Child Health Annual Report

Priority Need: Improve child health through early childhood developmental screening, and complete vaccinations.

NPM 6 - Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool

ESM 6.1 - Implement a Comprehensive Developmental Screening tool for 10 through 71 months children

Currently, the developmental screening tool is completed by the nurses while asking the parent/s. It is easier for the health care professional and the parents to have it this way so that the health care professional explains the screening tool. In this reporting period, MCH program with PIHOA-Zika consultant updated the developmental tool. We are in the process of update our data system to accommodate the revision of the developmental tool.

ESM 6.1 is completed. Both NPM and ESM will not be applicable in the next reporting period.

Well Baby Clinic Update

In 2016, Pacific Health Officers’ Association (PIHOA) provided consultants funded by their Zika Response Funding. 1 consultant was assigned to work on with us in MCH Clinic and Program.

From November 2016 to July 2017, consultant worked with us on the following activities:

During a Well Child Care (WCC)  visit, on a child the participant will:

1- know the number and intervals of WCC visits in a child’s 1st 2 years of life

2-demonstrate understanding of what a WCC visit constitutes; “it’s more than taking a weight”

3-demonstrate accurate skills in taking weight, Head Circumference, Chest, and length measure

4-record on a WHO approved graph and interpret measures accurately enough to know when to refer a child who is not developing properly

5-apply and interpret a simple 10 question Denver developmental based assessment tool accurately enough to know when to refer a child who is not developing properly

6-give at least 1 reason why WCC visits are important 

Participants and dates: Over the last year, a concerted effort was made to roll out systematic training of MOHHS health care providers in an attempt to build better well child skills in hopes of identifying and referring children early to care or further evaluation.  The next step is Outer Island pregnancy care.

NPM 7 - Rate of hospitalization for non-fatal injury per 100,000 children ages 0 through 9 and adolescents ages 10 through 19

2016 - Cause for hospitalization are burn, injury, suicide, MVA, and environmental accident.

2017: Cause of hospitalization: Burn, Fall, Drowning, Moving Vehicle Accident, hot liquid, injury.

2018 - Diagnosis for hospitalization are head injury, burn and MVA

Child injuries are preventable but we still continue to receive patients in the hospital. Community and families need to work together to make the environment safe for the children.

The Ministry of Public Safety continues to implement the following activities to support the promotion of child safety:

1.      Seat Belt Law

2.      Police man assigned to each school during arrival and dismissal of students

3.      Traffic stops when school bus stopped and wait for pick up or return the students from school to their designated area

In 2017, there are 68.6 per 100,000 children ages 1 to 9 yrs old. Underlying cause of death are: 2 to drowning, 1 vehicular accident, 1 laceration of the neck (murder), 3 malnutrition, 1 dehydration, 1 probable meningitis, 

In 2018, Causes of death: Severe malnutrition: 1, Drowning: 2, MVA: 1, Septicemia: 2, Meningitis: 1

It is unfortunate that young children are dying of malnutrition and dehydration. We need to strengthen family and community support group. If a child in the community is malnourished, members of the community can refer them to MCH Program to be able to refer to the health care that the child needs. We don’t have WIC.  

SPM 2 - Final and endorsed readiness assessment of RMI MOHHS to handle Autism Spectrum Disorder, Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder Program

RMI MOHHS MCH Program needs TA in conducting the readiness assessment. This has been requested under the TA section. This will be the first time that RMI MOHHS will be assessing our capacity. Using the readiness assessment report, we can create our strategic plan to be able to address the proper management of these conditions.

In September 2017, a Psychiatrist was hired under the Bureau of Behavioral Health. He started looking into ASD and ADHD services in RMI as he has a child with ADHD. But he can’t find any previous data or guidelines Referral from Well baby clinic and Children’s clinic was not fully functional. A screening tool for ASD and ADHD was developed and endorsed. In 2018, Behavioral Health and MCH Program with CSHCN will implement the screening tool in all well baby and children’s clinics. Strengthen referral system to be able to provide the proper diagnosis, management and treatment.

SPM 3 - Increase percentage of fully immunized children ages 19 to 35 months

The National Immunization Program continue to provide vaccination services. The RMI Immunization schedule is 4DTAP, 3HepB, 1HIB, 1MMR, 3IPV for 19-35 months. Immunization program had to visit 1 island for 4 times a year to be able to reach 90% immunization rate in the Outer Islands. This is an ideal situation where in the program is having difficulty to achieve due to challenge in air and sea transportation, staff and movement of population from island to island.

RMI Immunization Coverage Rate for children 19-35months (4DTAP, 3HepB, 1HIB, 3IPV, 1MMR

Below is the RMI Immunization schedule:

We don’t have cold chain equipment in the Outer Islands due to problem in supply of electricity. WHO has recommendations on solar powered cold chain equipment. But CDC didn’t agree that the vaccines funded under CDC will be stored in equipment not assessed or approved by CDC.

Immunization continue to provide vaccines in Majuro, Ebeye and Outer Islands. Program has zoning and outreach mobile visits. They bring the services to the public.