Reducing risk for neural tube defect among immigrant Latino Women in Northern California

In California, more than 60% of pregnancies are unintended and bear an increased risk of poor birth outcomes. Since 1997, 83% of California infants born with Congenital Rubella Syndrome (CRS) were born to immigrant Latinas. A chart review of Latina prenatal clients seen at the Palo Alto, California MayView Community Health Center in 2002, found 18% to be Rubella non-immune. Although surveys show an increased awareness by English-speaking women of folic acid consumption for the prevention of Neural Tube Defect (NTD), the awareness level of Spanish speaking women is unknown but presumed to be very low. Infant deaths from birth defects is slightly higher for Latinos (1.5), living in Santa Clara County, compared to Californians (1.4) as a whole. Folic acid deficiency may be a factor. In 2004, the MayView clinics developed a culturally-appropriate program to increase rubella immunization and folic acid consumption among Latinas, with funds from the March of Dimes. The presentation will describe how focus groups with Latino clients were used to develop culturally-appropriate educational and outreach materials and to improve staff communication with their Latino patients. After one year, under the guidance of a physician assistant health educator, the evaluation showed that staff training and new protocols, combined with culturally-appropriate screening and counseling methods resulted in 183 women being immunized. In addition, at least 512 bottles of 400mcg Folic acid were dispensed. At follow-up, 60% of women in the study reported taking folic acid daily; a rate significantly higher than reported by other folic acid programs. Follow-ups in 2007 and 2008 showed that the program was institutionalized and still effectively reaching the priority population.