Perinatal/ Infant Health – 2023 Annual Report

Priority: Improve perinatal/infant outcomes through early and adequate prenatal care services including Gestational Diabetes and anemia screening

The perinatal mortality rate in the FSM in 2023 was 22.0 per 1,000 live births, which is a decreased from 2022. 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. About 19 percent of pregnant women attended prenatal clinic beginning of the first trimester last reporting year. Adequate visits are measured by the Kotelchuck Index in which the numbers of visits are marked at or above 8 prenatal visits.

Lack of screening for gestational diabetes during prenatal care effects newborn outcomes.  About 18% of pregnant women receiving services at the MCH program were found to have gestational diabetes in 2023; an increase in GTT screening from 2022. All pregnant mothers at first visit within the 24-28 weeks are screened with GTT. 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.

In 2023, there was an increase in percentage of Anemia (5%) in less than one year old than in 2022. There were several home births and loss to follow up babies referred to Well Baby Clinics due to inaccessibility of services at the dispensaries in the remote areas, specifically the outer islands.

 YAP STATE MCH PROGRAM PROGRESS REPORT:

Perinatal and Infant Health:

Figure # 3: GDM   and Figure 4: Breastfeeding

Figure 5:  HEARING SCREENING:

Accomplishment:

At Public Health, breastfeeding counseling was conducted during prenatal visits, especially first time visit to the clinic and continues while they return to monthly appointments. The most part of breast-feeding hands-on activities is during post-partum clinics and New Born Clinics after discharged from the hospital and we do face to face monitoring while we ask mothers to breast feed at the moment to see how they attach baby to the breast and how the lactation goes. It also initiated at one month of visit during WBC.  At the CHC sites, more counseling was done with mothers who brought their babies in for WBC and for immunization.

GDM Screening usually done in the Prenatal Clinic at 24wks-28wks of gestation. MCH program was so fortunate to continue with the GDM screening even there is no doctor to look after the program clinic. GDM screening also done at the 5 CHC site as well.

 MCH Program was able to contacted minimum of two health awareness on exclusive breast feeding in the outer island (Ulithi Atoll and Fais).

Furthermore, through the EHDI program, and the existence of tele audiology, we were very fortunate to received replacement of the 3 hearing aids and books for communication purpose.

Challenges:

As it shows in figure 4: most of our mothers are working mothers, that they have to go back to work after the six weeks of maternity leaves so exclusive breast feeding not done. That six week of maternity leave is not enough for working mothers. There isn’t enough time to initiate breast feeding to their babies exclusively.

In figure 3: GDM screening remained below 50% due to most of our OB’s client comes from the island are only high risk and first pregnancy. Therefore, the rest of the number remain in the islands which under reported to the program. The referral case usually comes down to the proper when they’re already in their second and third trimester due to policy of not keeping them long in the main because of no fund to support them for their staying. Furthermore, transportation from the islands down to the main is a long standard problem, the program been encountered through the year all the time. Most Public health program rely on Immunization program when they will have a trip to the islands then all programs tagged along. In that way these are the only chance for most of our client to come down to the proper. As of now at the moment Yap MCH program don’t have the GDM screening tools for Prenatal. It’s been 1 year and half that we don’t have the screening kits for the GDM.

Newborn hearing screening remained at above 95% for hospital discharged babies, but babies born in OI continued to miss out on this screening opportunity. Most babies born in the Outer Islands who miss newborn hearing screening continued to prevent us from reaching this goal of 100% coverage.

MCH Program will do more health awareness in the community and contact more outreach awareness in the islands on the importance of GDM Screening in prenatal Clinic. MCH program will also have to work closely with the V6AI radio station and other communication agencies to contact at least 5 health awareness on air or on text messages on the importance and the prevention of GDM among mothers of the child bearing age. MCH Program will make sure the GDM mothers will have to go through the complete gestational diabetes screening during prenatal visit. MCH program will ensure all GDM mothers screens at the appropriate weeks of gestation (26wks-28wks gestation and will ensure the clinic will have enough adequate supplies available in the clinic for GDM screening. MCH Program will work closely with national to support in fund of all supplies in screening of GDM case in pregnant mothers.

MCH plans to conduct more outreach activities on promoting of breastfeeding in the clinics and importance of early booking in the first trimester in the communities and also extended out in the islands. MCH will work closely with individuals or the women group in the community to implement the breastfeeding group in the community to help the working mothers and the new moms as well on the important of exclusive breastfeeding. MCH wishes to do more education on manual express for mother going back to work and school just right after delivery. MCH program will work closely with the state leader to extend the maternity leave up to 6 months for the sake of the children of Yap State.

MCH Program will continue working 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. MCH/EHDI will continue to work remotely with the EHDI consultants to screen children with hearing development issues

CHUUK STATE MCH PROGRAM PROGRESS:

Perinatal/Infant Health

In 2023, GDM and Anemia screening continued to be part of the Antenatal care services at the clinic at Public Health. Percent of pregnant women who have screened for gestational diabetes increased by 3% from 20% in 2022 to 23% in 2023. During this reporting period, MCH program staff conducted a refresher training on the GDM screening protocol to approximately 50 Public Health nurses, these nurses were well represented from other Public Health programs (NCD, Immunization, PREP, HIV/STIs/TB/HD). The purpose of this cross training was to upgrade their skills and knowledge in MCH field and to be familiar with the updated protocols in the MCH program so they could provide these services when program staff are not available.

MCH staff also provided training to 15 new health assistants from the lagoon islands on basic antenatal care. These new health assistants just graduated last December and hoping that they will start providing basic Antenatal services in their respective communities. Furthermore, MCH Program provided some ANC screening tools (measuring tapes, pregnancy wheels, Doppler and ANC forms) to the dispensaries in Mortlock region, so they could continue to provide ANC services in their communities. Also during the TB mass screening, MCH Program staff continued to refer the pregnant women they have encountered in the communities with no antenatal care to Public Health for prenatal care service

MCH program had also worked closely with Family Planning/FSM Health and Dispensary Office for the installation of the Satellite dishes in the dispensaries in outer islands. The main reasons for these satellite dishes mainly for telehealth, consultation and Educational information purposes. So far, 4 dispensaries in outer island (Mortlock region) have access to internet using the satellite dishes that were funded by the Title X Program.

 MCH Program also collaborate with JICA on the project for Pacific Co-Learning Towards Resilient Health System. The Project aims to build resilient health system that can respond to health emergencies in the Pacific region and to promote "Building Back Better Health System, the focus will be on strengthening the health system to maintain and enhance essential MCH services through activities such as training for health workers and innovations in service delivery

Challenges:

In 2023, the percentage of pregnant women received prenatal care in the beginning of their first trimester decreased to 17% and there was a high rate of maternal deaths, infant deaths and still births. Some of the contributing factors include; delay in seeking care due to lack of transportation and other family issues, inaccesibility of services in most of the remote islands and in the communities on Weno. Although we have the 3 CHCs established in the communities, however, people that lived far on the mountains sites and at the end of the islands still have difficulties to reach these CHCs. As of last year, the community health centers also experienced shortage of manpower (Doctors and nurses) to provide ANC services, 5 of their clinical staff (doctors and nurses) had resigned. This impacted on pregnant women in the communities for they could not able to receive prental care on time or as early as possible. Furthermore, the extension of service hours was not offered at the CHCs as well due to limited of staff they had.

At the community level, many health assistants were still not providing GDM screening and ANC services in their dispensaries due to lack of screening supplies (Glucose syrup, maintenance of the glucometer strips, Soda for GDM screening, lack of GDM protocol and trained personnel on the GDM part). Also, many health assistants are using their private houses as their dispensaries instead of a standalone dispensary due to the land issues experienced in the state.

POHNPEI STATE MCH PROGRAM PROGRESS:

Perinatal/Infant Health

There are has been a 13.8% increase in the number of women receiving prenatal care services in the 1st trimester since last reporting period. However, due to the lack of laboratory capacity in the dispensaries, all first visits are scheduled to take place in public health center only, which may deem inaccessible to populations in the rural areas and the outer islands. The partnership with CHC ended over 5 years ago, which enabled dispensaries to provide services during extended hours, therefore, clinics and services are provided only during working hours, making it challenging for working women to have time to access service.

Due to limited supply options with printing vendors, no standing banners were designed and requested at the time. However, just recently the program approached UNICEF and received a positive response to the request to assist with banner production from outside vendors. Banner design production is near completion.

Challenges

Program has been experiencing some challenges in trying to carry out its plans for improving GDM screening. The lab at the Pohnpei State Hospital was under construction and so many laboratory services were unavailable due to this construction. The lab has since been completed and has started ordering new equipment including supplies such as glucose liquid used in GDM testing. One of the downfalls of the glucose liquid is the short shelf life resulting in the supplies expiring in stock before being used.

Due to these limitation, ANC clinic is unable provide GDM screening to all woman 20 -24 weeks gestation unless they are classified as at risk for GDM by the physician.

MCH will continue to carry out efforts to further improve the rate of pregnant women receiving prenatal services at 1st trimester. In addition, now that the lab construction has completed, the program will once again work with laboratory supervisor to share cost on procurement GDM screening equipment/supplies and ensure consistent availability of glucose solution thru monthly monitoring of lab supplies needed for MCH clinics.  Increase visibility thru providing program signs.

KOSRAE STATE MCH PROGRAM PROGRESS:

Perinatal/infant Health

The Percentage of pregnant women who received prenatal care in the first trimester increased to 49% in 2023 from 35% in 2022

The percentage of pregnant women diagnosed with gestational diabetes increased to 3% in 2023 from 2% in 2022.

The percentage of pregnant women screened for anemia remained 100% in 2023 and 2022 and the percentage of pregnant women diagnosed with anemia increased to 4.5% in 2023 from 1.6% in 2022.

Accomplishments:

The percentage of first trimester visit has increased by 14% from 2022 to 2023.  The community education and awareness activities carried out by the Family Health Programs last year could be the contributing factors to this change.

The percentage of pregnant women screened for gestational diabetes increased in 2023. This change is a result of the implementation of the (GDM) protocol.

Challenges:

 The early booking is still a challenge because of the following: cultural barriers (single and teen mothers refused to be seen pregnant by others, so that mentality led them to wait until their pregnancy becomes visible.) and the mentality (we are already experts at giving births) that some women have, especially those with prior deliveries.

The major challenge we experienced last year was the shortage of GDM screening supplies. Because of the shortages in the GDM supplies not all pregnant women we received get screened.