Newborns, infants and toddlers thrive.

This report on health status in North Hawaii is organized into a life course framework in order to encourage conversations, analysis and collaboration around life stages. This life course framework sets the stage for collaboration by identifying health trends, as well as existing resources and gaps.  A life course framework for measurement and improvement has been used effectively by Vermont, which has moved from a healthy state ranking of 15th in 1992 to a healthy state ranking of number one (best) in 2002 and 2003, 2005 and 2006.

Prenatal Care of pregnant women in the first three months of pregnancy is highly correlated with better outcomes and is a reflection of access to care as well as awareness.

This graph shows that the percentage of pregnant women receiving first trimester care in North Hawaii increased from 80% in 2000 to 83% in 2005, which is slightly higher than the State rate. On the other hand, there is still significant room for improvement toward the 90% Healthy People 2010 goal.  The Center for Disease Control and Prevention has recently come out with recommendations for earlier preconception care.  See http://www.cdc.gov/ncbddd/preconception/default.htm

Infant mortality is defined by an infant’s death within the first year after birth.  In general, infant mortality is linked with socioeconomic indicators.  Because it is a relatively rare occurrence, rates vary more in smaller populations.

Malama a Ho‘opili Pono, which is a federally funded grant to reduce infant mortality, was implemented in Hawaii County in 2000.

Between 2000 and 2004, the rate of low birth weight babies in North Hawaii was slightly higher than the County and State, and did improve in 2005.   There is need for further improvement in North Hawaii, Hawaii County and the State to meet the Healthy People 2010 goal of < 5%.  There is a higher percent of low birth weight babies in teen births, births to women older than 40 years old and with maternal chronic infections such as dental infections.  Low birth weight rates are also higher with cigarette, alcohol and illegal drug use during pregnancy.

Implication

Low birth weight babies often require prolonged hospital stays, are expensive and are frequently associated with developmental delays, including lower rates of graduating from high school.  The need for collaboration to improve is clear, including improving maternal access to dental care in Hawaii County.

Testing for Drugs

At this time, there is no available public data at the County or Sub-county level on how many infants are born testing positive for drugs, especially for ice (crystal methamphetamine).

Implication

As State and Federal monies are mobilized to reduce substance abuse, obtaining credible data in this area is clearly a priority to monitor progress.

Teen births are a concern because children born to teens have a higher probability of living in poverty, a higher risk for abuse or neglect, and both mother and child are at a higher risk for low educational attainment.

In 2000, the North Hawaii Community Forum identified high teen pregnancy as one of the top six priorities for community health improvement.  A broad group of stakeholders met in 2001 to address this issue.  A North Hawaii non-profit, North Hawaii Women and Children’s Services, developed an evidence-based teen pregnancy prevention curriculum which was integrated into several North Hawaii schools. The chart to the right reflects a clear downward trend of births to teens since 2000.

While a complete list of evidence-based strategies is beyond the scope of our work, such a list would be helpful. The following list of local resources is only a start.  

• Kahua Project, Teen Pregnancy Prevention, at Hamakua Health Center  (808) -775-9133
• CDC Life Skill Curriculum Teen Pregnancy Prevention
• Family Support Services of West Hawaii –

(808) 326-7778

• Healthy Start – Gwen Kamakani – (808) 733-4184
• BISAC – Substance Abuse Treatment Program for mothers -Hale Ho‘opulapula O Na Wahine Therapeutic Living Program – (808) 969-9952

A review of existing programs and the Center for Disease Control prevention guide suggests these additional recommended strategies.

• The CDC Guide to Community Preventive Services is available at www.thecommunity.org.
• Increase screening pregnant women for: - Dental infections (a risk for premature labor), and - Alcohol, cigarettes, substance abuse and risk for depression.
• Increase screening adolescent women for:
• -Diabetes, -Smoking, -Obesity, -Sexually transmitted diseases, and -Depression and risk for depression.
• Increase access to prenatal care.
• Increase support for young mothers.
• Link with the national campaign to prevent teen pregnancy.
• Reduce teen pregnancies.
• Increase access to Center for Disease Control’s Life skills curriculum. Increase access to family planning.
• Increase access to dental care for pregnant women.