Cluster Evaluation on Teenage Pregnancy Management in Hong Kong

Abstract

INTRODUCTION: The Comprehensive Child Development Service (CCDS), a community-based early childhood intervention program aiming to improve child health and targeting high-risk families, was implemented step-by-step in different districts of Hong Kong after the 2005 policy address. Pregnant teenage ladies aged below 18 were one of the targeted risk groups under the program which provided antenatal and child care by collaboration of the Departments of Obstetrics, Paediatrics and Maternity and Child Health Centers. The New Territories West cluster was one of the first pilot clusters for the CCDS program provided by Tuen Mun Hospital from 2006. This service was extended to the New Territories East cluster in March 2012. AIM: The aim of this evaluation is to compare child health problems among the intervention cluster (NTW) and control cluster (NTE) over the following 2 periods: (1) the period without a CCDS program in 2001 to 2005 and (2) the period with the CCDS program implemented in 2007 to 2011 in NTW. Method: Data was retrieved by the Clinical Data Analysis Report System (CDARS). Results: There were 146 and 167 of births from teenage in NTW in these 2 periods respectively, whereas, 129 and 104 in NTE. No significant difference was found in all demographic parameters of birth weight, gender ratio, gestational age, mode of delivery or requirement of NICU admission in these two periods in both intra or inter-cluster comparisons. There was a significant increase in the number of Accident and Emergency unit (A & E) attendance of children aged below 2 years with teenage mothers in NTW, changing from 48.5% to 73.3% respectively, before and after the implementation of the CCDS program (p<0.0009). However, this trend increase was not noted in the control cluster (NTE). The median number of A & E admissions rose from zero to three times in the intervention cluster (NTW) after the CCDS program was implemented (p<0.0035). But there was no positive associated increase in hospital admission in the same periods, which indicates that the medical consultations were not for urgent or serious conditions (p=0.14). After the implementation of the CCDS program in NTW, 99% of children aged under 2 years with teenage mothers were followed under the CCDS Paediatrician (p<0.001). The median number of attendance rose from zero to three times in NTW during the 2 periods. (p<0.001) In contrast, the control cluster showed a significant decrease in the number of A & E attendances which fell from 73.9% to 45% (p=0.001). Moreover, in this control cluster the median attendance number of outpatient consultations dropped from two to zero over these periods. Longer follow up for analysing details of admissions, death rate or child abuse rate are required. CONCLUSION: A comprehensive inter-departmental and well planned program providing antenatal and child care was successfully reaching nearly all targeted teenage mothers. The increase in A & E attendance after the commencement of the CCDS program may indicate the satisfactory engagement and rapport among the Paediatrician and the families, and the enhancement in the early recognition of subtle symptoms. Moreover, this group of teenage mothers under the CCDS program was more ready to seek public medical services. We would like to suggest for long term follow up for details of adverse outcomes.