Women’s/Maternal Health
Overview of Health Status for Women’s/Maternal Health
Palau’s projected population, based on the 2015 census is 18,089 for 2018. Gender difference indicates more male than female in all age groups except for ages 65 and above. Approximately 45% are within the reproductive age group (15-44) while children and infants 0 through 19 comprise about 27%.
The overall fertility rate for Palau in 2018 was 2.2 per 1,000 women. Fertility rates of women within the high risk group of < 20 years old has doubled in 2018 at 50.8 as compared to 2014 at 24.9 respectively. This indicates a drastic increase of teen pregnancies in the past 5 years.
Palau’s total fertility rate (TFR) in 2014 was at 1.6 as compared to Guam at 2.4 and the US at 2.01 and has steadily increased to 2.2 in 2018. Overall, the 5-year average remains a little lower than the global average of 2.3 children per women.
Summary of the Strengths and Needs of Women’s/Maternal Health
Strengths
Palau continues its effort to promote and educate mothers on the importance of early prenatal care. In 2018, 38% of females delivering a live birth received prenatal care beginning in the first trimester. About 40% received prenatal care in the second trimester. However, through community partnerships and awareness efforts other pregnant women access early prenatal care through private clinics. These women are then referred by the private clinics to public health for subsequent prenatal care and booking (2nd and 3rd trimesters).
Availability of Family Planning Services are offered to all women within the reproductive age group to include postpartum women during their 6 weeks visit.
- Aligning reproductive health community outreach with other public health programs to maximize capacity
- Efforts to ensure traditionally and culturally competent services reflective to the needs of men and women of reproductive age in Palau (ie. Clinic hours, clinic locations, and identifying providers who better address client needs)
- Strategic collaborations with community partners (CAT Team) in providing a diverse workforce to provide services to Palauan’s who are not comfortable speaking to a Palauan provider.
Needs
Access to care is still an issue for women in Palau. According to the results of the 2018 PPRASS, 25% of pregnant women who did not get prenatal care as early as desired. About 43% said “did not know she’s pregnant,” 20% had too many things to do due to work and/or customary obligations, 4% said no baby sitter.
From 2014 to 2018, more than half of the pregnant women who participated in the Palau Prenatal Risk Assessment Surveillance System (PPRASS) survey said they wanted to be pregnant. On average, about 33% of women wanted to be pregnant later or they did not want to be pregnant. As part of the PPRASS Survey, women who had an unintended pregnancy were asked why they did not use birth control. Overall, majority of pregnant women stated “they wanted to get pregnant.” Furthermore, 38% said “they didn’t think they could get pregnant.”
Overview of Health Status for Infants
The number of registered births in Palau for 2018 was 256. There were 250 singleton births and 6 multiple births. More than half of the births from 2014-2017 were male except for 2018 where 51% of the births were female. In 2018, 99% of infants born received newborn genetic and hearing screening. All the infants screened passed the newborn hearing screening. Two (2) infants were screened positive for Congenital Hypothyroidism and three (3) were screened positive for Glucose-6 Phosphate Deficiency.
Summary of Perinatal/Infant Health
Strength
Through strong community partnerships with the “Breastfeeding Community Workgroup”, a designated area within the health facility was established to provide health education and promote safe sleep and breastfeeding as a protective factor and a strategy to prevent infant mortality. In 2018, 98% of infants born are breastfed at birth. Exclusive breastfeeding up to 3 months has remained the same from 55% in 2014 to 52% in 2018.
In promoting safe sleep, women are provided counseling and educational materials as part of the discharge plan. In 2018, about 83% of women placed their infant to sleep on their backs. 13% said they either placed them on their back or side. And about 5% said they placed them on their stomach or chest.
Furthermore, the Palau Non-Communicable Disease prevention and control included in their action plan (2015-2020) under “Improving Nutrition” to increase breastfeeding by mothers of infants up to 6 months of age by collaborating with Palau MCH and other community partners.
Needs
Based on preliminary data for 2018, the infant mortality rate for Palau was 11.9 per 1,000 live births. The 5 year average of infant mortality is at 12.9 per 1, 000 live birth from 2009 to 2018. With Palau’s small population, the rate tends to fluctuate with small number of infant deaths.
2018 fetal mortality rate at 28 or more weeks’ gestation was 11.9 per 1,000 live births plus fetal deaths. The five year running average from 2009 – 2018 was 16.2. Fetal mortality is often under reported since data on spontaneous abortions are not collected.
In 2018, there were 29 preterm births of <37 weeks gestation in Palau representing 11.5% of live births. About 3% were less than 34 completed weeks gestation. Majority of the preterm births are due to complications in pregnancy.
The percentage of infants born at low birth weight (LBW) of <2,500 grams has slightly decreased in 2018 at 11% as compared with 15% in 2014. Birth weight distribution has moved toward more normal birth weight of 3,000 grams (6 lbs.) or more. Average birth weight of infants born in 2018 was 3,081 grams (6.79 lbs. or 7 lbs.).
75% of 19 to 35 month olds received full schedule of age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis, Haemophilus Influenza, and Hepatitis B in 2017. The program continues to advocate and encourage parents on the importance of bringing their infants in for their scheduled immunization.
Overview of Child Health
The school health program provides comprehensive health screening services annually to all schools in the Republic of Palau, including both public and private schools. A team coordinated by the School Health Program consisting of doctors, nurses, hearing technicians, dentist, dental nurses, counselors and health educators work together to promote the effective and integrated provision of targeted services for children and adolescents. Students in odd grades of 1st, 3rd, 5th, 7th, 9th, and 11th are screened for common health problems and psychosocial experiences.
All children are offered immunization based on the national immunization schedule. Health and education are working together to ensure that children who miss their age appropriate immunizations receive their needed vaccinations by reaching out to the parents for consent.
Summary of Child Health
Strength
A summary of prevalence study “2013 Children’s Healthy Living program (CHL Survey)” a comprehensive community report, provided a snapshot of Palau’s children between the ages of 2 to 8 years old. The study involved health and behavior measures. As a result, the study provided a detailed report and recommendation for actions to health programs to include the Palau MCH Program.
Approximately 74% (1158/1568) of the students in odd grades participated in the school health screening indicating an 8% increase between 2017 and 2018 exceeding the programs annual target goal of a 5%.
Needs
Overall, 14% of the students screened between the ages of 5 to 11 years old were overweight or obese (≥ 85th %ile) and 23% were obese (≥ 95th %ile) in 2018. High levels of overweight and obesity for both male and female indicate a need for collaborated efforts to improve diet and physical activities. Screening efforts also enable the program to identify children who require immediate intervention and referral.
Other issues include physical inactivity, unintentional injuries, and immunization coverage. The results of the 2018 SHS indicated 74% (95%CI 72.6-78.9) of 501 children were physically inactive for at least 60min/day. Female students were more likely to be physically inactive at 78%. Overall, 5% did not participate in any Physical Education (PE) classes. About 58% spend more than 3 hours/day sitting, watching TV, and playing games, talking with friends or other sitting activities.
Summary of CSHCN
The 2017 survey for children with special health care needs identified about 4% of Palau’s children and adolescent population require special health care needs. During the legislative compliance review for disability, some of the challenges that were identified were; lack of family and social support, transition services and programs, community based rehabilitation services for the outlying states and the need for better coordination amongst NGO’s, government agencies, development partners and stakeholders.
The survey for children with special health care needs (SLAIT-LIKE Survey) surveyed a total of 162 parents, guardians, and care givers of children and adolescents ages 0-17 with special health care needs.
Strength
The program works with interagency partners to strengthen collaborations and to also refine referral process for children who are diagnosed with conditions. The program will continue to work with the state ECCS team to provide awareness of services and the medical home concept. Trainings will be provided on case management and follow up as well as early intervention services.
Needs
About 43% were identified with physical and medical health care needs, 18.4% with educational attainment needs, and 9% had mental and/or behavioral health care needs. Additionally, 85% said their child had some form of insurance. About 66% of parents and or guardians spend more than $200 per month for their child’s medical care. Overall, they spent on average $700 per month (min. 0 – max. $7,000)
Additionally, 78% of parents and or guardians spend more than 40hrs per week caring for their child. More than 20 of families said that they needed additional income to support their child; 19.6% said their child’s care caused the family financial problems; 14% said they had to cut down their hours of work; and 9% stopped working to take care of their child with special health care needs.
Summary of Adolescent Health
Adolescent well visits are provided through the annual school health screening. 48% of adolescents between the ages of 12 to 19 participated in the screening. In 2018, the program identified and referred 60% of the participating students for further assessment, counseling and to receive free preventive medical visits.
Strength
FHU through the annual school health screening continues to screen, identify, and provide immediate interventions for adolescents who are at risk of suicide. Interventions addressing this measure are coordinated through the adolescent health program at the school health clinic.
In house trainings for counselors and other service providers are ongoing and trainings are also extended to our outside partners. In the past few years we worked with the Ministry of Education and all private schools in providing health education on suicide prevention. We also conducted three counseling skill trainings for teachers and school personnel on suicide prevention. These trainings aimed at training teachers in recognizing potential signs of suicide and providing immediate intervention. In addition to this, we worked with our NGO partners doing community talks on the issue of suicide.
Needs
From 2014 to 2018, there was a noticeable increase in the number of students who experienced depression as well as the thought of harming oneself. Additionally, there is an increase in the number of students who are bullied in school or at home or have experienced strong fears. Many of the students that experienced strong fears attribute them to insects, dogs, ghost, darkness, and heights. Moreover, 15% of the students in 2018 said they needed help with their psychosocial issues or concerns. In 2018, about 3.7% of the students screened said they been told to have special learning problems and 15.2% had problems with their grades.
According to the results of the 2018 SHS, 17% percent of adolescents were overweight or obese at (≥85th%ile) and 27% were considered obese at (≥95th%ile). Additionally, the YRBS survey identified 14.1% (95%CI 13.9-14.2) of the students having a BMI of >=95th%ile based on sex-and-age specific reference data from the 2000 CDC growth charts. 13.7% (95%CI 13.5-13.9) had BMI of >=85th%ile but <95th%ile for body mass index.
Immunization for HPV and DTap are provided on site for children ages 13-17 years old. 55% received their first dose of HPV vaccine.
According to the Youth Risk Behavior Survey (YRBS) for High Schools in Palau, 28% of female students reported ever having sexual intercourse, thus 22.6% have had sexual intercourse with at least one person during the 3 months before the survey. Less than 1% had sex before the age of 13. About 4.6% reported having sexual intercourse with four or more persons.
Summary of Cross-Cutting or Life Course
Tobacco, such as cigarettes (loose/packed) are commonly chewed with betel nut by Palauans. Results of the Palau 2013 STEPS Survey show significantly high use of tobacco with betel nut amongst women between the ages of 25-64 years old at 90.4% (95%CI 87.9-93.0) than men.
Strength
The FHU program through collaborative efforts with the Ministry of Education provide trainings on screening children and adolescents for substance use. Also through the annual health and PE workshop, FHU supports schools in developing health initiatives to decrease tobacco use amongst children and adolescents.
Additionally, the Palau MCH program with the NCD program and Behavioral Health program are working collaboratively with community partners on awareness campaigns to decreasing tobacco use and increase taxes on tobacco. Women and children who want to quit tobacco use are provided counseling and cessation services. Aside from policies and legislations, program strongly supports tobacco-free education and awareness during pre and postnatal screening and counseling.
Needs
In 2018, the 'Palau Pregnancy Risk Assessment Surveillance System (PPRASS) shows that tobacco use among pregnant women in Palau has remained the same in 2018 (62%) as compared to 2014 (58%). Tobacco is commonly used with betelnut.
Additionally, there was an increase in smoking cigarette among the students from 43% in 2014 to 58% in 2018. There were more female students who smoked cigarette as opposed to male students.
Overall, there was a 6% increase in tobacco use among the students in 2018 as compared to 2014 at 7%. About 72% said they use less than a stick of cigarette per day and 28% use more than a stick to close to a pack a day.
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