Maternal Child Health Services Contract Work Plan FFY 2015-2017

LPHA Contractor: Audrain County Health Department

Selected Priority Health Issue: Prevent and reduce adverse birth outcomes

Statement of the Problem: According to the Infant Health Profile from MODHSS, 2005-2009, Audrain County has a high rate of neural tube defects, 25.6/10,000 births, with the State of Missouri’s rate being 6.28/10,000 births. That puts Audrain County significantly higher than the state rate.

The CDC’s Data and Statistics states national estimates in 2004 – 2006: anencephaly as 1 in 4859 births, spina bifida without anencephaly as 1 in 2858 births, and encephalocele as 1 in 12235 births. Compared with infants of non-Hispanic white mothers, infants of Hispanic mothers had a higher birth prevalence of anencephaly, spina bifida, and encephalocele.

Folic acid is a B vitamin that, if taken before and during early pregnancy, can help prevent neural tube defects, which are major birth defects of the baby’s brain and spine. Neural tube closure is completed 28 days (four weeks) from conception, and the preventive effect of folic acid is not effective after that period. Moreover, highest serum folate levels require at least three weeks of treatment with folic acid. That is why folate supplementation should start at least one month before conception and continue until at least two months after conception. (According to the Journal of Prenatal Medicine, 2008, Oct-Dec)

In 1991, the CDC recommended that women with a history of a prior neural tube defect (NTD) affected pregnancy should consume 4000 mcg of folic acid daily starting at the time they begin planning a pregnancy. Subsequently, in 1992, the U.S. Public Health Service recommended that all women of childbearing age consume 400 mcg of folic acid daily through fortification, supplementation, and diet to prevent NTD’s. In 1996, the United States Food and Drug Administration (FDA) mandated that by January 1, 1998 all grain products labeled as ‘enriched’, such as bread, cereals, and rice have folic acid added to them to help reduce the risk of neural tube defects. This is known as folic acid fortification. After folic acid fortification was started, there was a 36% decrease in the prevalence of spina bifida and a 17% decrease in the prevalence of anencephaly. In 1998, the Institute of Medicine recommended that women capable of becoming pregnant should consume 400 mcg of folic acid daily from fortified foods or supplements, or both, in addition to that obtained through a normal diet. In 2009, the U.S. Preventive Services Task Force published updated guidelines that reinforced these recommendations.

According to a 2007 Survey done by the CDC among all women of childbearing age: 40% reported taking folic acid daily, 81% reported awareness of folic acid and 12% reported knowing that folic acid should be taken before pregnancy. Women of childbearing age who were aware of folic acid reported hearing about it from: health care providers (33%), magazine or newspaper (31%), radio or television (23%). Women aged 18-24 years were more likely to hear about folic acid from a magazine or newspaper (25%) or school or college (22%) than from their health care provider (17%). Whereas 37% of women aged 25-34 years and 36% of women 35-45 years reported hearing about folic acid from their health care provider. Among women who reported not taking a vitamin or mineral supplement on a daily basis, the most common reasons were: forgetting (33%), no need (18%), no reason (14%), already get balanced nutrition (12%).

Goal(s): Improve the knowledge and attitudes and behaviors of men and women related to preconception health.

Strategies: Implement health promotion and education efforts to improve birth outcomes by supporting folic acid campaigns to target preconception and interconception women about the importance of folic acid to reduce the occurrence of neural tube defects.

Instructions: Develop a three-year work plan for actions in each level of the Spectrum of Prevention for each contract period year that progress toward the planned System Outcomes, giving consideration to the Life Course Framework and issues in Risk and Protective Factors (see MCH Services Contract Proposal Guidance).

Spectrum of Prevention / Activities / System Outcomes by Sept. 30, 2017
Influence Policy and Legislation
Develop strategies to change laws and policies to influence outcomes in health, education, and justice / FFY 2015: Research and develop policies for Audrain County Health Department programs. / The Audrain county Health Department has a policy that for integrating preconception health education into existing programs as evidenced by other ACHD standing programs.
FFY 2016: Implement policies at Audrain County Health Department into applicable programs.
FFY 2017: Brief BOH and local policy makers on outcomes.
Change Organizational Practices
Adopt regulations and norms to improve health and safety and creating new models / FFY 2015: Research and develop policies for Audrain County Health Department programs. / Number of ACHD clients receiving preconception/
interconception health education on folic acid has increased as evidenced by health department documentation.
FFY 2016: Implement policies at Audrain County Health Department into applicable programs.
FFY 2017: Brief BOH and local policy makers on outcomes.
Foster Coalitions and Networks
Bring together groups and individuals for broader goals and greater impact / FFY 2015: Share data on adverse birth outcomes with coalition members. / The coalition (HSC) has engaged in a Folic acid media campaign as evidenced by health department documentation.
FFY 2016:
Identify possible media campaigns.
FFY 2017: Implement media campaign plans.
Educate Providers
Inform influential organizations and leaders to transmit skills and knowledge to others / FFY 2015: Research and develop information specific for providers. / The number of providers that receive information and tools related to preconception/interconception health education has increased evidenced by health department documentation.
FFY 2016: Provide information and literature to nurses in the physician offices, FQHC, and SSM Audrain
FFY 2017: Provide information and literature to nurses in the schools and school counselors.
Promote Community Education
Reach groups of people with information and resources to promote health and safety / FFY 2015: Research and assess what information is available in Audrain County and to Audrain County residents. / The coalition (HSC) has engaged in a Folic acid media campaign as evidenced by health department documentation.
FFY 2016: Get information out to the community through newspaper articles and ads, social media like Facebook, mass e-mails, and presentations at clubs and organizations in Audrain County, etc.
FFY 2017: Continue education and expand coverage with updated information, through social media.
Strengthen Individual Knowledge and Skills
Enhance an individual’s capability for health and safety / FFY 2015: Develop a survey and present to ACHD clients, especially clients who come for WIC, STD testing, Love & Logic Parenting Classes, and pregnancy testing. / The number of ACHD clients who receive folic acid education has increased as evidenced by ACHD documentation.
FFY 2016: Educate through Love & Logic, WIC Breastfeeding Peer Counselors, WIC, STD testing, and pregnancy tests by providing handouts and one on one education.
FFY 2017: Continue education and perform a follow-up survey of ACHD clients, especially clients of WIC, Love & Logic Parenting Classes.

Revision Date:

(to be completed only for an amendment)