2018 Accomplishments:

The following are four performance measures that American Samoa selected for Children’s Health domain:

1.      NPM 6 - Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

2.      SPM 2 - Percent of children, ages 1 through 3 years, who had a preventive dental service in the past year.

3.      SPM 3 - Percent of children ages 3 who have completed their age-appropriate routine vaccinations.

4.      SPM 4 - Rate per 10,000 children, ages 5 - 17, diagnosed with (A) Rheumatic Fever or (B) Rheumatic Heart Disease.

NPM 6 - Percent of children, ages 9 through 35 months, who received a developmental screening using a parent completed

A total of 49 unduplicated children, ages 9 through 35 months (2 years), whose parents completed a Standardized Developmental Screening tool in the past year were reported by the MCH CSHCN Program (18 children ages 9 through 35 months) and Helping Hands (31 children ages 9 through 35 months). A count from the data in the well-baby clinics could not specify this number as providers are using a self-developed checklist created to screen for developmental delays.  This checklist is not AAP approved or standardized.  Hence, there may be children with a developmental condition that may not be identified due to this process.

MCH Title V will take a more vigorous approach in assuring children in this age group will receive a developmental screening that is culturally sensitive and appropriate and comprehensive to promote early detection of developmental delays and treatment or referral to appropriate resources and services.

SPM 2 - Percent of children, ages 1 through 3 years, who had a preventive dental service in the past year.

Dental Services at the community health centers reported that a total of 44 children ages 1 through 3 years received a preventive dental service in 2018. This is 1.1 percent of total population ages 1 through 3 years. Preventive services included a dental check-up, cleaning, topical fluoride varnish treatment and oral hygiene instructions. Only 15 of these children had more than one visit for a dental restoration or dental extraction due to untreated cavities. Despite getting dentists at the Community Health Centers to approve providing preventive dental services for this age-group, there is no care coordination services to ensure that those who are seen at the Well Baby Clinic are also enforced to also get a dental check-up, especially to receive their first dental visit at 12 months of age. The plan to hire a dental assistant to provide at least fluoride varnish, oral hygiene instructions and provide care coordination services to ensure each child gets seen by a dentist by their first birthday did not get executed because hiring process took more than a year. Despite the low percentage, this SPM has improved slightly compared to year 2016 and 2017.

SPM 3 - Percent of children ages 3 who have completed their age-appropriate routine vaccinations.

According to the US Census for this age group, a denominator of 957 was reported.  Of this group, 576 (60.2%) children ages 3 completed their age-appropriate immunizations. In the past years, the reported percentage was low, this may be attributed to over estimations of the total population of this age group.  For this year’s reporting, the MCH Title V epidemiologist revised the numbers to reflect a more appropriate count based on the US Census report.  This SPM is linked to the NOM 22.1. 

It is also imperative to report that from November 2018 to January 2019, ASDOH overall executed an island wide Meningococcal Vaccine campaign to address the low numbers of children ages 13-17 receiving this vaccination.  This was initiated by the Director of Health after notification of children dying from the neighboring Samoa Islands due to meningococcal infection.

Considering the frequent travelling of people between the two Samoa Island countries, it was essential to address this issue and not wait for American Samoa to deal with an actual case.  Nonetheless, the territory reported one case of an infant who travelled with parents from New Zealand to American Samoa to visit families.  The infant became ill and was tested positive for meningococcal.  All necessary precautions were exercised, the child’s condition improved, and the territory was able to prevent a possible outbreak from this contagious disease.  MCH Title V personnel was in the forefront of this campaign and contributed time and resources to this effort. 

A sonography training was initiated in February 2018, inviting 2 US certified sonographers who train internationally to come to American Samoa and train individuals who can learn basic echo protocols to screen for acute rheumatic fever and rheumatic heart disease among the school-aged children population.  Training was conducted over a period of 2 weeks which included theory and practical sessions.  Local personnel who were trained were selected from the LBJ Hospital and the local health department.  All seven trainees received a certificate of completion and encouragement to continue practicing their learned skills.

Following this training, a central echo clinic was open to the public where parents can bring their child in for an echo, providers from both LBJ and DOH can refer their suspected cases for a screening.  This opportunity was provided at no charge to the public, and offered to any age group that needed this service.  Echo images were then uploaded to a cloud-based HIPAA compliant system, in which cardiologists from off-island could view and provide a final diagnosis.  Report would then be forwarded to patient or client for management by their primary care provider. 

At present time, only two of the trainees are consistently practicing their echo skills, while others have had difficulty continuing this skill due to their previous job obligations.  MCH Title V and the RHD program will have to re-examine this issue and strategize on how to support an independent team of echo technicians who will go out to the schools and screen children throughout the school year. 

To date, more than 100 children and adults have come through this clinic to be screened, with echo images upload for interpretation.  Through a recent CDC Epi Aid project, RHD prevalence was noted at 13.5 per 1000 for children ages 5-17.  This is a collective number derived from databases maintained by DOH, OHSU, and BYU, as well as the Electronic Health Records managed by LBJ between the years 2016-2018.  This continues to confirm that RHD is a significant problem among children of American Samoa and should be prioritized in resources and services.

NPM 6 - Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

• CHC’s Well Baby Clinic is an appropriate venue to implement the screening tool
• Clinicians are aware of the importance of this tool
• Care Coordinators can assist with translating and filling out of parent questionnaires.
• Helping Hands PT Dr. Joyce Ursulino is willing to provide the ASQ training once the tools are purchased.

SPM 2 - Percent of children, ages 1 through 3 years, who had a preventive dental service in the past year.

• There are plenty of children this age group attending the Well Baby Clinics.
• MCH Dental Assistant recently hired can provide care coordination, referrals and appointment reminders. She can also assist with the oral health surveillance of this initiative.

SPM 3 - Percent of children ages 3 who have completed their age-appropriate routine vaccinations.

• Immunization Program provides technical assistance for clinician and nurses, provide vaccines as well as responsible for updating the database WebIZ.
• MCH Epi provides surveillance and reporting to key leaders and stakeholders.
• Headstart ECE collaborates with DOH and enforces the completion of all needed vaccines prior to entering preschool.

SPM 4 - Rate per 10,000 children, ages 5 - 17, diagnosed with (A) Rheumatic Fever or (B) Rheumatic Heart Disease.

• Ultrasound machines are available
• Trained personnel is available to provide limited RHD echocardiograms.
• Pediatric Cardiologists on a voluntary basis reads these echos and send results back to the RHD coordinator.
• Antibiotic prophylaxis Bicillin is now affordable through the 340B program.

NPM 6 - Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

• Awaiting ASQ tools to be purchased.
• Clinicians may approve of the new screening tool but may not have time to provide the screening if its lengthy.
• Once tool is purchased, it may still need to be translated.

SPM 2 - Percent of children, ages 1 through 3 years, who had a preventive dental service in the past year.

• MCH Dental Assistant position remained vacant until March 2019.
• Inadequate space at the Tafuna dental clinic to accommodate four dentists at a time. There are only three dental chairs and barely any other space for a fourth dentist to utilize.
• CHC purchasing of dental supplies takes a long time. MCH has been providing fluoride varnish and dental sealants in the last three years.

SPM 3 - Percent of children ages 3 who have completed their age-appropriate routine vaccinations.

• Families wait until child is ready to be registered for preschool then bring their children to update their vaccinations. It may take more than one visit to complete them.
• None of the CHC WBCs have appropriate refrigerators. Immunization Program staff delivers every morning and pick-up leftovers after work daily.

SPM 4 - Rate per 10,000 children, ages 5 - 17, diagnosed with (A) Rheumatic Fever or (B) Rheumatic Heart Disease.

• Need a full-time echo technician dedicated to RHD screening. Right now, trained personnel have other commitments and only screen when they are available.
• Need commitment from the advisory board to meet more frequently.
• Insufficient program staff. Only the program coordinator and an administrative assistant.
• Need a full-time nurse who can also be a case manager and care-coordinator.