program for young parents

Hospital del Sur in 1911Southern Islands Hospital in 1913Southern Islands Medical Center in 1984

HVMADAMBA 2015 DOH 2ND NATIONAL STAFF MEETING

VISION

A safe and globally competitive center

in health service, training and

research.

MISSION

As a collaborating center of excellence, VSMMC commits to :

• Provide quality health care services to all clients

• Serve as a training center for medical , allied medical and related hospital support services;

• Conduct significant , relevant, quality research to improve health care delivery system;

• Sustain an environment that promotes self reliance and fiscal autonomy

SERVICE TRAINING

RESEARCHHVMADAMBA 2015 DOH 2ND NATIONAL STAFF MEETING

Accredited as a Mother-Baby Friendly Hospital by DOH-UNICEF

on June 25, 1992

Department of Obstetrics and GynecologyTRAINING PROGRAMS

Aim: to reduce maternal and child mortality

Situationer on Teenage Pregnancy

Navarro J 2012. A Retrospective Study on the

Maternal and Fetal Outcome of Teenage Pregnancy in Vicente

Sotto Memorial Medical Center (January 2011-December 2011)

Teenage Pregnancies in 2011

Navarro 2012

Deliveries No. of cases Percent

Deliveries ≥ 20 yo 5139 88% Teenage Pregnancy 698 12% Total 5837 100%

Navarro 2012.

Include 19yo pregnant patients: • 66% are ≤ 18 yo• 33% are 19 yo

Age (years) No. of Cases Percent

15 37 5% 16 79 11% 17 135 19% 18 214 31% 19 233 33%

total 698 100%

Navarro 2012

The main high risk complication is preterm labor (18%) and severe preeclampsia, occurring in 6% of teenage pregnancies.

Type of Hypertension Total No. of Cases Percent

Teenage Pregnancy Percent p-value

Antepartum Eclampsia: 121 2% 19 3% Severe Preeclampsia: 979 19% 42 6% Gestational hypertension: 284 6% 31 4% Mild preeclampsia: 654 13% 26 4% 0.000

Fetal Outcome Preterm: 702 14% 129 18% Fullterm: 4421 86% 561 80% Posterm: 16 0% 8 1% 0.000

PROGRAM FOR YOUNG PARENTS

VICENTE SOTTO MEMORIAL MEDICAL CENTER

PROPONENTS• Hospital Executive Committee• Department of Pediatrics• Department of Obstetrics and Gynecology• Women and Child Protection Center• Nursing Services• Department of Internal Medicine• HACT (HIV and AIDS Core Team)• Department of Mental Health Services and Behavioural

Sciences• Hospital Training Division• Medical Social Services• Support Services (Dietary Section, Dental Services

Pharmacy, Security etc.)• Peer support groups

PROGRAM FOR YOUNG PARENTSPlanning Workshop for the PYP Feb 1, 2014 at Be Resort, Mactan

INAUGURATION OF THE PYP CLINIC

March 4, 2014 at the Outpatient Department, VSMMC

VICENTE SOTTO MEMORIAL MEDICAL CENTER

HELEN V. MADAMBA MD MPH-TM

1. Gateway service2. Obstetric Evaluation and Care3. Adolescent Health Assessment4. Psychosocial Evaluation5. Health Classes6. Delivery at VSMMC7. Post-natal Check-up & Family Planning Services8. Gateway Service9. Adolescent Health Care10. Pediatric Care11. Parenting Classes12. Personal Advancement and Development13. Peer/Breastfeeding Support Group Sessions14. Endorsement to Appropriate Services for Preventive &

Promotive Care

GENERAL OBJECTIVE

to provide comprehensive “one-stop shop” care to the

pregnant adolescent, her partner, and infant

SPECIFIC OBJECTIVES

1. Provide comprehensive pre-natal, intra-partum (EINC) and post-natal care including immunization to the pregnant adolescent

2. Provide ENC and post natal care, including immunization to the baby

3. Promote exclusive breastfeeding up to 6 months and continue breastfeeding up to 3 years

4. Reduce pregnancy among women 19 years old and below

SPECIFIC OBJECTIVES

5. Increase FP acceptance to prevent subsequent unplanned pregnancies

6. Promote active participation of patients’ support group (i.e. husbands/ partners/ significant others/ peers) during pregnancy, care of the newborn and children and family planning

7. Prevent STIs and HIV among pregnant adolescents

Vicente sotto memorial medical center

SERVICE

RESEARCHTRAINING

COMPONENTS

SERVICE1. Medical

a. Obstetrical Care/Adolescent Healthb. Medical/ Pediatrics Carec. Nutritional Support

SERVICE2. Psychosocial

a. Counselingb. Social Servicesc. Women and Child Protectiond. Peer-support Group (Breast is Best

Brigade (BIBB), The Share a Child Movement, others to be identified)

SERVICE3. Health and Parenting

Education4. Personal Advancement (i.e.

Self-sufficiency Education, Vocational, Income Generation, Higher Education)

SERVICE5. Referral Services and

Networking (i.e. Legal, Police, Social Services LGUs, Spiritual)

PYP PROTOCOL

Step 1: Gateway service

• Triage at PHN at OPD• Referred from admitted patients• Referred from or refer to WCPC• Identify pregnant patients ≤ 20

yo• Enrollment to the PYP clinic

61% of ER admissions aged <20 yo due to

abortions

Age in years

Step 2: Obstetric

Evaluation and Care

Step 2: Obstetric

Evaluation and Care• PYP clinic on Wednesdays

Patients <20 year old Seen at the

PYP Prenatal Clinic from October 2014 - April2015

Month Prenatal ≥20yo

PYP <20yo %

October 2014 710 64 9.01

November 2014 623 41 6.58

December 2014 408 33 8.09

January 2015 454 30 6.61

February 2015 476 47 9.87

March 2015 563 39 6.93

April 2015 1094 38 3.47

TOTAL 4,328 292 6.75

Step 3: Adolescent Health Assessment

Step 4: Psychosocial Evaluation

Step 5: Health Classes

Attendance to “Usapan” Sessions

1. Danger Signs of Pregnancy

2. Birth Planning and Philhealth

3. Family Planning4. Breastfeeding before

delivery5. Breastfeeding after

delivery – return demonstration

Step 6: Delivery at

15.7% of all babies delivered to pregnant

teenagers in 2014 were preterm

Antenatal Corticosteroid Use for all pregnant patients at risk

for preterm birth

o Preterm laboro Preterm pre-labor

rupture of membranes o Severe preeclampsiao Antepartum hemorrhage

UNDELIVERED PATIENTS

3.6% of all pregnant teenagers admitted in 2014 required perinatal specialist care for control of high risk conditions:

• preterm labor• antepartum haemorrhage• elevated blood pressure• elevated blood sugar

Intensive Maternal Unit

•10-bed capacity• focused management of high risk pregnancies supervised by perinatalogist

• dedicated nursing staff• fetal monitoring equipment

Age Distribution of Pregnant Teenagers at VSMMC in 2014

• Out of 1,888 teenage pregnant patients admitted in 2014, 35% were 19 years old and 65% were 13-18 years old.

• There is an increasing frequency of teenage pregnancies with increasing age. Age in years

17.5% of pregnant teenagers were delivered by cesarean

section

Step 7: Post-natal Check-up

& Family Planning Services

• 1st visit: first Wednesday after discharge follow up at PYP clinic

• 2nd visit: 4 weeks postpartum• 3rd visit: 6 weeks postpartum

Subsequent visits• Every month for 6 months• Every 2 months for 6 months• Every 3 months for the 2nd year

Patients <20 year old Seen at the

PYP Postnatal Clinic from October 2014 - April2015

Month Postnatal ≥ 20yo

PYP <20 yo %

October 2014 131 2 1.53

November 2014 124 2 1.61

December 2014 103 7 6.80

January 2015 148 6 4.05

February 2015 109 13 11.9

March 2015 116 10 8.62

April 2015 85 11 12.94

TOTAL 816 41 5.02

Acceptance of Family Planning

• Counselling Tracking Family Planning Method

# patients

Patients <20 yoIUD 15Pills 6Implant 9Total patients counselled in 2014

Step 8: Gateway Service

Step 9: Adolescent Health Care

Step 10: Pediatric Care

Kangaroo Mother Care Month #Patients #Discharged #Follow up

Sept 2014 19 23 19

Oct 2014 66 38 66

Nov 2014 45 24 45

Dec 2014 51 27 51Jan 2015 32 23 32

Feb 2015 63 17 63

Mar 2015 66 23 66

Apr 2015 50 21 50

May 2015 48 17 48

Pediatric Follow up Statistics

Feb 2015 March 2015

April 2015 May 2015

Prenatal 15 13 16 24

Prenatal consult for the pregnant teenagers

Postnatal consult for the newborn Most referred to LGUs

Step 11: Parenting Classes

Step 12: Personal

Advancement and

Development

Step 13: Peer/Breastfeed

ing Support Group Sessions

Initiation of Breastfeeding

• EINC core steps ensure successful breastfeeding.

• All postpartum patients are offered breastfeeding.

• Formula feeding is not allowed in the hospital.

Breastfeeding Support Group

Breast is Best Brigade

Step 14: Endorsement

to Appropriate Services for Preventive &

Promotive Care

TRAINING OBJECTIVES

1. To enhance the skills of hospital staff and residents in dealing with health issues of young parents, in management of pregnant adolescents, and in responding to their reproductive health needs

TRAINING OBJECTIVES

2. To develop skills of service providers, specifically the nurses, midwives and social workers in the conduct of health education

TRAINING Dealing with Adolescent Patients Gender Adolescent Friendly Health Facility and Adolescent Job Aid

Promoting Male Partners Participation Interpersonal Communication e.g. Increasing Spousal Communication

Conduct of Usapan Refresher Training for Breastfeeding Support Group

Essential Intrapartum Newborn Care

Gender Orientation on May 3, 2014 at the Crown Regency Hotel

Workshop on Adolescent Job Aid ManualAugust 7, 2014 at Quest Hotel

RESEARCH PROJECTS

• To encourage research on issues related to adolescent health such as teenage pregnancy

RESEARCH PROJECTS

• Helen Madamba. Association of Human Immunodeficiency Virus (HIV) Knowledge, Testing Attitudes and Perception of Teenage Pregnant Patients with the Uptake of HIV Counselling and Testing and Prevalence of HIV Infection Among Teenage Pregnant Patients in Selected Government Hospitals and Barangay Health Centers in Central Visayas, Philippines

RESEARCH PROJECTS

• Helen Madamba. Registry of teenage postpartum patients and the Impact of the two-year program for young parents (PYP) at Vicente Sotto Memorial Medical Center

RESEARCH PROJECTS

• Carolyn Tabaloc. Comparison of Abstinence Counseling against Conventional Family Planning Methods on the Teenage Mothers in Vicente Sotto Memorial Medical Center.

• Carolyn Tabaloc. Predictors of teenage pregnancy: a case control study.

RESEARCH PROJECTS

• Princess Lorezo. Clinical Profile of Teenage Pregnancies in Vicente Sotto Memorial Medical Center from 2005-2014.

• Christine Rose Nonan. Incidence of Dexamethasone Use among Patients at Risk of Preterm Birth from January 2014 to December 2014.

RESEARCH PROJECTS

• Gladys Hojas. Knowledge and attitudes on family planning among teenage mothers seen at Vicente Sotto Memorial Medical Center

RESEARCH PROJECTS

• Virdel Marie Senica-Isidro. A review of factors related to the pregnant teenagers in Sambag II from January to September 2014.

CHALLENGES ENCOUNTERED

o no dedicated social worker and psychologist to focus on teenage patients

o teenage pregnant patients who deliver at VSMMC are referred from distant municipalities, hence poor follow up postpartum

o strengthen referral system with LGUs for follow up of mother and baby postpartum

FUTURE DIRECTIONS

• USE OF SOCIAL MEDIA FOR CREATION OF SUPPORT GROUPS FOR YOUNG PARENTS

• COMPUTERIZED REGISTRY• MONTHLY AND QUARTERLY ASSEMBLIES• DEDICATED SOCIAL WORKER FOR PYP• RESEARCH FUNDING GRANTS

FUTURE DIRECTIONS

• Skills Training at TESDA• Alternate Learning System by

DepEd• Job Opportunity at DSWD

PROGRAM FOR YOUNG

PARENTSVICENTE SOTTO MEMORIAL MEDICAL CENTER

AKO PARA SA BATA CONFERENCECyber Safety of Children: Internet and Mobile Protection for Minors

December 1-2, 2015Marco Polo Plaza Hotel, Cebu

program for young parents

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