County Health Department
From 2020 to present, the state of Alabama has had the third highest MMR in the U.S. According to rankings provided by CDC, between 2022 and 2023 that rate was 64.63 per 100,000 live births, which is significantly higher than the national average of 34.09 per 100,000 live births. Women in Alabama succumbed from pregnancy and pregnancy-related complications at twice the national rate. For black women that rate is exceedingly higher at 100 per 100,000 live births. The fetal and infant mortality rates also rank high in Alabama with over 400 infants dying before they reach their first birthday. Data provided by 2023 March of Dimes Report Card indicates an infant mortality rate of 7.8 per 1,000 live births in Alabama. This number is higher than the national rate of 5.6 reported by CDC. In Mobile County, the infant mortality rate is 6.7. Contributing to the high rates include LBW, preterm births, birth defects, and SUID such as SIDS. The maternal, fetal, and infant mortality rates are disparagingly higher for black mothers and babies who live in poverty, lack education, and lack quality prenatal and maternal care.
MCHD has a primary care division, FH, with a mobile medical unit and eight clinic sites located throughout the county. FH clinics are designated as FQHC and Primary Medical Homes. FH serves uninsured, underinsured, Medicaid recipients, and those with other forms of health insurance. MCHD has patient care coordinators to help navigate community members to various services provided at the agency. MCHD’s Prevention and Wellness Division promotes education, health and wellness, and preventive services to the communities of Mobile County. The MCHD MCH Program helps to encourage and promote healthy women during pregnancy, childbirth, and postpartum as well as the healthy development of infants and children. The program provides education, information, resources, access, and referrals to recommended prenatal and postpartum services including doula services, oral health, well-childcare, infant and maternal mortality prevention education services, behavioral health services to address postpartum depression and other mental health concerns, newborn screenings, child immunizations as well as maternal, and infant and child nutrition through WIC.
The MCHD MCH Program coordinator also works with the FIMR coordinator to provide information to mothers in recognizing key factors that may contribute to SIDS and maternal mortality. The MCH Program helps with Group Connect activities within MCHD Family Support/Home Visitation which services young pregnant and parenting youth, teens, and young adults aged 10 - 19. The MCH Program also provides assistance and services to pregnant and parenting families ages 19 - 44 in Mobile County through community partnerships and collaborations.
The MCHD MCH Program promotes doula and prenatal services, the importance of breastfeeding and lactation services, provides education on safe sleep practices, promotes car seat safety, and encourages positive parenting in collaboration with the Fatherhood Initiative. The goals of the MCH Program are to increase awareness of factors that adversely affect the health of mothers and babies; promote and increase education and resources available to mothers living in Mobile County; and provide services to decrease the rates of infant and maternal mortality in the county. Community collaborations include over 10 community-based, faith-based, and health services organizations. Through its collaborative efforts, the MCH Program assisted over 134 mothers and children and reached over 500 community members in FY 2024.
Safe sleep classes are offered to Home Visitation/Family Support participants starting at 6 months prenatal up to 12 months postpartum. There were eleven safe sleep classes held during FY 2024. Each class participant received a portable Pack ‘n Play playard for their baby and a certificate of completion as incentives participating in the 1-hour class. MCH Program staff participated in seven group connect activities and numerous community outreach events where information, education, and resources on mental health, healthy eating, breastfeeding, car seat safety, and safe sleep, along with information on local resources, education and services, and other MCH topics were provided. In addition to the community events and group connect activities, the partnership between the MCH and Lead Poisoning Prevention Programs progressed in the first quarter as the need to educate parents on lead exposure and poisoning for children remained relevant. During National Lead Poisoning Prevention Week, October 22-28, 2023, program information and resources were shared with the Family Support/Home Visitation Program participants.
In November 2023, a significant staffing change occurred within the MCH program. The MCHD MCH coordinator offboarded from the agency. Due to the coordinator vacancy, proposed activities such as outreach participation, virtual MCH webinars and trainings, and other initiatives were continued by the MCHD MCH Program administrator. Additionally, to fill the gap, Safe Sleep Ambassador trainings were completed by the collaborating Family Support/Home Visitation parent educators. The newly trained ambassadors continued the safe sleep classes and referrals to existing and new participants without interruption. Participation in outreach and community events and MCH trainings also remained, along with referrals for other services such as child passenger safety, doula services, and behavior health.
In FY 2024, the MCHD MCH Program welcomed two new collaborations and partnerships. The first was with a local doula company, Mama Bloom Doula Company, LLC, which was established to provide quality prenatal and postpartum doula services to pregnant and parenting families. This collaboration is essential in promoting healthy pregnancies, healthy outcomes, and a reduction of maternal and infant health disparities. In addition to doula services, the MCH Program continued to provide referral services to lactation consultants to encourage breastfeeding. The second was with the Greater Mobile Chapter of the Links, Incorporated. The Mobile Chapter requested to host a car seat donation drive in March where over 30 child passenger safety seats were donated to the MCH Program.
In the month of February, National Children’s Dental Health Month was observed through billboard messaging and during the virtual Group Connect meeting. A local dentist presented on the importance of dental health for both mom and baby, with an emphasis on those pregnant and breastfeeding. The young ladies in attendance were not only asking questions and showing interest in referrals for dental services, but dental professions as well. Through the Alabama Career Center, some young ladies were later provided with information on programs to further careers as dental hygienists and dental assistants. Medicaid has discontinued dental services for young adults aged 19 and up, therefore; participants were encouraged to find local providers, including those at FQHCs that offer sliding and nominal fee scales.
In March 2024, the MCH program administrator attended a Medical Town Hall in the City of Prichard with a focus on maternal health. Local physicians including obstetricians and other health care providers were present. A special guest, Mr. Anthony Wallace, whose wife Dr. Chaniece Wallace tragically passed away due to complications from her first pregnancy, spoke about the tragic and preventable loss.
In 2024, the MCH program administrator participated in the Inaugural Period Party presented by a local service organization whose purpose is to encourage, educate, and empower young girls in grades 9 - 12. The importance of healthy relationships, hygiene, mental and physical health, and responsible choices were shared. The mothers attending the event along with their daughters asked for information on perimenopause, menopause, and changing hormones. Several of the mothers wanted information to share with their daughters on reproductive health.
In May 2024, MCH information and resources were shared with the East Coast Migrant population. Over 30 families received folders on MCH resources in both English and Spanish including safe sleep books.
In June 2024, a billboard campaign was launched in collaboration with the MCHD FIMR coordinator to encourage education on gestational diabetes and promote healthy nutrition during pregnancy. Billboards were created and placed in locations throughout Mobile County that read: “Do You Know How Your Weight Affects Your Pregnancy?” The campaign was designed to address the areas in Mobile County having the most fetal/infant deaths, along with obesity as a factor. This campaign received positive community feedback and resulted in several families receiving education, referrals, and nutrition resources encouraging a healthy pregnancy.
Throughout FY 2024, the MCH Program administrator attended outreach and health events as well as garnered new partnerships for the MCH Program. A summary of events follows:
- Mobile Babypalooza Expo - over 150 families and vendors participated in the event.
- Juneteenth Health Event - shared MCH information, including oral health and Count the Kicks.
- City of Prichard Housing Authority, Back-to-School Event - over 100 families in attendance.
- Southwest Mobile County Chamber of Commerce Annual Kid’s Day Event - Over 250 families received information, education, and resources on lead, Count the Kicks, child health immunizations, developmental milestones, doulas, safe sleep, and breastfeeding.
- MCHD WIC 50th Anniversary and Breastfeeding Celebration - over 40 women and families in attendance.
In summary, FY 2024 continued the momentum of the previous grant year in providing additional education, resources, and information to pregnant, parenting mothers and families in Mobile County with an emphasis on the Family Support/Home Visitation and Fatherhood Initiative participants and their children. With an increase in new participants for Family Support/Home Visitation, safe sleep classes were referred to the Cribs for Kids® - Alabama Program. The search to fill the MCHD MCH coordinator position continued. The MCH coordinator vacancy reduced some activities early in the first quarter including safe sleep classes, car seat safety referrals, and daycare and provider visits. However, the MCH Program continued to thrive in its goals to decrease the maternal and infant mortality rates in Mobile County through its program objectives and a host of services, education, resources, and community partnerships. In FY 2024 and beyond, the MCH Program looks forward to expanding information on doula services, breastfeeding campaigns, addressing issues directly affecting black maternal health, and providing maternal and infant health resources to communities in Mobile County. The program’s future goals will be continuing campaigning for safe sleep and car seat safety, being instrumental in helping to address maternal mental health, and utilizing all forms of social and print media to reach more mothers to help combat the high rates of fetal, infant, and maternal mortality in Mobile County and the state of Alabama.
Southeastern Public Health District
CHS reported that the Southeastern Public Health District had an infant mortality rate of 6.7 for all 10 counties in 2022. Nine of the ten counties within the district experienced at least 1 infant death in 2020, with a total loss of 27 infants. In January 2023, the district introduced the Safe Bama Baby Project in three counties. In 2024 the Southeastern District expanded SBB to include four new counties, bringing the total to seven. The participating counties are Barbour, Butler, Coffee, Crenshaw, Dale, Houston, and Pike. SBB is a grassroots safe sleep survey and education project designed to increase local safe sleep practices. There are now 4 district staff certified as Cribs for Kids® Safe Sleep Ambassadors. These ambassadors identified and met with WIC recipients and gifted them tote bags containing oral health, car safety, and safe sleep educational materials and related items. SBB surveyed women in their third trimester of pregnancy and parents/caregivers of infants up to 4 months of age and provided individualized education. If the ambassadors determined that a safe sleep space was needed, they submitted a referral to SPP for the pregnant mom to receive a Cribs for Kids® Cribette®. The incentive item for completing the survey included a Snoozzzette™ Cotton SleepSack from Cribs for Kids®. The zip-able blanket reinforces safe sleep practices.
Unfortunately, in June 2024 the Butler County Health Department was destroyed in a fire. The fire consumed SBB supplies as well as the June surveys for both Crenshaw and Butler Counties. Survey and incentive distribution data will be estimated in this report. Total survey loss is estimated to be between 21-25 surveys for Crenshaw and Butler Counties. An estimated 536 tote bags were distributed in participating counties. Data was collected from 476 surveys. Notable survey responses for the year include: 56 percent deny receiving prior safe sleep education for baby; 67 percent believe that baby should be propped up, placed on their side, or stomach for sleep if baby has GERD or often spits-up; 52 percent of infant sleep spaces contained dangerous items; 5 percent smoke or vape in the home; and 5 percent do not plan to vaccinate. Eleven families were referred for a Cribette®. A total of eight percent of the mothers that completed the SBB required the assistance of an interpreter. Due to differences in dialects, a picture flip book was utilized to provide visual reference in the event the interpreter was unfamiliar with the object of discussion. In 2025, the district MCH coordinator plans to complete a video in collaboration with the Office of Minority Health in an effort to provide education and assist with taking the SBB survey.
Other ADPH Perinatal/Infant Health Programs
Pregnancy Risk Assessment Monitoring System
PRAMS is a joint surveillance project between the CDC Division of Reproductive Health and state health departments, developed in 1987 to reduce infant morbidity and mortality. ADPH began participating in PRAMS in 1993. The purpose of PRAMS is to find out why some infants are born healthy, and others are not and to positively influence maternal behaviors before, during, and immediately after birth. Mothers are randomly selected from the state’s birth registry using Alabama’s defined stratum of Medicaid versus non-Medicaid insurance. Developed by the CDC, sample sizes ranging from approximately 1,000 - 3,000 women represent all new mothers who either delivered a live-born infant or had an infant death during the time frame of interest. The PRAMS survey captures information on maternal experiences and behaviors before, during, and after pregnancy by asking mothers questions about their pregnancy and their new infant. To encourage survey completion, sampled mothers can receive rewards such as diapers, insulated coolers, manicure sets, and thermometers if they complete the survey.
There were 1,493 mothers selected to receive a PRAMS survey in 2024. Of these, nearly half of the mothers (47.8 percent; n=714/1,493) completed the survey. To continue building new and existing partnerships, PRAMS staff worked with FIMR and the OHO staff during FY 2024. With the PRAMS data selected by FIMR, PRAMS began designing a breastfeeding factsheet. PRAMS met with the OHO to start designing an oral health fact sheet highlighting 2016 – 2021 PRAMS survey data on dental cleanings, nicotine use, and alcohol use. To continue its existing partnership with the MMRP, PRAMS data was provided to strengthen recommendations highlighted in the 2020 – 2021 MMR Annual Report. Moving forward into FY 2025, the FIMR Breastfeeding Fact Sheet was completed and posted to the Alabama PRAMS website. In addition, PRAMS partnered with eight healthcare providers who agreed to place the fact sheet in their waiting rooms. Providers were selected from counties with the lowest breastfeeding initiation percentages as reported by CHS. With the continued partnership with the OHO, a fact sheet and brochure are being developed to highlight what PRAMS respondents selected concerning their oral health. The OHO will work with OCHA to distribute the produced materials to their target population. Similar to the OHO, a brochure and fact sheet are also being developed for the WW Program highlighting the following topics for 2021 - 2022: chronic disease health conditions before pregnancy, alcohol use, physical activity, and plans for birth control use. The goal is to distribute the fact sheet and brochure within the 12 active WW locations.
Alabama Newborn Screening Program
The ANSFD is part of the BCL. ANSFD ensures that state laws, rules, and regulations mandating newborn screening are followed. Newborn screening includes the bloodspot, hearing, and pulse oximetry screening to detect critical congenital heart defects. In 2024, there were 7.0 FTE to support newborn screening follow-up activities for all disorders tested.
ANSFD establishes protocols to ensure early identification and follow-up of infants affected with certain genetic or metabolic conditions. Early diagnosis reduces morbidity, premature death, intellectual disability, and other developmental disabilities. The program partners with pediatric specialists throughout the state to ensure all babies identified with abnormal results receive timely diagnosis and treatment.
BCL is the sole provider of blood analysis for newborn screening in Alabama. BCL screens approximately 58,000 babies annually, and approximately 150,000 specimens are sent yearly to the lab for testing. The testing panel allows screening for approximately 59 core and secondary disorders. BCL also provides filter paper for screening to medical providers. The current disorder panel includes 35 core conditions of the 38 nationally RUSP.
In 2024, the Administrative Code, Chapter 420-10-1: Care and treatment of infants identified through the Newborn Screening Program, was amended to add Pompe disease and Mucopolysaccharidosis type I. Testing was implemented for both conditions on July 29, 2024. ADPH partners with the UAB Department of Genetics to evaluate and confirm the diagnosis for these two genetic disorders.
In February 2001, the EHDI Program was established as a new initiative to ensure that every baby born in Alabama is screened for hearing loss. The program aims to provide early and appropriate hearing screening and follow-up when indicated so that infants who are deaf or hard-of-hearing are identified as early as possible and receive timely diagnosis and intervention. In 2008, newborn hearing screening became mandated by public health law. The Alabama EHDI Program collaborates with the ACCP and FHS to provide care coordination services to any baby who does not pass the newborn hearing screening at birth. The ACCP provides case management services, including coordinating appointments, assisting with insurance, and providing transportation and resources as needed to families. Currently, BCL funds social work staff with the BFHS at 2.45 FTE to provide care coordination services to newborn screening referrals. Additionally, the Alabama EHDI contracts with Auburn University, Department of Speech, Language, and Hearing Sciences, to fund four audiology graduate student interns to support hearing activities. The Alabama EHDI Program is supported by two federal grants provided by CDC and HRSA.
In 2024, ANSFD received 2,951 lab, hearing, and heart defect referrals requiring follow-up. Of the babies requiring follow-up, 173 were identified with a disorder (see the table below).
ANSFD mandates initial newborn blood screening at 24 - 48 hours of age, with a second screen highly recommended as best practice at 2 - 6 weeks of age to detect delayed thyroid evaluations. Many pediatric providers collect a second newborn screen between 2 and 6 weeks of age. In addition, ANSFD notifies providers if an infant had an initial unsatisfactory newborn screen.
ANSFD seeks to expand relationships with other health professionals in the state, including hospitals and pediatricians, to enhance existing services and ensure objectives are met. Additionally, 6 Community-Based Sickle Cell Associations provide counseling services for children identified with sickle cell disease and sickle cell trait. The Alabama EHDI Program collaborates with the NCHAM to ensure that all infants with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention. In addition, the program collaborates with ADRS, including Alabama EI Services and CRS, to ensure all infants with hearing loss are identified by 3 months of age and enrolled in EI services before 6 months of age.
ANSFD partners with the UAB Sparks Clinic to provide a grant to supplement metabolic foods and formula for infants identified with an inborn error of metabolism. In addition, the program contracts with seven medical consultants connected with diagnostic centers throughout the state who provide comprehensive diagnostic services and medical treatment. One diagnostic center provides confirmatory testing and treatment to newborns who are identified with a newborn screening condition. Children diagnosed with sickle cell disease receive consultation with a board-certified pediatric hematologist at one of three regional pediatric hematology treatment centers. Children diagnosed with cystic fibrosis are referred to an accredited Cystic Fibrosis Care Center, which provides comprehensive care and treatment.
ANSFD has an active advisory committee that consists of professionals and citizens knowledgeable in the area of newborn screening. The Alabama Newborn Screening Advisory Committee provides advice to the ADPH on issues relative to newborn screening and meets twice a year.
ANSFD maintains a website to provide parents and healthcare professionals with access to information. The website includes information on news and events, frequently asked questions, parent information and resources, hearing information and resources, practitioner information and resources, disorder descriptions, rules and laws, brochures and education material, and newborn screening education resources. The website is found at the following link: https://www.alabamapublichealth.gov/newbornscreening/index.html.
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