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 upon child’s visit.  Program nurses have been filling out these forms and  given to the pediatrician, which has led to a number of referrals to the human services for further care. There is a plan to have a child passbook which will include the developmental milestones and other information on mother and child in local language.  With the new passbook, parents will be filling out the forms. There will be a 2 day training for the Ministry staff and representatives from the community to showcase the passbook and get their feedback.

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

Well Baby Clinic Update

In 2019, Program nurses were able to meet the objectives of the training that was conducted by PIHOA on Well Child Care

Objectives

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

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

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

4-r nurses recorded on a WHO approved graph and interpreted measures accurately enough to know when to refer a child who is not developing properly

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

6- nurses were to able to give at least 1 reason why WCC visits are important 

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

*MCH JS

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- There’s a seat belt law but none for mandatory child car seat.

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

In 2019, Cause of death: Pneumonia: 3, Drowning: 1, Congenital Heart Disease: 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:

RMI Immunization Program is working with UNICEF for the upgrade of the cold chain equipment. The new cold chain equipment implementation plan includes Outer Islands. 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.

Due to the Dengue Outbreak that started in June 2019, the Outer Islands Mobile visits were on hold because of the travel ban. One of our challenge is timeliness and accuracy of the data entry. To address this, we are implementing a mobile WebIZ that we can use off the network. We can bring the mobile WebIZ to the Outer Islands and use it to search and update the client’s immunization history.