Perinatal/Infant Health

Priority: Improve Perinatal/Infant Health outcome thru Gestational Diabetes, anemia screening during early and adequate prenatal services, hearing and anemia screening of the infant and promoting breastfeeding

The perinatal mortality rate in the FSM in 2020 was 37.2 per 1,000 live births, which shows an increase of 8.9 per 1,000 live births from 2019. The data continues to paint a scenario that unplanned pregnancy, late access and inadequate prenatal care, and poverty play a significant role in poor birth outcomes, causing additional stressors on the family, community, the health care system and the government. Lack of screening for gestational diabetes during prenatal care effects newborn outcomes.  About 2% of pregnant women receiving services at the MCH program were found to have gestational diabetes in 2020.  The MCH Program is committed to improving prenatal care access and adequacy through the MCH clinics and dispensaries in remote villages. In 2020 the NPM for exclusive breastfeeding through six months was decrease by 10% in women who are receiving services at the MCH programs in the States.  This measure does not assess exclusive breastfeeding for the entire women of childbearing age population in the FSM.  The qualitative reports from pediatric providers is that although women are still offering the breast at six months, most working women give bottled formula to their babes. Anemia is prevalent in the infant population of FSM as well as the childbearing woman population.  In 2020, infants up to 1 year old who were screened for anemia were found to be at 9%, which is a decrease of 1.3% from 2019.

Most of the babies who were born in 2020 have had their hearing screening by OB nurses or MCH screeners. Overall, 85% of all newborns had hearing screening; 6% increase from 2019.  The State MCH Programs reported problems with their screening equipment (OAEs) during OB screening, and further remedy was done on the screening equipment. Those that failed the initial hearing screened are required to return after two weeks for follow up screening. After passing the follow up screening, they are cleared from the list. For those who failed, they are referred for Diagnostic Audiological Evaluation (DAE) and await an appointment by the Audiologist. The MCH/CSHCN and Special Education Related Services Assistants (RSA) along with the Speech Pathologist continue to work with the parents in providing education and other support in an effort to reduce parental concern and anxiety about their children’s conditions.

Chuuk State:

In 2020, the hearing screening is increased by 17% from 71% in 2019. There were more home births and loss to follow up babies referred to Well Baby Clinic at Public Health from Dispensaries, CHCs and the Public Health outreach team. Number of pregnant women attended prenatal clinic beginning of the first trimester increased by 6%. This was because of the accessibility of services at the CHCs in the rural areas. In addition to this, there was a good collaboration between MCH Program and the CHC in providing Antenatal services at their sites.

There was no workshop on breastfeeding conducted in 2020, because of the Covid-19 policies on social distancing, this specific activity was postponed to this current year. So far there were 25 women from the communities who have been recruited and trained on Breastfeeding this year. 72% of babies in Chuuk were exclusively breastfeeding, which was slightly decreased from the previous year and this was because of the data source from the well-baby clinic that was counted, and other data source where not factor in.

Chuuk MCH Program will continue to decentralize the MCH essential services Antenatal care to the CHCs and dispensaries and to continue to collaborate with other public health programs to ensure all these essential services are well implemented. MCH is also planning to recruit more breastfeeding support groups from the communities, and continue to promote exclusive breastfeeding in the hospital and communities.

Kosrae State:

Percentage of pregnant women diagnosed with gestational diabetes remained 0% in 2020 and 2019. All pregnant mothers screened with GTT at first visit. It became a routine screening for prenatal clinic however intervention and treatment given early. Screening for gestational diabetes with GTT is currently in the protocol for prenatal clinic and it is part of the routine screening.

The percentage of infant breastfed up to six months of age increased to 78.9% in 2020 from 67% in 2019. The percentage of newborns screened for hearing before hospital discharge slightly decreased to 97% in 2020 from 98% in 2019.

The percentage of pregnant women used tobacco during pregnancy decreased to 0% in 2020 from 8% in 2019. Tobacco counseling and education were given to the pregnant mothers during prenatal clinics. There is a significant decrease in pregnant women who received dental screening in 2020 (36%) from 2019 (100%). Because of the Covid-19 pandemic, Dental services and schedules of the services were ceased. Dental staffs stopped coming to the Public health site on Tuesdays and Thursdays to do dental screenings and fluoride varnish. The percentage of pregnant women age 15 to 44 diagnosed with Syphilis slightly decreased to 0% in 2020 from 0.7% in 2019.

Kosrae MCH Program maintained the Breastfeeding Support Group. Breast feeding support group members follow up on mothers after delivery at their homes and provided One-on-One counseling session and education on breastfeeding at the home. MCH program nurse and counselor provide one-on-one counseling on breast feeding to new pregnant mothers during prenatal clinics and at two weeks postpartum. OB nurses provide one-on-one counseling session at the OB ward to those delivered before discharge.

All STI screening reagents, supplies were available including the lab top for the gene expert testing. Strong collaborations between programs and staffs still exist in the health arena.  The syrup use for GTT screening is still not available however regular cola drink was the alternate.

Customary adoption, short period of maternity leaves and teenage student mothers were still the challenges for breastfeeding up to six months. In 2020, the Family Trac data system that collect, store and report newborn hearing screening was still a challenge because of the slow internet connections.

The MCH program plans to continue to utilize the breastfeeding support group members to do home visit follow ups and provide breastfeeding education at homes. Strengthen breastfeeding policies within the government and private sectors is highly recommended by the MCH program. The MCH program will continue to work with the department of Health to establish a Baby Friendly Hospital. It is request that there should be an external assessment and certification of Kosrae state hospital for Baby Friendly. In addition, it’s requested that a law should be in place to prosecute those men who impregnant the teenage girls. The program will continue to procure hearing screening supplies and calibration of hearing screening machines. There is a plan to ask the FSM national government to provide a high-speed internet connection for Kosrae MCH program so it can improve the timeliness and need of MCH data systems in 2021. 

Pohnpei State:

The decentralization of services and COVID-19 pandemic social distancing confused the people on where to received desired services thus decreased the number of patients seen for prenatal care beginning in the first trimester as well as regular visit. Planned community outreaches which included formalizing community breastfeeding support groups were cancelled so MCH staffs and OB nurses resorted to providing counseling on breastfeeding in clinics.

Prenatal first visit was one of the clinics recalled to Public Health for convenience of physician and service requirements. Formalizing a breastfeeding support group to provide breastfeeding services was part of the community outreach activities that were canceled due to COVID-19 however, MCH staffs and OB and Pediatric nurses continue breast feeding benefits counseling and awareness in their clinics. Pohnpei State hospital is a certified Breastfeeding Friendly Hospital Initiative and breastfeeding up to 6 months was always encouraged at OB wards, Immunization, MCH clinics and Well baby clinics.

Because of COVID-19 social distancing planned community outreaches to visit communities and selected breastfeeding support groups were canceled. COVID-19 prevention activities continued took up most of the staffs’ time with outreach awareness, vaccination and quarantine shifts.

Formalize Breastfeeding support group and continue provide one to one counseling on benefit of both breastfeeding and early prenatal care to mothers at OB ward, postpartum and well-baby clinic to all women and families who receive services from the MCH program.

Yap State:

Yap still does not have the breastfeeding support group. It was not possible to initiate the breast-feeding group due to the lack of available time and expertise to conduct training amid COVID19 prevention activities. Trainings of staff were focused on COVID19 prevention and activities. Unfortunately, the rate for exclusively breastfeeding babies at six months old could not reach the targeted 80%, but remained above 50%.  Newborn hearing screening remained above 80% due to children born in Outer Islands who never had the chance to be screened.

Despite the lack of breastfeeding group and the limitation of the usual breastfeeding counseling, the rate of breastfed babies at 6 months of age remained above 50% during the year.  At Public Health, breastfeeding counseling was only conducted during prenatal visits and post-partum clinics.  At the CHC sites, more counseling was done with mothers who brought their babies in for immunization. 

COVI19 pandemic has impacted all the services at health services. There was a government lock down, and interruption of clinics including the WBC.  The department was all focused on COVID19 trainings and activities, so it was not possible to initiate the breastfeeding group.  Training the selected members of the breastfeeding group would mean bringing in people from the public, and that was discouraged as to comply with COVID19 mass gathering and social distancing protocols. Further, babies who came for immunization were served at Public Health as walk in basis.  Children who showed up for vaccination got their vaccination through walk in; counseling on breastfeeding was limited to the children observed to be thriving slowly.

Newborn hearing screening remained at above 95% for hospital discharged babies, but babies born in OI continued to miss out on this screening opportunity.  A child with suspected hearing issues would only be referred to the main hospital for evaluation when he/she entered school with speech delay, via the school system referral. And at times, they were most likely beyond the age for proper management. Babies born in the Outer Islands who miss newborn hearing screening continued to prevent us from reaching this goal of 100% coverage. Further, one of the hearing equipment broke down leaving one machine to be shared between clinical and Public Health for screening. Due to boarders being closed to incoming visitors, the machines missed their calibration services.

MCH plans to conduct more outreach activities on promoting of breastfeeding in the communities and continue to promote breastfeeding in the clinics. With the recent situation, MCH will work with individuals to initiate the breastfeeding group.  MCH wishes to purchase multiple user breast pumps for mothers to express breast milk for babies before going to school or work as this is one excuse for not exclusively breast feeding. MCH will support any activities to extend the maternity leave back to 6 months and initiate the breastfeeding group in the state current plan.  MCH will work with the Health Assistants in the Outer islands to monitor children with suspected hearing defects and to make the referral for proper screening early in life.