Abstract
Immunization service availability and readiness in the hard to reach zones of Ethiopia
Muluken Alemu1 and Filimona Semunigus, MD+MPH2
(1)CCRDA/CORE Group, Addis Ababa, Ethiopia, (2)CORE Group Polio Project Ethiopia, Addis Ababa, Ethiopia
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: CORE Group Polio Project in Ethiopia conducted mid- term evaluation for its polio eradication project. In the evaluation the need for assessment on immunization service availability and readiness was identified.
Objective: assess immunization service availability and readiness in hard to reach areas of Ethiopia.
Method: Health facilities based cross sectional study using structured self-administered questionnaires and observation checklist. The health center head, delivery ward nurse and EPI focal person from all health centers in the project area were expected to respond. Data was entered in to EPI data and analyzed in STATA 12.0.
Result: Among respondents 88.5% reported that they involved in providing immunization service and 76.2% of them involved both in static and outreach programs and 97% reported walking as means of transportation to outreach site. Frequencies of immunization service provision were reported to be daily (48.3%), weekly (21%), or monthly (28.3%). Only 29.8% reported sufficient number and qualified health workers involved in immunization service provision. About 80% reported availability of national EPI guideline in the facilities and there was stock out of at least one antigen.
Conclusion and Recommendation: The majorities of health centers provided immunization service and had national EPI guidelines but less than 50% provided immunization service daily. In relation to number and quality of health workers, 70.2% reported insufficient number or poor quality or both. Therefore, avail sufficient number of trained health worker, increase number of vaccination dates and means of transportation are important for future better achievements.
Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Improving 1st Antenatal Clinic Booking before 14 weeks. Lessons from Chikando Zonal Health Centre, Chipata, Zambia
Patrick Chibanda, B.A(Econ);Dip(Med);MPH1 and Kuwani Banda, Dip(Nur);B.A2
(1)USAID Systems for Better Health(SBH), Lusaka, Zambia, (2)Ministry of health-Zambia, Chipata, Zambia
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
Early Antenatal care is key to enhancing Maternal and newborn health. To improve pregnancy outcomes,it is desirable for women to attend first antenatal clinic before fourteen weeks of gestation. Chikando RHC had challenges in providing quality ANC services as not more than of 26% of women attended ANC before 14 weeks in the period 2013 to 2016.
Objective:
To increase percentage of first ANC bookings before 14 weeks from 26% to at least 45% within 9 months.
Abstract objective:
To share best practices that result into higher early utilization of ANC services.
Methodology:
The project was conducted using the Performance Improvement approach. The data aggregation tool (HIA 2) was used to generate summarized maternal health data, which subsequently identified bottlenecks and root causes. Community volunteers(SMAGS) were used to make referrals to the health facility for management. The SMAGs were involved in outreach programs to distribute IEC materials and dispel cultural beliefs surrounding early booking. Gravidex tests were introduced at all service entry points with immediate booking for ANC after confirmation of pregnancy. The testing logistics were sourced locally using monthly imprest. Gravidex testing was conducted to all women suspected to be pregnant. From January to September 2017, 86 of those suspected were tested,with 65 testing positive.
Results:
First ANC bookings before 14 weeks increased from 26% to 75% in only 9 months.
Lessons:
The use of the performance improvement approach improved first ANC bookings before 14 weeks. Low cost institutionalized interventions are sustainable and are of long-term high impact.
Administer health education strategies, interventions and programs
Abstract
Influences on Rural Mothers’ Decision Making When Their Infant Is Ill
Mechelle Perea-Ryan, RN-BC, PHN, PhD, FNP-BC
CSU, Stanislaus, Oakdale, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background: Emergency department (ED) utilization by pediatric patients, especially infants, is a good indication of the healthcare delivery system effectiveness in that region. When the ED is used for nonurgent issues, added complications arise: lack of continuity of care, increased cost of care, ineffective utilization of resources and overcrowding. While research has elucidated causes for nonurgent ED use in pediatric urban hospitals, little research has explored the decision-making among mothers of infants in rural settings.
method: The study was a descriptive qualitative study guided by grounded theory. The sample consisted of fifteen English- and Spanish-speaking mothers of White, Asian and Latino infants within California’s Central Valley.
results: In interviews, mothers reported a process of observation, consultation, assessment, and decision-making about home, clinic, or ED care for their infants when there was a health concern. Themes that emerged from the interviews as important in the pathway were a change in behavior or sign of illness, the use of resources, reassessment, relationship with their provider, cost, day of the week or time of day and a gut feeling. Previous experience influenced the process for all mothers. A conceptual model was developed to illustrate the common pathway and influencing factors that emerged.
conclusion: Recognizing the process mothers’ use when making decisions about an infant health concern, assists health professionals within rural settings at both the community and institutional levels to target interventions and/or education to support effective healthcare utilization.
Provision of health care to the public Public health or related nursing Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Characterization of social determinants of health among urban underserved families of newborns and its effect on well child care in the first 6 months of life
Brian Lefchak, MPH1, Ann Cushwa, LSW2, Hans Kersten, MD2, Renee Turchi, MD, MPH3 and Katie McPeak, MD2
(1)Drexel University College of Medicine, Philadelphia, PA, (2)St. Christopher's Hospital for Children, Philadelphia, PA, (3)Drexel University Dornsife School of Public Health, Philadelphia, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Timely well child care (WCC) is critical in monitoring the health and well-being of children and caregivers, especially newborns. Low income, Medicaid-insured newborns are at known risk for delays in access to WCC. These delays can be exacerbated by missed appointments and no-shows fostering negative impacts on health outcomes. Examining psychosocial needs and social determinants of health (SDH) in the newborn population may inform predictive variables for healthcare utilization. Caregivers of newborns initiating WCC at St. Christopher’s Hospital for Children complete a routine intake survey assessing social stress. Screener responses between December 2016 and June 2017 were correlated to sociodemographic data and 5 month appointment attendance histories in the EHR. Analysis included a total of 720 screeners. Newborn caregivers demonstrate consistent needs for child care support, food, insurance and newborn supplies with significant rates of missed/cancelled appointments. 16.3% of the cohort screened positive for 3 or more social stressor variables. Within that cohort, a previous maternal mental health diagnosis was most predictive for missed/cancelled appointments (p=0.01). A linear regression model was constructed for subjects with any missed/cancelled appointments. The predictive variables for missed/cancelled appointments included those identifying a need for another adult caregiver (p=0.09), number of siblings (p<0.01) and maternal age (p<0.01). Associations with appointment compliance, maternal demographics, household makeup, and maternal mental health status inform clinical practices on possible preventive interventions to best meet the needs of newborns and their families. Understanding trends among newborn-caregiver dyads may assist pediatric practices in tailoring upstream resources for patients at highest risk.
Advocacy for health and health education Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related organizational policy, standards, or other guidelines
Abstract
Mother-infant health care utilization in the year following pregnancy complicated by diabetes, high blood pressure, or obesity
Emily F Gregory, MD, MHS1, Molly Passarella, MS1 and Scott A. Lorch, MD, MSCE2
(1)Children's Hospital of Philadelphia, Philadelphia, PA, (2)Children’s Hospital of Philadelphia & CHOP PolicyLab, Philadelphia, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Women with prenatally identified modifiable health conditions may particularly benefit from interconception care. These women interact with health systems as patients in adult systems and as parents in pediatric systems. We compared the distribution of care between these systems for women with known cardiovascular risk factors and those without.
Methods: This cohort derives from Medicaid Analytic eXtract (MAX) data in which mother-infant dyads are linked (94% of births linked). Dyads had births from 2008 – 2011 in 21 states and continuous Medicaid eligibility for the year after birth. We defined prenatally identified health risks using ICD9 codes for diabetes, hypertension, and obesity. We used ANOVA to compare visit counts between adult and pediatric settings and between dyads with health risks and those without.
Results: We identified 153,402 mother-infant dyads with continuous Medicaid eligibility in the year following birth. Of these, 25% had cardiovascular health risks (hypertension 13%, diabetes 12%, obesity 6%). All dyads were seen more frequently in pediatric settings than in adult settings (high risk: 10.8 vs. 5.3, p-value < 0.001; no risk 10.1 vs. 4.7, p-value < 0.001). This pattern was also seen when restricting visit count to preventive visits only. Dyads with health risks had more visits in the both pediatric and adult settings compared to dyads with no risk.
Conclusions: Women with a high need for interconception care present in pediatric settings more frequently than in adult settings. Integrating preventive care across settings may improve receipt of interconception care and birth outcomes.
Chronic disease management and prevention Provision of health care to the public Public health or related public policy
Abstract
Postnatal Care in Nepal: Challenges and Opportunities
Nadia Anderson, MPH1, Cyril Blavo, D.O., M.S., M.P.H., T.M., Sujan Marahatta, PhD, Mayur Sharma Banjara, MPH3 and Shelley Xu, OMS-II
(1)International Health Initiatives, Inc., Davie, FL, (2)New Mexico Department of Health, Davie, FL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Objective: One-third of maternal deaths in developing countries occur in South Asia. Despite significant improvements in the Nepalese healthcare system over the last decade, many maternal and neonatal deaths still occur during this period. The objective of this study is to identify barriers to postnatal care utilization in semi-urban Nepal.
Methods: The study is a descriptive, cross-sectional needs-assessment, through collaboration between public health researchers from the United States and Nepal, to determine the extent of postnatal care utilization in the Mahalaxmi municipality in the Lalitpur district of Nepal. All structured questionnaire respondents were women between the ages of 16 and 39, who had children (ages 0-2), residing in the Lalitpur district for at least 6 months.
Results: Survey results showed that there was a significant reduction in postnatal care utilization among mothers. Fifty-two percent (52%) of mothers received postnatal care, while 83% of the women reported that they did not receive any additional postnatal visit within 6 weeks postpartum. 65% of women said that they were unaware of available postnatal care. Healthcare facilities were found to be accessible, with 87% of the women reporting that the nearest healthcare facility was within 30 minutes of travel.
Discussion: The survey results provide an insight into the needs and gaps in postnatal care utilization in Nepal. The information collected is incorporated into a strategic plan to conduct a postnatal care education program and training initiative of Nepalese health professional students, who will in turn train local community health workers.
Assessment of individual and community needs for health education Planning of health education strategies, interventions, and programs Program planning Public health or related research
Abstract
Defining and Building Success Factors in Innovative Teen Pregnancy Prevention Programs
Daenuka Muraleetharan, MS1, Whitney Garney, PhD, MPH1, Kelly Wilson, PhD, MCHES1, Kristen Garcia, MPH1, Jordan Nelon, MPH1, Christi Hays, MEd, CHES1, Jennifer Farmer, MS, CHES1 and Kenneth McLeroy, Ph.D.
(1)Texas A&M University, College Station, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background: In 2015, the Department of Health and Human Services funded Texas A&M University to create the national Innovative Teen Pregnancy Prevention Programs (iTP3) project to enable innovation in teen pregnancy prevention (TPP) programs. The purpose of this study was to determine what iTP3 program developers define as programmatic success and how that definition transformed after 12 months of program development. methods: Evaluators conducted intake interviews with iTP3 program developers (innovators) to determine indicators of programmatic success. After 12 months, follow-up interviews were conducted to determine if innovators still subscribed to their initial views of success. results: All innovators (n=15) indicated the following as elements of programmatic success: 1) engagement with target populations in program design, 2) partnerships with unique community stakeholders, 3) development of capacity-building tools for target populations, and 4) plan for intervention delivery. Forty percent of innovators (n=6) stated that some elements of success changed after 12 months of program development. These elements include 1) increasing target population input through needs assessments and 2) piloting interventions before delivery. Evaluators will analyze indicators of success in TPP innovation in June 2018 to determine if success indicators transform after another 12 months. conclusions: Findings indicate that innovation in TPP could benefit from utilizing human-centered design approaches, including ideation and iteration, to develop the most relevant and effective programs. To support this process, technical assistance in human-centered design and systems thinking will be provided to build capacity of innovators to engage target populations and prepare for pilot testing.
Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Picture Books as a Parent Education Strategy to Promote Physical Activity in Young Children
Debra Vinci, DrPH, MS, RDN and Christopher K. Wirth, PhD
University of West Florida, Pensacola, FL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Let’s Wiggle with 5-2-1-0 is a public health initiative promoting physical activity in young children as a strategy to prevent childhood obesity in NW Florida. As a part of this initiative, obesity prevention strategies included the “Let’s Wiggle” childcare teacher and parent trainings on the role of physical activity in healthy living. Workshop attendees had opportunities for hands-on engagement throughout the training including practicing movement activities. While the childcare teacher trainings were successfully implemented with > 90% of registered attendees participating in the trainings, parent education trainings had < 50% attendance rate. Contributing factors to this higher no-show rate included parental work demands, carpooling commitments, siblings’ school and activity schedules, sick children, and/or just not having enough time.
Literature review of parent education strategies identified picture books as a potential health promotion approach in targeting parents and caregivers. There is a growing body of research on the role of picture books in children’s life experiences. Picture books enhance language and academic literacy; expand life experiences; promote creativity; explore/regulate emotions; and nurture parent/caregiver interactions.
The purpose of this presentation is to provide the formative research process in developing the picture book, Walker Finds His Wiggle, as a novel approach in parent education to role-model movement and physical activity in young children. The development of the picture book took place over 16 months and consisted of four phases: Phase 1: Researching and Brainstorming; Phase 2: Drafting Storyline; Phase 3: Revising to Improve Stoyline; and Phase 4: Printing and Publishing of Book.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
RCT of a Community Awareness Campaign on Home Visiting Enrollment
Elizbeth Mcfarlane, PhD, MPH
University of Hawaii, Honolulu, HI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Home visiting programs can improve an array of outcomes for mothers and children (Homvee.acf.hhs.gov/). Yet, many mothers offered services do not enroll. Enrollment is a continuum from introduction to the program to completing home-based services intake activities (Damashek, Doughty, Ware, and Silovsky, 2011) and an essential component of service capacity or the number of families a program has agreed to serve. Thus, Hawaii's Home Visiting Awareness Campaign video message to racially and ethnically diverse mothers and their communities is an innovative approach to improve program enrollment rates by enhancing mothers' understanding of home visiting services and the expected benefits of participation for themselves and their children. 1132 women were screened for services with 185 eligible for program services and randomized on a week-on, week-off basis to receive the usual home visiting recruitment or recruitment plus video protocol. A Chi-square test was conducted using IBM SPSS version 24 to examine the relationship between video exposure and enrollment in home visiting. The X2 (1, N = 185) = 2.753, p-value = .097 was not significant at p < .05. Though, the finding are meaningful and significant from a program performance perspective.
Communication and informatics Conduct evaluation related to programs, research, and other areas of practice Provision of health care to the public
Abstract
Firearm ownership and storage practices among families with young children: Family and neighborhood characteristics
Adriana Cimetta, Ph.D., MPH, Christina Cutshaw, Ph.D., Ronald Marx, Ph.D., David Yaden Jr., Ph.D. and Jenna Hollander
University of Arizona, Tucson, AZ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The risk of firearms injury for children in the United States is of great concern in recent years due to the increased number of school shootings and youth suicides. Extending previous research1 exploring family processes associated with firearm ownership and storage, this study examines additional family process variables and includes neighborhood characteristics while controlling for sociodemographic and socioeconomic characteristics of the family. Using a sample drawn from a study to examine early childhood health and educational outcomes in Arizona (n = 4,501), logistic regression models were used to examine family processes associated with (1) firearm ownership among all families and (2) firearm storage among families possessing firearms. Variables examined included: spousal conflict (hitting), food security in the home, previous child injuries, maternal depression, parental engagement, spanking one's child, parental smoking, presence a working smoke detector, opinions of neighborhood safety, and rural/urban setting. Results showed that 27% of Arizona families with children under six own firearms. Among families owning firearms, 27% reported storing those firearms in an unlocked cabinet. Whether guns were typically unloaded when stored is unknown. Results suggest that owning a firearm was related to living in rural settings, spanking one's child, and having a higher income. Storing that firearm in an unlocked cabinet was associated with spousal conflict, maternal depression, and a non-English primary language spoken in the home. The findings of potentially unsafe firearm storage behaviors in the presence of families with some risk factors for poor health outcomes for youth suggest areas for injury prevention.
Public health or related laws, regulations, standards, or guidelines Public health or related public policy Public health or related research Social and behavioral sciences