With the COVID-19 Pandemic, most of our activities and meetings were deferred.

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

Highlights:

•            COVID-19 vaccinations for children are available and provided in Majuro and Ebeye. Increase number of immunization outreach visits in the Neighboring Islands through the COVID-19 vaccination campaign
•            Early Childhood program supports the Parents as Teacher project under the Women United Together Marshall Islands.
•            Continue to support the oral health with supplies and travel to the Neighboring Islands.

Challenges:

•            Availability of immunization services in the Neighboring Islands is dependent on the outreach mobile visits for the two main islands (Majuro and Ebeye). Currently, there is no cold chain equipment in the Neighboring Islands Health Centers

Plan:

•            Implement cold chain equipment system in the Neighboring Islands for storing of vaccination. Build the capacity of the health assistants to vaccinate and monitor the cold chain of the vaccines.
•            Conduct community awareness on the proper immunization schedule and the benefits of immunization
•            Continue to provide outreach services to improve access to services

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

A task force was created to develop and implement the milestone passbook that supports the data collection for ESM 6.1. There was a delay in 2021 due to the activities related to COVID-19 pandemic. Task force has drafted the milestone passbook with English and Marshallese version. It is ready for review. Aside from the passbook, electronic version of the passbook will be developed in MHIS (Marshall Health Information System) for data collection.

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

In 2020, Cause of death: Accident (Drowning: 2, Fall from tree – 1): 3; Gastroenteritis: 2; Pneumonia : 2; Congenital Heart Disease: 1; Sepsis : 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.

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

ESM 6.2 - Percentage of children diagnosed with ASD and ADHD

Under the Behavioral Health Clinic, Clinical Director and team strengthen the referral system of children with behavioral problem see in the Children’s Clinic. Clinical Director provided the guidance and referral forms to ensure that the referral and transition of management is done properly.

Psychiatrist in Behavioral Health Clinic in Majuro developed a referral system with the Majuro Hospital Pediatricians for evaluation of children with behavioral and emotional disorder. Out of the 19 referred patients, there were 2 that meet the clinical diagnosis for ADHD

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

With the preparedness and response on COVID-19 Pandemic, the Immunization rate decreased by 6% in 2020. The Immunization team was unable to do meet their goal of at least 2 Outreach mobile visits to the Outer Islands.

Below is the RMI Immunization schedule:

RMI Immunization Program received cold chain equipment from UNICEF to upgrade of the cold chain equipment. New cold chain equipment were distributed in the immunization depot in Majuro and Ebeye. The next project is to implement solar powered cold chain equipment in the Outer Islands Health Centers. With CDC funding, Immunization continues to provide vaccines in Majuro, Ebeye and Outer Islands. Program has zoning, house to house visit and outreach mobile visits.