Priority Need: Infants breastfed exclusively through six months.

 

NA = Not available, PC = Percent Changes, AAPC = average annual percent change

Data for ESMs is not available for PC or AAPC analysis. Not included in table.

p<0.05 = statistically significant change

Sources: 1 MCH-JS 2019 and 2021; 2 MCH Program 2017-2021; 3 Vital Statistics 2019-2021

 

Periods and sources to measure ever breastfed and exclusive breastfeeding trough 6 months are different. However, MCH-JS data shows a 61% significant increase of infants who are ever breastfed between 2019 and 2021 (55.8% to 90.1%, respectively), while MCH program data from 2017 and 2018 shows a significant increase (PC:4%; p<0.05) for infants exclusively breastfed until 6 months (40.5% to 42.3%, respectively). According to Vital Statistics data, infant (AAPC: -3%; p<0.05) and neonatal (AAPC:-32%; p<0.05) mortality rates decreased even though not significantly, while Sudden Unexpected Infant Death (SUID) were only reported during 2020 (97.3 per 1,000 live births).

 

Highlights:

•           Continued counselling on importance of exclusive breastfeeding to all mothers at the Reproductive Health clinic, maternity ward, and the Postpartum clinic.
•           Community awareness: radio spots, newspaper advertisements, and social media postings on the importance of early prenatal visits and schedule of prenatal clinics are ongoing.
•           Distribute baby bags to mothers who attended prenatal care in their 1st trimester
•           There are 3 New ultrasound machines purchased.
•           Availability of new space and ultrasound machines for prenatal and women’s clinic at Laura Clinic
•           We received 24 solar freezers from UNICEF. 22 of the 24 solar freezers were distributed to 22 health centers during the COVID-19 vaccination outreach visits.

 

Challenge:

•           Due to preparedness and response to COVID-19, activities Limited newborn screening for Neighboring Islands (NI) due to lack of equipment and trained staff
•           Availability of immunization services in the NI is dependent on the outreach mobile visits.
•           The hiring of nutritionist and lactation nurse that will train the health care workers were stalled because of the closure of RMI borders which limited the capacity to bring subject matter experts.
•           We need to improve on the breast feeding and postnatal data collection.

 

Plan:

•           Improvement of services in the NI Health Centers by providing cold chain equipment, training of health assistants on cold chain equipment storage and handling and vaccination.
•           Partner with community-based organizations to promote and support breastfeeding practices, Baby friendly initiative projects including breastfeeding awareness and education.
•            Partner or seek technical assistance to update birthing hospitals SOP for delivery and management of newborns.
•            Implementation of Registry Data Unit that will assist each program on data collection, reporting and analysis.

 

 

Improve perinatal/infant’s health through adequate and quality prenatal services and newborn screening.

 

MCH Block Grant Program works closely with EHDI Program. Collaboration of work and alignment of plans are engaged to ensure that both programs don’t duplicate work but able to support the needs of Infant Health.

 

 

Early Hearing Detection & Intervention (EHDI) Program

 

 

2022	MAJURO	EBEYE	TOTAL
Births	697	204	911
IP Screened	676	195	871
Deceased	12	4	14
% Complete Screening	99%	98%	98%
Referred	79	16	95
IP Passed	597	179	776
Missed	9	5	12
OP Passed	42	9	51
OP Referred	7	0	7
LTFU	29	7	36

 

**Acronyms**
IP	Inpatient
OP	Outpatient
LTFU	Loss to Follow Up

 

Early Intervention is provided to all babies who have been identified with a hearing loss/deafness.  These families get home visits once a week and join a playgroup also once a week. Families on Ebeye only receive weekly home visits. 

 

Challenges

The greatest challenge has been the pandemic.  The EHDI Program requires routine visits by a Pediatric Audiologist to travel to the RMI, both Majuro and Ebeye to conduct Diagnostic Evaluations on babies who failed their initial hearing screening tests.  These audiological visits take place three to four times a year.  Because of the pandemic the nation has been forced to close the borders EHDI program had to cancel all scheduled audiological visits for the entire year. A pediatric Ear, Nose and Throat (ENT) was scheduled to travel in June 2020 to conduct hands on training to the newly hired ENT which has been canceled due to the pandemic. With cancellation of routine visits by the itinerant audiologist, babies who failed the newborn hearing screening do not get audiological diagnostic evaluations.  These babies are at risk of having a hearing loss or deafness. Hearing Screening and diagnostic equipment need periodic calibrations.  With the borders closed there is no way for the equipment to be calibrated since there is no specialist on island.

 

Accomplishments

 

2022: The EHDI program collaborated World Teach deaf schoolteacher in training the program’s deaf mentor who directly work with the families enrolled in the program. Although we have challenges with funding and bringing in specialty services, the program to provide the newborn hearing screening to 98% of the newborn in Majuro and Ebeye Hospitals.

 

Ways forward. Set up tele-audiology and tele-intervention capabilities.

 

Perinatal/Prenatal Services

 

Having healthy infants are linked to the good health of the mothers. Prenatal care services are available in the 2 main hospitals and all 60 health centers. In the health centers, service is limited wherein tests that needs laboratory confirmation are not available.

 

ESM 1.3 - Percent of women booked for prenatal visit in first trimester.

 

We were advised to change this ESM into SPM from the last block grant review. MCH Program will address this in the next needs assessment and application cycle. 
 

 

	2021	2022
Annual Indicator	18.7	25.8

 

In 2022, MCH Program continued to advertise the Prenatal Clinics schedule in the MOHHS FB page, newspaper, and local radio station. During the COVID-19 community transmission, prenatal service was provided via telehealth.

 

Ensure every woman has skilled professional at delivery

 

99% of births in 2022 are delivered by skilled attendants like nurse, midwife, health assistant, medical assistant, and doctors. In childbearing, women need a continuum of care to ensure the best possible health outcome for them and their newborns. This includes care at the clinic before and after delivery, as well as high quality midwifery care at delivery. The risk of stillbirth and maternal deaths is reduced by about 20% with the presence of a skilled birth attendant.

 

Births Attended by Skilled Health Personnel, 2018-2022

	2018	2019	2020	2021	2022
Percentage of Births attended by skilled health personnel	98%	99%	99%	99%	99%

 

 

 

Infant Health

 

23 per 1,000 live births infant death in 2022 before they reach the age of 1 yr. old. Prematurity, aspiration, and pneumonia, congenital defects are the most common underlying causes of death for these infants which is the same as in 2021.   This stresses the importance of Early prenatal care and good management skills during labor. The importance of exclusive breastfeeding up to 6 months is part of the counselling services at the RH clinic, maternity ward and the postnatal clinic.  With the Early Childhood Development (ECD) program in place, there are plans to have BF class to pregnant mothers by a nutritionist and a trained lactation nurse. Lactation nurse will trained staff from maternity, labor and delivery and pediatric wards. But due to the closure of borders and challenge in hiring new staff, Lactation Nurse was not hired in 2022. ECD Program will continue to provide the support.

 

 

In 2019, RMI conducted survey on child health and nutrition for 0-5 yrs old. Below is the result on breastfeeding and infant feeding,

 

 

MCH Program is actively advocating breastfeeding inside and outside the hospitals. In the hospital, no bottle feeding is implemented but there are mothers that are not following the policy.

 

There are still children coming in with malnutrition. One of the needs presented by the Pediatricians is to have a feeding program. This issue on the feeding program was discussed by the leadership team. With the ECD program in place, there is a plan to have cash transfers to families with low income to support purchase nutritious food

 

 

	2017	2018	2019	2020	2021
NPM 4 - A) Percent of infants who are ever breastfed	100	100	55.8*	55.8*	90.1
NPM 4 B) Percent of infants breastfed exclusively through 6	40.5	42.3	42.3	42.3**	42.3**

*MCH JS

**Children and Nutrition Health Survey

 

NPM 4 A): Once the mothers give birth, the newborns are immediately breastfed. RMI practice First Embrace. First embrace is lifesaving skin to skin contact immediately after birth between the baby and the mother.

 

NPM 4- B) We need to strengthen our community awareness and data collection. We will be working with women’s group to reach the women population and able to provide them health education on the remind them on the benefits of breastfeeding for their children.