Ongoing Needs Assessment Activities

Back in August of 2020, American Samoa concluded an extensive five-year needs assessment that led to the selection of the state MCH priorities and development of the MCH Action Plan. Since summer 2020, there were several additional needs assessment activities that were conducted to monitor ongoing changes to health status and public health systems in American Samoa.  The year 2021 did not allow for the Title V team to conduct a needs assessment the same way, however, throughout all activities in preparation for a COVID community spread, MCH utilized these opportunities to gather applicable data, input from partners, and access for ways to continue to support women, pregnant mothers, all children including those with special needs. 

Collaborating with the DOH Behavioral Health Services Division and its partners to mitigate the rise in Suicide rates continued to be a priority. MCH Title V a Telehealth Grant through AMCHP to fund training, purchase communication equipment and electronics, and improve access to affordable wifi for the local Suicide Hotline. Title V continues to actively collaborate with NGO’s EPIC and Intersections Inc. to assist with school suicide screenings, education, as well as creating and disseminating public service announcements on sucide prevention. Title V staff also assists with operating the 988 Suicide Prevention Lifeline afterhours, the challenge is sustainability so there continues to be a need to address this concern for adolescents at this stage of life.

Over the course of 2021, ASMCH Title V continued to monitor the impact of the COVID-19 pandemic on MCH services and outcomes. Many services had to be centralized at Tafuna CHC because outer clinics were closed and staff were deployed to vaccination pods for COVID vaccinations. This resulted in overall decrease of clinical service rates including medical, prenatal and dental visits. These data reports are included in Form 10 and Population Domain Narrative sections.

Stakeholder involvement

ASMCH had to be strategic this year in obtaining feedback from stakeholders. Due to the ongoing public health emergencies American Samoa faced in 2021, small groups meetings via zoom and face to face meetings for interviews were carried out. After the Needs Assessment were finalized and submitted, it was a challenge to find time for ongoing stakeholders’ meeting. Title V had to maximize various partnership meetings for planning and community outreach activities to share health findings and discuss strategies and ESMs. Such meetings included:

1. Protect As One Festival with Chambers of Commerce members
2. Planning meetings with DOE to boost vaccinations
3. COVID-19 Vaccination Working Group weekly meetings
4. COVD Task Force meetings
5. CMEs with medical staff
6. Weekly DOH Key Leaders Meeting

Changes in Health Status

Women’s/Maternal  Health: For the Data Trend 2015-2019, the percentage of pregnant women giving birth annually decreased by 25%. The number of females in the reproductive/child-bearing age group (ages 18-44) was 9496 representing 18.9% of the total population in 2019. Maternal Mortality continues to be zero 2015 - 2018 but we have yet to receive the rate for 2019 – 2020. While monitoring postpartum women’s data, it was obvious that those who were accessing early prenatal in their first trimester did not necessarily mean they were receiving adequate prenatal care. Tafuna prenatal care was not always consistent in opening due to lack of provider and hence not all women were consistently being seen by a provider when they showed up for their check-up appointments. Definition for first prenatal care visit at the CHC level may be different from OBGYN Clinic at the Hospital.

Perinatal/Infant Health: Preterm births have gradually decreased in the past 6 years, from 9.14 per 1000 livebirths in 2014 to 5.92 per 1000 livebirths in 2019. Number of pregnant women have also been decreasing in the past five years. Approximately 80% of babies are born with normal weight and only 4% are born with low birth weight. There is obvious decrease in 2020 but it is not yet determined if its due to COVID-19 restrictions.

Child Health: High immunization coverage of routine vaccinations like the measles, mumps and rubella (MMR) is a strength for the child health MCH population domain in American Samoa. This was evident during the recent measles outbreak in American Samoa from November 2019 to March 2020. The 1st MMR dose for school age children (both public and private schools) and children in childcare services at 12 months and older, was estimated to be at 99.5%. In addition, 2nd MMR dose coverage for the same group was estimated to be at 99.5%. For the measles outbreak situation in American Samoa, a total of 16 laboratory confirmed measles cases and 0 deaths were recorded. However, the measles outbreak situation in neighboring Samoa was unfortunate. A total of 5,707 measles cases and 83 deaths (~80% among children less than age 5 years) was documented. WHO and UNICEF estimated MMR coverage in Samoa among young children to dramatically decrease from 74% in 2017 to 34% in 2018. The low MMR vaccination coverage in 2018 is largely attributed to the deaths of 2 infants who were mistakenly injected with the wrong MMR vaccine mixture.

Adolescent Health: Bullying and suicide have been shown to be significant behavioral health among adolescents in American Samoa according to the YRBBS data. Adolescents reported bullying on school property has increased from 25% in 2011 to 30% in 2015. Furthermore, there is an increasing number of adolescents who reported to have attempted suicide from 20% in 2007 to 25% in 2015. Suicide rates have yet to be finalized for 2019 – 2020 but there were definitely a rise in cases in 2020. This is why MCH Title V staff were deployed to assist the Suicide Prevention Initiative spearheaded by the DOH Behavioral Health Services.

Children and Youth with Special Health Care Needs: MCH Title V continues to provide care coordination services to CYSHCN. Appointment reminders for medical checkups and immunization, transportation and transition services. All children are Medicaid eligible hence receives free medical care at the LBJ Hospital and Community Health Centers. There are still challenges with ensuring CYSHCN have access to affordable and appropriate durable medical equipment because they are not readily available on island. An example is not only ensuring all children needing appropriate wheelchairs have them but also ensuring homes have accessible  sidewalks, walkways and ramps their homes to the main roads.

Changes in Title V Capacity/Structure:

Since the submission of the Needs Assessment in 2020, the MCH Epidemiologist moved to the Territorial epidemiology Office to assist with the COVID-19 Surveillance and Operations. Last year, the MCH Epidemiologist left the island on August 12, 2021, to pursue her Public Health doctorate degree at Yale University. She will be away for four years. It will take some time to hire another qualified MCH Epidemiologist. In the meantime, Title V staff who are also Epi Tech Certified will be overseeing MCH Epi Surveillance, analysis and reporting and working closely with Territorial Epidemiologist Dr. Aifili Tufa to validate data reports.

Emerging Public Health Issues and Future Needs Assessment Activities:

The AS Title V Program will continue to collaborate with the Public Health Surveillance Office to monitor the long-term impact of the COVID-19 pandemic among its MCH population. The travel restrictions, shortage of staff and clinic hours of operations will continue to have a negative impact on utilization of services and early prenatal care. ASMCH continually plays an active role in the COVID-19 vaccinations to reach the territory’s target of 80% coverage for all AS residents. Title V will continue to assist Behavioral Health with promoting Suicide Prevention Initiatives and also collaborate with EPIC and Intersections Inc to promote outreach activities for children and adolescents.

Future needs assessment activities are outlined in the Cross-cutting/System Building Domain application section. In FFY 2022, ASMCH aims at conducting a more in-depth needs assessment pertaining to the actual number of CYSHCN as recommended in the FY2021 grant review summary statement. Part of this assessment will also be in-depth to determine how many requiring transitional services actually received them.

Based on the FY2021 Grant Review, American Samoa Title V Program was encouraged to collaborate with the Department of Education to develop methods to capture CYSHCN data among school-aged children and to develop upstream approaches to encourage the incorporation of developmental screening into school-based programs and pediatric care.

The American Samoa Title V MCH Program will also standardize data sources and reporting process for measures, in order to properly track and report on trends, over time.