MOHAVE COUNTY DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT FISCAL YEAR 2007 - 2008 TABLE OF CONTENTS LETTER FROM THE DIRECTOR Page 1 BOARD MEMBERS Page 2 MOHAVE COUNTY PROFILE Page 3 OFFICE LOCATIONS Page 4 DEPARTMENT ORGANIZATION Page 5 FINANCIAL INFORMATION Page 6 SUMMARY OF DIVISION PROGRAMS A. ENVIRONMENTAL HEALTH Page 7 - 10 B. NUTRITION AND HEALTH PROMOTION Page 11 - 12 C. PUBLIC HEALTH NURSING Page 13 - 18 D. SENIOR PROGRAMS Page 19 - 20 E. BIO TERRORISM & EMERGENCY RESPONSE Page 21 PATTERNS IN HEALTH, MORBIDITY & MORTALITY Page 22 - 26 Director’s Message: Working in Public Health is always a challenge. This past year we have faced decreased funding (seems to be a regular challenge!) and increased workload, working with our local partners on the National Public Health Performance Standards Assessment, and continuing to prepare our workforce to respond to an all-hazards approach to emergency preparedness. The citizens of Mohave County have an exceptional team here working on their behalf to assure them that they have a safe and healthy community in which to live. We recognize the importance of working with our local partners and we are dedicated to making a difference and assuring our citizens that they can “count on us”. Patty Mead Health Director Mission Statement The mission of the Mohave County Department of Public Health is: To create a safe and healthy community. 1 BOARD MEMBERS BOARD OF SUPERVISORS Pete Byers, Chairman District 1 Tom Sockwell, Member District 2 Buster Johnson, Member District 3 COUNTY MANAGER Ron Walker BOARD OF HEALTH 2007 - 2008 Pete Byers Chairman Steve Greely Vice-Chairman Margaret Nyberg Member Janet Watson Member Doug Haslan Member Vacant Member Vacant Member Phil Moon Member Dr. Lehi Barlow Physician Member HEALTH DIRECTOR Patty Mead, R.N., M.S. 2 MOHAVE COUNTY PROFILE Mohave County is geographically the second largest county in the state and has a population just over 200,000. Most of it is classified as desert, but of its 13,479 square miles, 186 square miles are water. The county has over 1,000 miles of shoreline and is a great water sports center with the Colorado River and Lake Mohave, Lake Havasu, and Lake Mead. Mohave County is situated in northwestern Arizona and is bordered by the states of Utah, Nevada and California and the counties of La Paz, Coconino and Yavapai. Mohave County has four incorporated cities: Bullhead City, Lake Havasu City, Colorado City, and Kingman (the County seat). The Mohave County Department of Public Health offices are located in Kingman, Bullhead and Lake Havasu with a senior nutrition site in Golden Shores and Nursing staff in Colorado City. July 1, 2007 Population Figures (from Arizona Dept of Commerce Estimates) Bullhead City Colorado City Kingman Lake Havasu City Unincorporated Total 41,000 4,053 28,635 55,263 75,171 204,122 2007 Age Distribution (from Arizona Vital Statistics) Age <1-14 15-19 20-44 45-64 65+ TOTAL Population 37,008 11,776 59,594 51,771 41,544 201,693 Percent of total 18.35% 5.84% 29.54% 25.67% 20.60% 100% 2007 Population Composition (from Arizona Vital Statistics) Race White Non-Hispanic Hispanic or Latino African American American Indian or Alaska Native Asian or Pacific Islander Population 165,988 25,259 2,579 Percent of total 82.29% 12.53% 1.28% 5,192 2,675 2.57% 1.33% 3 DISTRICT OFFICES Kingman Lake Havasu City 700 West Beale Street P.O. Box 7000 Kingman, AZ 86402-7000 2001 College Drive Box 9, Suite 115 Lake Havasu City, AZ 86403-1953 Bullhead City 1222 Hancock Rd Bullhead City, AZ 86442-5940 1230 Hancock Rd Bullhead City, AZ 86442 SATELLITE LOCATIONS Golden Shores Senior Nutrition Site Colorado City Clinic ‘ › 4 DEPARTMENT ORGANIZATION The Mohave County Department of Public Health is administered through six divisions including Administration, Bioterrorism Defense and Emergency Response, Public Health Nursing, Environmental Health, Senior Programs, and Nutrition & Health Promotion. Each division (except Administration and BT Defense) has program sites in each of the County’s major cities. The Department Director is responsible for the oversight of the department programs. The division managers are responsible for the implementation, management and operation of the programs in their division. DIRECTOR Patty Mead ASSISTANT DIRECTOR Jennifer McNally SECRETARY SENIOR Krista Gunnoe Account Specialist – 2 Office Specialist – 1 Office Assistant – 1 frozen Office Clerk - .5 frozen NURSING SERVICES MANAGER Christy Bronston SENIOR PROGRAMS MANAGER Brad Bixler Nursing Supervisor – 2 Nurse Midwife – 1 Office Assistant – 3 Public Health Specialist – 8 Public Health Nurse, RN – 8.5 Paraprofessional Temp – 2 Community Health Educators – 1 Site Supervisor – 3 Site Coordinator – 1 Senior Programs Assistant – 5 Cook - 3 Prep Cook-3 Labor/Trades Temp 9 ENVIRONMENTAL HEALTH MANAGER Rachel Patterson NUTRITION/HEALTH PROMOTION MGR. Carol Matthews Environmental Health Supervisor – 2 Office Supervisor - 1 Environmental Health Specialist I/II –10 Environmental Health Technician – 3 Environmental Health Tech P/T - 2 Permit Technicians – 7 Paraprofessional Temp – 2 Community Nutrition Specialist Sr – 2 Community Nutrition Specialist II – 2 Community Nutrition Specialist I – 1 Community Health Education Spec. I - 5 Community Health Education Spec. II.-I WIC Eligibility Worker – 10 Office Specialist - 1 Office Assistant Senior– 1 Part Time WIC Breast Feeding Peer Counselor - 2 BIOTERRORISM & EMERGENCY RESPONSE COORDINATOR Bruce Leeming Epidemiologist – 1 Volunteer Coordinator - 1 5 FINANCIAL INFORMATION July 1, 2007 – June 30, 2008 (from Mohave County Financial Services Year to Date Expenditure Report and Adopted Budget Report, August 2008) Revenues Federal Grants AHCCCS Reimbursement Fees from Services State Grants & Contracts County General Funds Miscellaneous & Donations $2,440,946 153,436 1,450,284 1,030,116 1,685,743 355,056 Total Revenues Expenditures Personnel Services Operating Supplies Other Charges/Services Capital Outlay $7,115,581 $5,330,268 810,880 1,647,613 33,372 Total Expenditures $7,822,133 Expenditures exceeded revenues due to expenditure of carry over funds and actual transfers from general fund at an amount less than budgeted. Fiscal Year 2007/2008 Funding Sources Miscellaneous & Donations 5% Federal Funding 35% General Fund 24% State Funding 14% Fees 20% 6 Evercare 2% DIVISION SUMMARIES ENVIRONMENTAL HEALTH The Environmental Health Division (EHD) is responsible for inspection of public places, enforcing various environmental laws and response to public nuisances. In addition, EHD is involved in the Mohave County Department of Public Health’s (MCDPH) Emergency Response Team. EHD receives authority through delegation agreements with the Arizona Department of Environmental Quality (ADEQ) and the Arizona Department of Health Services (ADHS). EHD has approximately 14 areas of responsibility including; food safety, public & semi-public swimming pools, RV parks, hotels/motels, pet shops, grooming parlors and kennels, septic pumper trucks, refuse haulers, onsite wastewater, public nuisance complaints, wells, Smokefree Arizona, school buildings, and campgrounds/children’s camps. As part of the food safety program, EHD offers food handler education. This fiscal year was the first complete year that the EHD implemented the Smokefree Arizona program. EHD responded to approximately 188 complaints, conducted 199 investigations of complaints including follow up visits to establishments, and wrote 10 Notices of Violations to businesses in Mohave County. EHD took one case to court and was awarded $1900 in civil penalties. In addition, an EHD staff member was assigned full-time to the Smokefree program this year. At the end of fiscal year 06/07, EHD was working on a new ordinance that revised and strengthened regulations on pet grooming shops and kennels. The ordinance was unanimously approved by the Board of Supervisors in October of 2007. Since then, EHD has signed intergovernmental agreements with both Lake Havasu City and Bullhead City for implementation of this program within the city limits. EHD expects to complete an IGA with the City of Kingman in the coming year. The fee schedule for EHD was revised for fiscal year 08/09 with an approximate 15% increase for most fees. The increase was required to cover increased personnel related expenses as well as increases for internal services and overhead. At the public hearing there were no objections and the fee schedule passed unanimously. During fiscal year 07/08, on-site wastewater (septic) permits continued to drastically drop in number. EHD issued 1,255 permits (compared with 2,156 last year) and performed 2,916 inspections. Due to the decrease in permit volume, 2.5 positions in this program were frozen. Our food safety program has stayed fairly consistent. This year 3,654 food handler cards were issued, representing a decline of only 17 over last year’s numbers. EHD received 739 public health nuisance complaints and conducted 1664 responses to these complaints. The complaints included nuisances associated with standing water, animal manure, trash/refuse, ground-feeding of pigeons and open sewage. Statute requires counties to respond to public health nuisance complaints but there is no funding associated with the requirement. 2,982 inspections of annually permitted establishments were made over the past year (compared with 2,048 in FY07) by EHD including: food establishments, RV parks, pet and grooming shops, hotel/motels, swimming pools, and septic and garbage haulers. EHD was able to make considerable improvements this past year in the number of inspections conducted as well as the timing of inspections as this program is now at full staffing levels. 7 SELECTED STATISTICS BY CATEGORY Food Service FY 06/07 FY 07/08 Temporary Permits 258 257 Annual Permits 1175 1233 Annual Inspections 1189 2090 Food Handler Cards 3671 3654 On-Site Wastewater Permits Issued 2156 1255 Inspections 2536 1209 Pools/Spas Permits 257 272 Inspections 273 496 Kennels/Grooming Permits 40 53 Inspections 36 58 Hotel & Motel Permits 86 89 Inspections 99 94 Trailer Parks Permits 98 100 Inspections 92 122 Campgrounds/Children’s Camps Permits NA 3 Inspections NA 3 School Buildings Permits NA 53 Inspections NA 75 Nuisance Complaints Number Received – land use 627 739 Inspections – land use 1059 1664 Number Received – annually 251 289 permitted establishments Wells (recommendation of approvals given to ADWR) Notice of Intent approvals 165 144 Smokefree Arizona Complaints NA 188 Inspections NA 199 8 Food Service FY 04/05 FY 05/06 FY 06/07 temporary permits annual permits 2090 1940 1882 1189 1233 1156 1164 1175 257 FY 07/08 231 226 258 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0 annual inspections On-Site Wastewater 3000 2500 FY 04/05 2000 FY 05/06 FY 06/07 1500 FY 07/08 permits issued 1209 2536 2967 3243 1255 2156 0 2903 500 2794 1000 inspections 9 Nuisance Complaints FY 04/05 FY 05/06 FY 06/07 number received - land use inspections land use 251 289 1984 1340 1059 1664 FY 07/08 1162 654 627 739 2000 1800 1600 1400 1200 1000 800 600 400 200 0 number received annual estab Inspection Percentage by Category Food Service Annual 27.08% On-Site Wastew ater 37.79% Kennels/Grooming, 0.75% Hotel & Motel, 1.22% Smokefree Arizona, 2.58% Nuisance Complaints - Land Use 21.56% Pools/Spas, 6.43% Trailer Parks, 1.58% Campgrounds Children's Camps, 0.04% School Buildings, 0.97% 10 NUTRITION AND HEALTH PROMOTION The Nutrition and Health Promotion Division works to promote healthy lifestyle choices through a variety of food assistance programs, tobacco use prevention and cessation programs, nutrition education, and physical activity programs. WIC, the Special Supplemental Food Program for Women, Infants, and Children contracts to serve 5300 participants per month in Mohave County. More than 55% of babies born in Mohave County are born to WIC mothers. About half of Mohave County infants and twenty five percent of children to age five are served by WIC. WIC is a supplemental food assistance program for pregnant, breastfeeding, and postpartum women, infants, and children to age 5. Income eligibility is met by families and clients enrolled in Food Stamp and AHCCCS or at 185% of poverty. The WIC program also provides individual nutrition education care plans and referrals to health and social services. The Mohave County WIC program continues to provide online nutrition education. Internet classes can be accessed by WIC clients anywhere they have access to a computer and the internet. About 40% of WIC clients now take classes at a location other than our clinics thereby reducing their appointment time by 10 to 15 minutes per visit and greatly improving clinic efficiency. We were notified during FY 07/08 that our funding for the next fiscal year would be reduced. In order to operate with the funding amount provided, we had to close the Littlefield WIC clinic. WIC Breast Feeding Peer Counseling Program Mohave County WIC was awarded a grant to initiate a breast feeding peer counseling program for WIC clients in Lake Havasu City, Kingman, Bullhead City, and Littlefield. Breast feeding rates have traditionally been low in Mohave County and we would like to move closer to the Healthy People 2010 goals of 75% of women breastfeeding their babies at birth , 50% of women breastfeeding their babies at 6 months of age and 25% of women breastfeeding their babies at one year of age. A peer counselor is often the ideal advisor because she offers more credibility to the participant than a professional. The Preventive Health and Health Services Block Grant is funded to reduce coronary heart disease by increasing the number of Arizona residents who get at least 30 minutes of physical activity on most days per week. Grant activities have targeted physical activity programs for youth. Program objectives include working with 4th through 8th graders at enrolled local schools to encourage daily, moderate intensity, physical activity. The Commodity Supplemental Food Program (CSFP) provides 600 nonperishable food boxes to income eligible women, children to age 6, and seniors. As in years past, the contracted caseload has been inadequate to meet demand. The Mohave County Community Nutrition Program provided a series of “FIVE a DAY” nutrition education classes to third graders at low income, participating schools. When possible, the presentations included a Smiths supermarket tour. Presentations were designed to encourage fruit and vegetable consumption. The funding for this program was cut from the State budget and our contract with the Arizona Department of Health Services was cancelled on June 30, 2008. The Local Incentive Award These funds provide us with additional resources to provide nutrition education programs to food stamp participating children and families. This grant is also used to provide “Bone Building” classes for fifth graders at participating schools. 11 The Mohave County Tobacco Use Prevention Program (McTUPP) works to prevent youth from using tobacco, supports those youth and adult tobacco users to quit, and educates the community on the hazards of use and exposure to tobacco. Disparate populations are a major focus when providing services. Most services are provided through multiple subcontractors including some local school districts and charter schools, local hospitals, youth coalitions, after school programs, and a city police department. McTUPP also educates business on implementing written tobacco free worksite policies, onsite cessation classes and promoting smoke free home environments. Each of the major tri-cities offers youth the opportunity to become members in an anti-tobacco youth coalition. These youth participate in local and statewide activities: Youth Leadership trainings which promote communication, leadership, and team building skills; Attorney General’s Merchant Compliance Program identifies local merchants that sell tobacco to minors; Peer-toPeer Tobacco Education presentation teach elementary age youth about the dangers of tobacco; and Media outlet projects whereby the youth participate in parades, health fairs, fund raising activities and sporting events. “Mr. Butthead” a 6’5” walking cigarette debuts in all of the local parades. Intensive stop smoking classes were held for community group and on-site work places. Those clients who enroll in our classes are offered vouchers to purchase nicotine replacement therapies. Youth cessation programming was held for students and business contacts were made to provide tobacco free technical assistance and all school campuses remain tobacco free. We were notified that our funding for this program would be cut in the next contract year (FY 2008/2009). The Arizona Department of Health Services (ADHS) was reorganizing the cessation services and planned to take the program in a new direction; therefore, cessation funding was cut from all county programs. This resulted in two positions in our program that provided cessation services being eliminated at the end of FY 07/08. 12 PUBLIC HEALTH NURSING The Nursing Division of the Mohave County Department of Public Health provides professional nursing services for high risk populations and is responsible for communicable disease control activities throughout the county. Many services are mandated in order to protect the health and safety of Mohave County residents and are free, regardless of household income. Other services are provided on a sliding fee scale basis and others are available at a low, fixed cost. Funding for Public Health programs comes from state and federal grants, fees, donations, and local and state revenues. During the latter part of 2007, Public Health Nursing became 100% fully staffed with both professional and para-professional personnel. Historically, the professional level positions have been very difficult to recruit as salaries of local competitive agencies have greatly exceeded what government agencies offer. This year, unique barriers include training a large number of new employees to perform essential functions of public health. Our role in Public Health has changed tremendously over the last few years. Public Health Nursing has been challenged with emergency preparedness and response responsibilities while balancing every day activities of public health. As a result of preparedness efforts and public awareness, the public health department is often contacted to investigate disease events or perceived health threats that occur in the communities. With newly hired personnel, the focus of the division has been training and equipping members of the team to respond appropriately when needed. Newborn Intensive Care Program: This is a grant funded, free program that features home visits by a Registered Nurse and includes developmental delay follow-up. Facilities such as St. Joseph’s Hospital in Phoenix and Flagstaff Medical Center refer babies with potential health problems to the local health department. A nurse arranges for home visits with the family to evaluate and monitor the child’s condition, screen for developmental delays, teach care taking techniques, and answer questions. Referrals are often made to other agencies that can assist with the child’s special needs. The program serves both Mohave and LaPaz counties. The number of visits to families increased 48% from FY 06/07 to FY 07/08. The increase in visits can be attributed to an increase in outreach activities and additional referrals to the program. Additionally, while the number of newborns admitted to NICU decreased during that time (from76 to 58), the number of low-birthweight births increased 16.1% (from 155 to 180). Immunization Program: Free immunizations are provided to children and adolescents through the Vaccines for Children Grant. The vaccines that are available are routine childhood immunizations recommended by the American Academy of Pediatrics. During this reporting period, new vaccination requirements were implemented resulting in an increased number of children requiring vaccination before school entry. To accommodate the increase in demand for vaccinations, the Public Health Nursing division offered additional immunization clinics in each community and offered extended hours during the peak immunization seasons. Immunizations were also provided at health fairs and other community events to improve access to vaccinations. Public Health Nursing has experienced a 25% increase in the number of children who receive vaccinations. This provides greater coverage of vaccination among the population which ultimately results in fewer vaccine preventable diseases circulating in the community. 13 Adults: Tetanus-diphtheria vaccine is recommended every ten years and Hepatitis B, Hepatitis A, Varicella, MMR, and pneumonia are also available for a minimal fee. Meningococcal is available and recommended for those entering into college or universities. Zostavax and Guardasil vaccines are also available for adults. Influenza Vaccine: The Public Health Division offers “flu” vaccine to seniors and other high-risk individuals, especially those with heart or lung disease. Typical flu season begins in November and runs through April in the western region of the United States. Clinics are held in Kingman, Bullhead, and Lake Havasu and usually begin early November. In previous years, additional “flu vaccine” providers have offered services in each community giving greater opportunity to those wanting to receive vaccination. Pneumonia vaccine is also provided for a minimal fee for those with serious medical conditions and those over the age of 65. Communicable Disease Program: Registered Nurses coordinate with local physicians, Arizona Department of Health Services, and the Centers for Disease Control & Prevention to limit exposure and control the spread of infectious diseases. This includes identifying those who are infectious and their contacts, conducting laboratory testing, and providing immunization, medications and other disease control interventions when necessary. The public health nursing division also provides information to the public on health issues that may pose a public health risk. During FY 07-08 year, communicable disease staff investigated 1,453 communicable disease reports, excluding Tuberculosis. This represents an increase of 10% over FY 06-07 disease reports. In addition to the “typical” disease activities there were a number of special investigations conducted. Public Health Nursing participated in eight special investigations compared to five in the previous year. These investigations often include many hours of personal interviews with persons believed to be ill from a common event or location. The larger the investigation, the more personnel required to assist in the interviewing processes. We have occasionally pulled personnel from other program responsibilities to assist in these large scale events. Ryan White Care Program: Assistance is available through this grant funded program for qualifying HIV positive clients. Current services include case management provided by a registered nurse, client eligibility and advocacy, food and nutritional assistance, Health Insurance Continuation, medication and primary medical assistance as well as transportation to infectious disease specialists in Las Vegas. Tuberculosis Control and Treatment: Tuberculosis is on the decrease in other states, but Arizona continues with the steady number of TB cases each year. To help combat this disease, the Public Health Nursing Division, with assistance from the Mohave County TB Control Officer, provides one-on–one case management for each case of active Tuberculosis. This includes Direct Observed Therapy to ensure the health and safety of the public. Treatment for active Tuberculosis is recommended for 6-12 months. TB skin testing is provided for a minimal charge. Those with positive skin tests receive counseling, a chest x-ray, and free medication, if necessary. A Registered Nurse and TB Control Officer closely monitor the progress of each patient on medication. During FY 2007-08, two large-scale TB investigations were conducted in the Lake Havasu City community. The investigations required months of interviewing, diagnostic screening, and preventive treatment for individuals who test positive for TB but do not have active disease (latent TB disease). As of July 2008, over 500 persons were interviewed as a result of possible exposure to Tuberculosis. 14 Pregnancy Testing: Healthy pregnancies start with early prenatal care. For this reason, Public Health Nursing provides pregnancy testing and counseling on a sliding fee-scale basis as early as fourteen days after a missed menstrual period. Referrals are offered for pregnant and non-pregnant clients. Reproductive Health: Some individuals have chosen to wait to begin or enlarge their families, so the Public Health Division conducts free and low cost Reproductive Health Clinics through grant funding. These clinics provide birth control to those who otherwise could not afford it. Our clinics are staffed by professionals who specialize in women’s health. Additional funding for this program has been provided by Arizona Family Planning Council to enhance the services available for our clients. Sexually Transmitted Disease Clinic: Clinics are held weekly to test for and treat the most common sexually transmitted diseases. A charge for services provides an exam, testing, counseling, treatment, and contact follow up if warranted. The overall trend for the past four years has been a decrease in the number of clinic visits (68% reduction from 04/05 to 07/08). However, the number of clinic visits from FY 06/07 to FY 07/08 increased 66%. HIV Testing and Counseling: HIV testing and counseling is provided by appointment only for a minimal fee. Registered Nurses are trained and certified by the Arizona Department of Health Services to provide risk reduction counseling and testing for HIV. Testing is conducted using strict confidential procedures to ensure patient privacy. Each testing session lasts approximately 20-30 minutes. Blood specimens are submitted to Arizona State Laboratory for testing with results provided within two weeks. Rapid testing which allows same-day results will soon be available. In addition to offering testing to high risk individuals, HIV testing has been offered to all clients being screened and treated for Tuberculosis in an effort to identify those that may be co-infected. The overall trend for the past four years has been an increase in the number of HIV tests conducted (43% from FY 04/05 to FY 07/08). The number of HIV tests increased 97% from FY 06/07 to FY 07/08. Maternal Child Health Program: A nurse case manager coordinates the activities of the grant funded maternal child health programs in Mohave County. The program is involved in activities with the Health Start and Newborn Intensive Care Program case management. The Maternal Child Health personnel also work with local schools to provide health education for high risk groups. Health Start Program: This grant funded home visiting program is a free service that permits a lay health worker, or “promotora”, to be a resource for pregnant women and their families. After the birth of the child, the promotora visits the family in the home to provide education on health and safety issues such as immunizations, car seat safety, home safety and many more. High risk mothers and infants are visited by a Registered Nurse to facilitate and encourage positive outcomes. Teen Pregnancy Prevention Program: This is a new grant funded program that was implemented in March 2008 to address increased teen pregnancy rates in Mohave County. In 2007, Mohave County’s pregnancy rate was 32.9 for women 15 - 17 years of age. 15 Mohave County Department of Public Health Nursing Division Statistics FY 04/05 FY 05/06 FY 06/07 FY 07/08 231 207 248 367 Communicable Disease Disease investigations 1,393 1,234 1,323 1,453 Childhood Immunization Program Children vaccinated Vaccinations given 5,816 13,955 3,898 13,090 5,612 20,406 7,006 18,541 Adult Immunizations Program Tetnus-Diptheria Hepatitis B Hepatitis A Varicella MMR HPV Zostovax Meningococcal Influenza Pneumonia 296 468 262 8 108 ---8,950 650 243 305 171 25 179 ---5,959 1,016 189 336 132 43 147 1 10 17 3,031 328 169 359 66 17 115 4 155 14 2,969 620 Tuberculosis Control TB skin tests Latent TB infection Active case visits Active case Chest x-ray/clinics Primary Reactor Visit 1,712 252 513 4 158 88 1,149 179 291 7 162 60 1,207 107 321 3 139 59 1,657 568 113 4 322 164 1,638 1,185 316 971 708 889 710 885 Sexually Transmitted Disease Clinic visits 394 150 76 126 Well Woman Clinic visits 40 9 0 0 HIV Counseling and Testing HIV tests HIV post counsel 139 97 146 112 101 95 199 143 1 0 0 0 259 236 530 441 Newborn Intensive Care Program Home visits Reproductive Health Pregnancy Tests New/Annual visits * Unduplicated clients (Title V/X) DNA Lab Draws Health Start Visits *New/Annual visits-change in data reporting to reflect unduplicated client count 16 Nursing Division FY 04/05 FY 05/06 FY 06/07 600 FY 07/08 500 400 300 200 NICP Home Visits STD Clinic Visits HIV Tests 441 530 236 259 199 101 146 139 126 76 150 394 367 248 0 207 231 100 Health Start Visits Communicable Disease Number of Investigations FY 07/08 1453 FY 06/07 1323 FY 05/06 1234 FY 04/05 1393 1100 1150 1200 1250 1300 1350 1400 1450 1500 Childhood Immunization Program 21000 FY 04/05 FY 05/06 18000 FY 06/07 FY 07/08 15000 12000 9000 children vaccinated 18541 20406 13090 13955 7006 5612 0 3898 3000 5816 6000 vaccinations given 17 Tuberculosis Control Program Number of Skin Tests Conducted FY 07/08 1657 FY 06/07 1207 FY 05/06 1149 FY 04/05 1712 0 200 400 600 800 1000 1200 1400 1600 1800 number Tuberculosis Control Program 600 FY 04/05 500 FY 05/06 FY 06/07 FY 07/08 300 200 latent infection active case visits 18 chest xray clinics 164 59 60 88 322 139 162 158 113 321 291 513 568 107 0 179 100 252 number 400 primary reactor visits SENIOR PROGRAMS The main purpose of Mohave County Senior Programs is to provide hot, nutritious meals to seniors and disabled citizens within the county. Senior Programs provides congregate meals at the senior center sites. Senior Programs also provides homebound seniors a hot meal and welfare check via the “meals on wheels” program. Due to an increase in fuel, food prices and units of service, some remote areas receive one hot meal with the remaining meals frozen. This reduces fuel and personnel expenses as a result. Senior Programs does daily phone checks in these instances and continues to call until we connect with the senior receiving frozen meals. Senior Programs offers other programs such as socialization, education, and support services at each of the senior centers. These services range from Social Security and Attorney General satellite offices located within several of the senior centers to activities such as bridge, tax aide, legal aide, yoga, crafts, parties, and exercise classes. The Senior Centers have volunteers who help seniors with problems related to Medicare Part D. Four senior centers exist within Mohave County with sites in Bullhead City, Golden Shores, Kingman and Lake Havasu City. The majority of funds to run the senior center nutrition programs come from federal funds via the “Older Americans Act”, Mohave County general fund, and donations from participants. AHCCCS/ALTCS also contract for services for home delivered meals. There are thrift shops at the Bullhead City, Kingman and Lake Havasu Senior centers. The thrift shops are operated by senior non-profits and the revenues are used to help pay for a portion of program expenses such as utilities, food purchases, equipment purchases and emergency repairs. Senior Programs served 188,435 meals to a total of 3,080 people during fiscal year 2007-2008. Volunteers are a key to the success of senior programs and during this year over 300 volunteers donated their time to helping at the Senior Centers. Senior Programs continues to seek ways to reduce expenditures and increase donations. Local grocers donate bread products and Senior Programs recently signed an agreement to become part of a cooperative purchasing partnership. By becoming part of a partnership, Senior Programs gets guaranteed prices on food product and prices can’t be raised without ample justification. During this fiscal year, Senior Programs completed the process of transferring transportation to the cities. Since Kingman, Bullhead, and Lake Havasu have transit systems, there was duplication of services. The county worked with the cities as well as Dolan Springs and Golden Shores/Topock to implement Intergovernmental Agreements (IGA’s) for senior transit. Through the IGA’s, the county transferred state LTAF II transit funds and some vehicles to the cities and rural communities. The cities used those funds plus increased revenues from the federal government to provide senior rides. In the rural areas, the senior non-profits used their donated vans to start their own senior disabled transit programs. Number of Meals Served: Bullhead City Golden Shores Kingman Lake Havasu Total Home Delivered 30,448 5,735 37,214 42,360 115,757 19 Congregate 13,126 7,356 21,717 30,479 72,678 Senior Programs Homebound Meals Served Senior Programs Congregate Meals Served 45000 35000 40000 30000 Kingman Bullhead Golden Shores Lake Havasu Golden Shores Lake Havasu 1200 300 2005-2006 200 2006-2007 150 2007-2008 100 800 2005-2006 600 2006-2007 2007-2008 400 20 1051 Kingman Bullhead Golden Shores Lake Havasu 464 582 644 564 323 0 Lake Havasu 260 200 144 Golden Shores 240 261 61 47 39 307 Bullhead 392 333 Kingman 232 263 261 200 1044 1069 Number of Clients 1000 250 263 270 Number of Clients Bullhead Senior Programs Congregate Clients Servce 350 0 Kingman 29532 30479 0 Senior Programs Homebound Clients Served 50 2007-2008 10000 5000 42360 32224 26927 5955 30448 29968 26475 37214 0 34856 5000 33751 10000 5735 15000 2006-2007 15000 30015 2007-2008 7356 20000 2005-2006 20000 9329 7249 2006-2007 12466 11460 13126 25000 25000 21717 2005-2006 23087 22885 Number of Meals 30000 4060 Number of Meals 35000 BIO TERRORISM DEFENSE AND EMERGENCY RESPONSE Preparedness planning with emphasis on Pandemic Influenza planning continued to be the key focus during fiscal year 2007-2008. In October we conducted three response exercises in conjunction with our flu vaccine clinics. 1449 flu vaccinations were administered along with 392 Pneumonia vaccinations. The Incident Command System (ICS) was exercised beginning with the first planning meeting on August 21, 2007. The Mobile Command Center was deployed to the Bullhead and Kingman clinics where command staff became familiar with its operation. In February 2008 we again exercised the department’s ability to provide mass vaccinations in a short period of time. Members of the department Nursing Division, Emergency Response Team, and Medical Reserve Corps participated in a mass clinic during the Lake Havasu Winterfest and vaccinated 309 individuals in a four hour period. The All Hazards Emergency Response and Recovery Plan revision was completed. This plan will continue to be updated as new information is received from the Arizona Department of Health Services, Arizona Division of Emergency Management and Mohave County Emergency Management. Our Medical Reserve Corp (MRC) volunteers participated at many emergency preparedness and community events such as the Lake Havasu Winterfest, the Mohave County Fair, the Bullhead City Safety Fair, Hardyville Days, and the Lake Havasu City Volunteer Fair. MRC volunteers also assisted with the staffing of the flu appointment phone bank call center and at the flu immunization clinic exercises, donating a total of 2,100 hours in 2007. In 2007, the Independent Sector (IS), a Washington, D.C.-based coalition of nonprofits and foundations, valued the hourly rate of volunteer hours at $19.51. This equates to our MRC volunteers contributing $40,971 in time to our communities in 2007. Because of the time, dedication and support by the MRC volunteers during 2007, the Mohave County Medical Reserve Corps was awarded the Presidential Volunteer Service Gold award. The President's Council on Service and Civic Participation created the President's Volunteer Service Award program as a way to thank and honor Americans who, by their demonstrated commitment and example, inspire others to engage in volunteer service. Our health department staff continues to receive training on a regular basis with regard to emergency response. Training and exercises this past year included NIMS (National Incident Management System) certification, Incident Command/Clinic Operations, Mass Fatality Response, Weapons of Mass Destruction, Joint Information Center and Media training. 21 PATTERNS IN HEALTH, MORBIDITY, AND MORTALITY Birth Rate Total Births 12.8 2500 2450 12.6 2400 2350 12.4 2300 12.2 2250 2200 12 2150 2100 11.8 2050 2000 2007 11.4 12.1 2006 12.7 2439 2005 11.9 2468 2004 12.2 2237 2003 12.5 2191 1900 11.6 2135 1950 2003 2004 2005 2006 2007 The trend for the total number of births in Mohave County has increased over the past five years with an overall increase of 14.2%. Due to increases in county population over that period of time, the birth rate has experienced an overall decrease over the past five years. Characteristics of Mothers *rates per 100 live births Characteristics of Mothers 1400 2003 2004 2005 2006 2007 1200 1000 50 2003 2004 2005 2006 2007 45 40 35 30 800 25 600 20 15 400 0 mothers 19 or under 15 13.8 16.1 15.8 15.2 unwed mothers 320 303 361 390 370 869 874 1009 1167 1150 0 5 40.7 39.9 45.1 47.3 47.2 10 200 unwed mother rate* mothers 19 or under rate* The number of unwed mothers has increased 32% over the past five years; however, the rate of unwed mothers per 100 live births has increased 15.6% during that period of time. The number of mothers 19 or under has also shown an increase over the past five years. However; due to the increase in the number of births, the rate of mothers 19 or under has increased only marginally at 1% during that period of time. 22 Characteristics of Newborns 180 2003 2004 2005 2006 2007 160 140 120 Characteristics of Newborns *rates per 100 live births 8 7 6 2 20 1 low birthweight babies 0 low birthweight babies rate* fetal mortality 0.72 40 0.84 0.6 3 6.8 6.7 5.9 6.3 7.4 60 10 11 19 15 17 4 145 146 133 155 180 80 0.47 0.55 5 100 0 2003 2004 2005 2006 2007 fetal mortality rate* The trend in the number of low birthweight babies has been an increase over the past five years with an overall increase of 24% while the rate of low birthweight babies has increased 8.8%. The number of fetal deaths has remained under 20 for the past five years. In 2008, the number of fetal deaths was .7% of the total number of births. Although this is a relatively small size, the number of fetal deaths has increased 70% over the past five years while the rate of fetal deaths has increased 53.2%. Death Rate per 10,000 population Number of Deaths 2400 130 2350 120 2300 2250 110 2200 100 2150 2100 2007 107 2006 121 2005 125 2153 2004 125 2354 2003 80 126 2345 2000 2253 2050 2151 90 2003 2004 2005 2006 2007 The number of deaths had been increasing each year; however, in 2007 to number of deaths decreased 8.5% from the 2006 levels. The rate of deaths in the county had remained fairly constant but in 2007 experienced a decrease of 11.6% compared to the 2006 rate. 23 Patterns in Cause-Specific Mortality Rates per 100 deaths Patterns in Cause-Specific Mortality 2003 2004 2005 2006 2007 50 40 2003 2004 2005 2006 2007 2 1.8 1.6 1.4 1.2 30 1 0.8 20 0.6 breast cancer breast cancer rate prostate cancer 1.4 1.4 1.4 1.8 1.3 1.6 1.4 0 1.7 1.5 30 34 32 41 29 34 32 39 28 0 32 0.2 1.2 0.4 10 prostate cancer rate The number of deaths from breast cancer has fluctuated over the past five years. The death rate from breast cancer has also fluctuated over the past five years with the highest rate experienced in 2005. Removing the high and low rates over the past five years provides a fairly constant at a rate of 1.4 to 1.6. The number of deaths from prostate cancer experienced its highest level in 2004; however, 2007 decreased almost to 2003 numbers. As with the number of deaths, the rate of prostate cancer saw its highest level in 2004 and has remained constant at 1.4 per 100 deaths since 2005. Patterns in Cause-Specific Mortality 60 3 Patterns in Cause-Specific Mortality Rate per 100 deaths 2003 2003 2004 50 2005 2004 2.5 2005 2006 40 2007 30 2006 2 2007 1.5 20 1 10 suicide rate 1.6 2.2 1.7 1.3 1.9 2.4 2.2 1.8 0 1.8 35 51 39 29 motor vehicle accidents 1.6 intentional self harm (suicide) 41 51 52 41 40 0 35 0.5 motor vehicle rate The trend for the number of deaths from intentional self harm (suicide) has been an increase. 2007 saw one less death from suicide than 2006. The number of deaths has increased 45.7% from 2003 to 2007. The death rate from intentional self harm has followed the same pattern with a consistent increase over the past five years of 50%. The number of deaths from motor vehicle accidents has fluctuated over the past five years with no discernable trend. The highest number of deaths from motor vehicle accidents was experienced in 2006 and the number significantly decreased in 2007 (31.4% reduction). The death rate has seen the same fluctuation with a decrease in the rate from 2006 to 2007 of 27.3%. 24 Patterns in Cause-Specific Mortality Rates per 100 deaths Patterns in Cause-Specific Mortality 800 35 2003 30 2005 600 2006 500 2007 25 0 cardiovascular myocardial disease rate infarction rate 8.5 9.7 9.6 9.2 8 lung, trachea, bronchus cancer 11.9 11.8 5.6 3.1 2.6 acute myocardial infarction 173 major cardiovascular disease 5 182 219 225 217 0 56 10 255 265 132 74 200 695 15 734 762 769 707 300 34.1 33.8 32.8 30 32.3 20 400 100 2003 2004 2005 2006 2007 2004 700 lung, trachea, bronchus cancer rate The number of deaths from cardiovascular disease, acute myocardial infarction, and lung, trachea, and bronchus cancer has shown a decrease since 2005. In 2007, the number of deaths from each of these conditions reached their lowest point in the past five years. From 2005 to 2007, the number of deaths has decreased by the following amounts: 9.6% for cardiovascular disease, 57.6% for acute myocardial infarction, and 23.1% for lung, trachea, and bronchus cancer. The rate of death for acute myocardial infarction and lung, trachea, and bronchus cancer has also experienced a decrease since 2005. From 2005 to 2007 they have decreased 53.8% and 16.7% respectively. While the number of deaths from cardiovascular disease has shown a decrease, the rate has shown an increase from the 2006 level (7.7%). This is due to a fairly small reduction in the number of deaths (12) while the total number of deaths decreased by 201 from 2006 to 2007. 25 Patterns in Morbidity Number of Reported Cases 60 Patterns in Morbidity rate per 100,000 of population 35 2003 2004 50 2003 2004 30 2005 2005 2006 2006 25 2007 2007 40 20 30 15 20 tuberculosis hepatitis A tuberculosis rate gonorrhea 15.2 27.7 28.7 28.7 14.9 0 30 26 50 54 57 0 8 15 2 1 3 2 0 6 5 0 4.7 8.3 1.1 0.5 0 5 10 1.2 0 3.2 2.5 1.5 10 hepatitis A rate gonorrhea rate The number of tuberculosis cases has fluctuated over the past five years from zero to six confirmed cases. The number of hepatitis A cases had been increasing in the past. With the creation of the mandatory food handler class, the number of hepatitis A cases has decreased to zero cases in 2007. The number of cases of gonorrhea increased from 2003 through 2006 but experienced a decrease in 2007; the number of cases decreased 47.4% from 2006 to 2007. As noted above for the number of confirmed tuberculosis cases, the rate of reported cases has fluctuated from year to year. The rate of hepatitis cases has mirrored the number of cases and decreased 100%. The rate of gonorrhea had been increasing but saw a 48.1% decrease from 2006 to 2007. Patterns in Morbidity - 2007 rate per 100,000 of population county rate s tate rate 70 60 50 40 30 20 valley f ever 26 20.3 1.5 w est nile virus 22.8 0 0.5 10 75.1 Mohave County’s rate of valley fever cases was 67% less than the state rate. The rate of West Nile virus cases was 66.7% less than the state. The rate of Methicillin Resistant S. aureus (invasive) (MRSA) was 11% above the state rate. 80 24.8 2007 is the first year for the annual report of comparing the rate of valley fever, West Nile virus, and MRSA cases for Mohave County and the State. MRSA Fiscal Year 2007 – 2008 Annual Report 27