mother and child health â€“ saving children lives

8/11/2019 Mother and Child health Saving Children Lives

1/103


2/103

Materials to take on a home visit


3/103

Married Woman Surveillance (13-49

years) visit

Greet the family

Tell the purpose of visit

Take verbal consent

Ask the status of Marriedwoman

Ask the status childrenunder five years

Discuss the problem

Thank the family Tell that you will visit

again according to theschedule


4/103

Pregnant Women Identification

Ask the woman whether she ispregnant or not

Probe the woman wellask aboutmissed period and LMP

Early pregnancy detection andidentification is very important forpregnant woman and her child

identify the pregnant woman within12-16 weeks of gestation

Once pregnant woman identifiedVERBAL CONSENT WILL BE TAKEN

AND FILL CASE REPORT FORM 1


5/103

First Pregnancy Visit: Promote

Antenatal Care

GREET THE FAMILY. Explain that you are visiting to talkabout care during pregnancy.

Ask & Listen: Do you have other children? (If yes) Did youattend antenatal clinic in previous pregnancies? In this

pregnancy? Understand the situation and adapt your advice

accordingly.

Give relevant information: Ask the family what they see inthe pictures and listen to their answers.

Check understanding and discuss what the family will do.Will the pregnant woman go for four antenatal care visits?If yes, praise them. If no, ask why not and try to solve anyproblems

Tell the story of Ayesha, who had a healthy baby:


6/103

Story of Ayesha

Ayesha went for the firstantenatal check up as soon asshe knew she was pregnant.

She knew this was important to: be examined to make sure she

was healthy (Picture 1-3), get injections to protect against

tetanus (Picture 3),

receive iron and folic acid tabletsto prevent anemia or weakblood (Picture 4),

get tested so she could receiveappropriate care and reduce therisk (Picture 5).

Ayesha went for antenatal checkups four times during her

pregnancy.

1 2

3

4 5


7/103

First ANC visit will be done between

24 to 28 weeks of pregnancy.

Topics covered :

Birth preparedness

Nutrition counseling Folic acid and iron supplementation

Immunization (TT)

FILL CASE REPORT FORM 1A


8/103

First Pregnancy Visit: Prepare for Birth

in a Health Facility

Ask & Listen: (If the woman has other children) Wheredid you give birth? (If not) Where did other

women in your family give birth?

Understand the situation and adapt your adviceaccordingly.

Give relevant information: Ask the family what theysee in the pictures and listen to their answers.

Check understanding and discuss what the family willdo. Will the family plan for birth in a facility. If yes,praise them. If no, ask why not and try to solve anyproblems

Tell the story of Ayesha, who had a healthy baby.


9/103

Story of Ayesha

Ayesha and her family:

Chose to have the birth in a healthfacility (Picture 1) because they knewthat complications can happen to anywoman and these can be preventedand treated immediately in a healthfacility.

Identified transport to get to thehealth facility when labour started,either during the day or night

Saved money for transport and otherexpenses for birth at health facility(Picture 2)

Collected supplies (towels for drying

and wrapping the baby and clothesfor the baby) (Picture 3) and plannedwho will care for the household whenthe woman is in the facility forchildbirth

Went to health facility early in labour(Picture 4)

12

3 4

i i


10/103

Pregnant Woman Registration at

Koohi Goth Hospital for delivery

Why?

Trained and experience staff for delivery

Clean environment and clean delivery

Prevention of any complication during delivery Near to Rehri Goth

New born will be save

Trained midwife is far better than traditional

birth attendant save your child

W i i


11/103



How?

Registration in first to early second trimester is

very importantto identify any risk and avoid any

complication

Lab test (Blood and urine)

Ultrasound

Antennal visit at Koohi Goth Hospital Midwives,sitting at Rehri Goth Center

P W R i i


12/103



How we can help pregnant woman?

Providing transport

Facilitating and helping pregnant woman to get

register at Koohi Goth Hospital

Free lab test

Free ultrasound

P W R i i


13/103



What we want for woman and her family?

Provide us with the time

Listen to the advice of Community health worker

Listen to the advice of Koohi Goth health team

Get register and visit for Antenatal care at Koohi

Goth clinic

Deliver at Koohi Goth Hospital

Be patient with the procedureas we are working

for the best of pregnant woman and her child

Fi P i i H C f


14/103

First Pregnancy visit: Home Care for

the Pregnant Woman

Ask & Listen: What care do you think womenneed during pregnancy?

Understand the situation and adapt your advice

accordingly. Give relevant information: Ask the family what

they see in the pictures on the next page

Check understanding and discuss what thefamily will do. Can the pregnant woman care forherself like Ayesha? If yes, praise them. If no, askwhy not and try to solve any problems and tellthe story; Ayesha:


15/103

Story of Ayesha

Ayesha ate more thanusual during pregnancy tohelp the baby grow(Picture 1)

Avoided heavy work andrested more, to help herand the baby stay healthy(Picture 2)

Took iron-folic acidtablets and followedother advice given at theantenatal clinic (Picture 3)


16/103

Health Nutrition for Pregnant Woman

Wh t k P t W


17/103

What makes a Pregnant Women

Healthy


18/103

Water

8-10 glass of water daily is very important to

drink for the pregnant woman

Clean and boil drinking is important

I d F li A id S l t


19/103

Iron and Folic Acid Supplement or

related items

Very important for the baby to deliver healthy

Prevent the birth defects and other danger

illness

Prevent complications related to blood


20/103

Prevention of Anemia

Women should know the signs of anemia

anemia is very dangerous but very easy to

prevent by Ferrous Sulphate tablet

Tiredness

Weakness

Headache

Whitening of skin below eye and nails

Sleep disturbance

Increase heart beat and fast breathing

Wh t t t F li id d F


21/103

When to start Folic acid and Ferrous

Sulphate

Folic acid should be given 1 tablet per day, as

soon as pregnancy is confirmed

Ferrous Sulphate should be given 1 tablet

twice daily, as soon as pregnancy is confirmed

Both tablet should be taking with food to

avoid stomach upset


22/103

Other source of Folic acid and Ferrous

Sulpate

We may provide you biscuit for pregnant

womanthis will help you to prevent

nutritional deficiency

CHW will provide you 42 biscuit for 1 week

duration to the pregnant woman and woman

has to consume 6 biscuits per day


23/103

Identification of Malnourished woman

Community health worker will identify

malnourished pregnant woman at the time of

registration or during ANC visit

The MUAC will be used to identify whether

the pregnant woman is malnourished or not

not.


24/103

Types of Malnutrition

Criteria Classification Treatment / care

MUAC less than 19 cm Severe acute malnutrition

(SAM) with complication

(fever, hypothermia, severe

anemia or dehydration,vomiting, bilateral edema

+++) or no appetite

Referral to the hospital

Ask the coordinator for further

plan

SAMwith appetite and no

complication

High energy biscuits or Super

cereal CSB plus

Weight loss or no weight gain

MUAC greater than or equal to 19

and less than or equal to 23.5 cm

Moderate/mild malnutrition High energy biscuits or Super

cereal CSB plus

MUAC > 23.5 cm Normal Nutritional advice + High energy

biscuit supplies as micronutrient


25/103

High Energy Biscuit for Malnourished

pregnantwoman

We may provide you biscuit for pregnant womanthis will help you to fulfill the nutritional

requirements deficiency

CHW will provide you 42 biscuit for 1 week duration

to the pregnant woman and woman has to consume

6 biscuits per day for whole pregnancy period and 6

months after delivery

CHW will follow you every 15 days and assess ournutritional status by taking your MUAC and weight.

What else pregnant woman need to


26/103

What else pregnant woman need to

eat apart from High Energy Biscuit

1 egg per day with high energy biscuits

1 glass of milk

AND Routine meals of three times


27/103

High energy biscuitsspecial instructions

Woman has to consumed 6 biscuits per day as

guided by the CHW

Drink plenty of water

These biscuits are specially made to fulfill the

nutritional requirements of pregnant woman

other family member should not use them


28/103

Tetanus prevention

Tetanus is a serious disease cause by germ

that affects your:

nervous system,

leading to painful muscle contractions, particularly

of your jaw and neck muscles.

Tetanus can interfere with your ability to breathe

and, ultimately, threaten the life. Tetanus is commonly known as

"lockjaw, and majorly fits occur.


29/103

What is the source of tetanus disease?

And what is Maternal and Neonatal


30/103

And what is Maternal and Neonatal

Tetanus?

Maternal tetanus occurs in the woman when shewas exposed to dirty tools is used duringchildbirth.

Neonatal tetanusis a form of that occurs in

newborns. A newborn baby may become infected:

if the knife, razor, or other instrument used to cut itsumbilical cord is dirty,

if dirty material is used to dress the cord, or if the hands of the person delivering the baby are not

clean.

Symptoms usually appear after 3rdday.

Do you know the symptoms of tetanus in


31/103

Do you know the symptoms of tetanus in

mother and baby?

We have discussed this earlier as well but now we tellyou again.

muscular stiffness in the jaw

stiffness in the neck,

difficulty swallowing,

stiffness in the stomach muscles,

muscle spasms,

sweating, and fever

Newborn babies who are normal at birth, but stopsucking between three and 28 days after birth


32/103

How is tetanus disease prevented?

Clean practices when a mother isdelivering a child, even if she has beenimmunizeduse of A completedelivery kit with disposable sheet,clean and sterile blade, thread, cordclamp, soap, gauze piece and swabs

Neonatal tetanus can be prevented byimmunizing women of childbearing agewith tetanus toxoid, either duringpregnancy or outside of pregnancy.

Immunizing infants and children withhexavalent vaccine


33/103

How many doses and at what interval

in woman of childbearing age?

Dose WhenHow long it will

give you projection

First dose 1. As soon as girl reach the age of 13 years or

2. As soon as woman got married or

3. Woman got pregnant at 5thmonth or4. Any one has deep wound

No protection

Second dose Four weeks after first dose 3 years

Third dose 6 months after second dose 5 years

Fourth dose One year after third dose 10 years

Fifth dose One year after fourth dose 30 years (through

out reproductive

age)


34/103

Ask the womancan you tell the

difference between these two pictures?

The difference between these two


35/103

The difference between these two

pictures?

And the difference between these two


36/103

And the difference between these two

pictures?


37/103

Special note for pregnant woman

If the mother comes later, then she could be

given two doses but the 2nd dose must be

given one month before the Expected date of

delivery.

If two injections have been given in the

previous pregnancy, then only one is required.

This can be given at any time during thepregnancy.


38/103

So what we learnt from last 6 picture?

What do you think is the better woman?

The one who was sick, and unconscious OR the one

which is health after child birth and enjoying with her

baby

What do you think is the best delivery?

The one by trained staff like midwife, nurse or doctor,

under hygienic condition OR the one by Daai underunhygienic condition.

What do you think is the better child?

The one who was sick, OR the one who is health


39/103

Arrangement of Transport

In case of labour pain or anyother related emergency,pregnant woman or thefamily member need to

inform our community healthworker in Rehri Goth

Woman should tell the healthworker about close address of

household The health worker will

arrange AMAN ambulance fortransportation

Please call at

number


40/103

Important things to rememberin

case of home delivery


41/103

Important precautions for woman during


42/103


pregnancy


43/103

Important precautions for woman

during pregnancy



44/103


pregnancy


45/103

Danger signs during Pregnancy

Vaginal bleeding

Severe Abdominal

painFits

Severe headache

High grade fever

Fast or difficult

breathing

Second pregnancy visit: Review Home


46/103

Second pregnancy visit: Review Home

Care for the Pregnant Woman and

Preparation for Birth GREET THE FAMILY. Explain that you are visiting to talk aboutpreparations for birth and care of the newborn after birth.

Ask, listen and discuss what the family will do: (use the pictures toreinforce advice, if needed)

Has the pregnant woman attended antenatal clinic? If she has, praise her and the family.

If not, ask why not and try to solve any problems they may have.

How has the woman been caring for herself?

If the woman has been able to eat and rest more, and take iron folic acidtablets, praise her and the family.


How are the preparations for birth going? If they have decided on health facility birth and are saving money, have

identified transport and are collecting supplies, praise them.


Second pregnancy visit: prepare for birth


47/103

Second pregnancy visit: prepare for birth

at home (for use if the family thinks

facility birth might not be possible) Encourage the woman and family that safest place of delivery is

good facility

There are important points which need to be remember in caseof home delivery Identified a midwife to assist at birth. They also identified an additional

person (her mother-in-law) to help the birth attendant care for the babyimmediately after birth

Knew that it is an emergency if labour lasts longer than 12 hours, there isheavy bleeding, the placenta is not delivered, or the baby has difficultybreathing

Saved money and identified transport to go the health facility in case ofan emergency

Collected clean towels to dry and wrap the baby, and a hat, socks andclothes to keep the baby warm

Cleaned the room for birth and had soap and water available for thebirth attendant and her helper to wash hands

Second pregnancy visit: advise on


48/103

Second pregnancy visit: advise on

immediate newborn care

Care of mother

Care of New born

Breastfeeding

Childhood immunization


49/103

Care of mother

Eating of multani mitti,paan, gutka , niswar,biddi ,chalia, sopari andother addicted drugs like

heroin and related drugare very dangerous forthe child - must beabsolutely discouraged.

Also ask to limit theirconsumption of tea andcoffee to 2-3 cups in 24hours.

C f h


50/103

Care of mother

Anxiety or depression is a common occurrence in

pregnant women especially in first pregnancy.

Mothers if sad, stressed or depressed must be

counseled to stay happy and stress free by sharing

their worries with the husband or family membersand friends.

Mothers are also asked to have some rest during

day time and appropriate sleep during night hours.

They are encouraged to identify their causes of

stress and help them to overcome by counseling.

Encourage the pregnant woman to continue

routine light work during pregnancy like cooking,

washing, cleaning, etc. but avoiding heavy work,

e.g. washing clothes, fetching water, moving heavy

Second pregnancy visit: Advise on


51/103

Second pregnancy visit: Advise onimmediate newborn care

Ask & Listen: What care do you think a baby shouldreceive right after birth?

Understand the situation and adapt your adviceaccordingly.

Give relevant information: Ask the family what theysee in the pictures and listen to their answers.

Check understanding and discuss what the family willdo. Can they care for the baby in the same way as inthe story? If yes, praise them. If no, ask why not and try

to solve any problems. Tell the story of the care that Ayeshas baby received

immediately after birth.

A h


52/103

Ayeshas story

The birth attendant dried the babyimmediately after birth (Picture 1), placedthe baby skin to skin on Ayeshas tummy, andcovered them with a blanket to keep thebaby warm (Picture 2)

The birth attendant cut the cord with a newblade, Ayeshasmother-in-law put hat and

socks on the baby, put him skin to skinbetween Ayeshasbreasts and coveredmother and baby (Picture 3)

In a few minutes, when the baby was ready,Ayesha put the baby to the breast to helpthe milk come in, reduce Ayeshas bleeding,and protect the baby from disease (Picture

4) The baby was allowed to suckle as long as he

wanted and kept in skin to skin contact withAyesha for one hour after birth, and thenwrapped well and kept close to her to makesure the baby stayed warm, the familydelayed bathing until the next day

Postnatal visit: Assess feeding danger


53/103

Postnatal visit: Assess feeding, danger

signs and weight GREET THE FAMILY. Ask and Listen: How are the mother and baby doing? IF THE MOTHER HAS HEAVY BLEEDING,

FEVER, FITS, SEVERE HEADACHE, DIFFICULT BREATHING, OR SEVERE ABDOMINAL PAIN, REFER URGENTLY TOHOSPITAL. If not, ask if the mother has put the baby to the breast. If yes, praise the family. If no, encourage herto do so now.

Understand the situation: WASH your hands. OBSERVE the mother breastfeed. Is the baby well attached

(CHIN TOUCHING BREAST? MOUTH WIDE OPEN? LOWER LIP TURNED OUTWARD? MORE AREOLA VISIBLE ABOVETHAN BELOW THE MOUTH?) and suckling effectively? If not, help the mother to improve positioning andattachment.

Ask the family if you can check the baby use the pictures to explain what you will do. ASSESS the baby

for these DANGER SIGNS: NOT ABLE TO FEED SINCE BIRTH, OR STOPPED FEEDING WELL

CONVULSED OR FITTED SINCE BIRTH

FAST BREATHING: 60 BREATHS OR MORE IN ONE MINUTE (TWO COUNTS)

CHEST INDRAWING

HIGH TEMPERATURE: 38C OR MORE

VERY LOW TEMPERATURE: 35.5C OR LESS

ONLY MOVES WHEN STIMULATED, OR DOES NOT MOVE EVEN ON STIMULATION

YELLOW SOLES SIGNS OF LOCAL INFECTION: UMBILICUS RED OR DRAINING PUS, SKIN BOILS AND EYES DRAINING PUS.

WEIGH THE BABY, record the weight

CRF 2 for outcome information and CRF 3 for baby registration willbe filled

Breastfeeding - What do mother need


54/103

Breastfeeding What do mother need

to know? Breast milk provides all the food and water

that your baby needs during the first 6months of life.

Make sure you feed your baby the firstyellowish milk known as colostrum.

Colostrum protects your baby from many

diseases. Exclusive breastfeeding means giving

breast milk only, and nothing else (noother milks, foods or liquids, not even sipsof water), except for medicines prescribedby a doctor or nurse.

Feeding your baby both breast milk andother foods or liquids, including infantformula, animal milks, or water (calledmixed feeding) before 6 months reducesthe amount of milk that you produce andcan make your baby sick.


55/103

Help baby attach to your breast Good attachment helps you to produce a good

supply of breast milk.

Put the baby to your breast within the first hour ofbirth.

Good attachment helps to ensure that your babysuckles well.

Good attachment helps to prevent sore andcracked nipples.

To make sure your baby is attached well: Touch babys lips with your nipple

Wait until your babys mouth opens wide

Quickly bring onto your breast from below,aiming your nipple up towards the roof of thebabys mouth

Baby should take a big mouthful of breast

The 4 signs of good attachment are:1. Babys mouth is wide open

2. You can see more of the darker skin (areola)above the babys mouth than below

3. Babys lower lip is turned outwards

4. Babys chin is touching your breast

Your baby should take slow deep sucks while

breastfeeding, sometimes pausing.


56/103

How often should I breastfeed?

Breastfeed your baby on demand,both day and night, at least 8 to 12times each day.

Frequent feeding will help yourbody to produce breast milk.

Continue to feed until your babyfinishes the breast and comes offon his or her own. Offer the otherbreast and let your baby decide ifhe or she wants more or not.

You will know if your baby is takingenough breast milk if he or shepasses light-coloured urine at least6 times a day and is gaining weight.


57/103

Things to remember

Breast milk is the best food for babies. Breast milk also protects against infections, which are the most common causes of

illnesses and deaths in newborn infants.

Breastfeed the baby within the first hour after birth to promote milk productionand to give the baby the benefits of colostrum, the first yellowish milk that issecreted initially.

Colostrum is a natural vaccine that protects the baby from illnesses. Do not throwit away; give it to your newborn baby.

Immediate breastfeeding also helps with the delivery of the placenta and reducesbleeding in the mother.

While breastfeeding, wait until the baby spontaneously lets go of the nipple beforeswitching to the other breast. In this way, the baby is more likely to receive the fatrich milk that comes out near the end of a feed as the breast gets emptied.

Breastfeed day and night on demand whenever the baby wants milk. This willpromote milk production; it will also prevent painful breast engorgement

Exclusive breastfeeding is essential during the first six months. This means givingonly breast milk; no water, teas, other liquids, herbs, or foods. During this period,breast milk is a complete food and contains all the water a baby needs, even in hotclimates.


58/103


59/103

Good and Poor Attachment


60/103

Good positioning


61/103

Feeding twin babies

Breastfeeding


62/103

Breastfeeding

the remarkable first hour of life

The mothers body helps to keep the babyappropriately warm, which is especially important forsmall and low birth weight babies.

The baby is less stressed, calmer and has stable

breathing and heart rates. The baby is exposed first to the bacteria from the

mother which are mostly harmless, or against whichthe mothers milk contains protective factors

The mothers bacteria helps to prevent infection in herbaby by colonizing the babys gut and skin; as well ascompeting with more harmful bacteria from healthproviders and the environment.


63/103

Colostrum for the first feeds

Colostrum is rich in immunologically active cells, antibodies andother protective proteins. Thus it serves as the babys first

immunization and protects against many infections. It helps to

regulate the babys own developing immune system

Colostrum contains growth factors, which help the infants

intestine to mature and function effectively. This makes it more

difficult for micro-organisms and allergens to get into the

babys body.

Colostrum is rich in Vitamin A, which helps protect the eyes

and reduce infection.

Colostrum stimulates the baby to have bowel movements so

that meconium is cleared quickly from the gut. This will help

reduce jaundice in the baby.

Colostrum comes in small volumes, just right for the new baby.

Importance of Breastfeeding for the


64/103


Infant/Young Child Saves infants lives. Is a whole food for the infant, contains balanced proportions and sufficient

quantity of all the needed nutrients for the first 6 months.

Promotes adequate growth and development, thus preventing stunting.

Is always clean.

Contains antibodies that protect against diseases, especially against diarrhea and

respiratory infections. Is always ready and at the right temperature.

Is easy to digest. Nutrients are well absorbed.

Protects against allergies. Breastmilk antibodies protect the babys gut preventingharmful substances to pass into the blood.

Contains enough water for the babys needs (87% of water and minerals).

Helps jaw and teeth development; suckling develops facial muscles. Frequent skin-to-skin contact between mother and infant lead to better

psychomotor, affective and social development of the infant.

The infant benefits from the colostrum, which protects him/her from diseases.

The amount is perfect for newborn stomach size.

Promotes brain development;



65/103


Mother Putting the baby to the breast immediately after

birth facilitates the expulsion of placenta becausethe babys suckling stimulates uterine contractions.

Reduces risks of bleeding after delivery.

When the baby is immediately breastfed afterbirth, breastmilk production is stimulated.

Breastfeeding is more than 98% effective as acontraceptive method during the first 6 months

provided that breastfeeding is exclusive andamenorrhea persists.

Immediate and frequent suckling preventsengorgement.

Care of the Low Birth Weight (LBW)


66/103

Care of the Low Birth Weight (LBW)

infant The low birth weight newborn is very fragile. It is important to take good

care of him/her to promote good health.

Avoid a dangerous drop in the babys body temperature, especially soon

after birth:

Dry the baby with a clean cloth, discard the wet cloth. Wrap the body,

including the head, with a fresh dry cloth or several cloths as required.

Ask the mother and another family member to practice continuous skin

to skin- contact, also known as kangaroo mother care

Do not bath the baby until the end of the first week.

Practice exclusive breastfeeding, day and night, at least 10 to 12 times aday.

Wash your hands with clean water and soap every time before touching a

low birth weight baby, in order to protect him/her from infections.

Visit the health center and get your baby weighed once a week to make

sure he/she is growing well.

Key points for counseling mothers and


67/103

Key points for counseling mothers and

families Much of the care of the small or low birth weight baby is similar to

that required by normal newborns, but these vulnerable babiesrequire extra support.

To avoid a dangerous drop in the babys body temperature,especially soon after birth:

Dry the baby quickly with a clean cloth and discard the wet cloth. Wrap the body, including the head, with a fresh dry cloth or several

cloths/blanket as required to keep the baby warm.

Check the temperature of the baby. Place your hand on the babystummy and compare its temperature with that of the hands and feet.The tummy, hands, and feet all should be warm, not too hot and nottoo cold.

Ask the mother and/or another family member to practice continuousskin-to-skin contact, also known as kangaroo mother care. Find outmore details of this component from your facility health care provideror supervisor if this is being practiced in your area.

Do not bathe the baby until the end of the first week.

d d b f di i


68/103

Recommended breastfeeding practices

Recommended

Breastfeeding Practice

Possible Points of Discussion for Counseling (choose most relevant to mothers

situation)Put infant skin-to-skin with

mother immediately after

birth

Skin-to-skin with mother keeps newborn warm

Skin-to-skin with mother helps stimulate brain development

Initiate breastfeeding within

the first hour of birth

This first milk local word is called colostrum. It is yellow and full of antibodies

which help protect your baby

Colostrum provides the first immunization against

many diseases. Breastfeeding from birth helps the milk come in and ensures plenty of breastmilk

Exclusively breastfeed (no

other

food or drink) for 6 months

Breastmilk is all the infant needs for the first 6 months

Do not give anything else to the infant before 6 months, not even water

Giving water will fill the infant and cause less suckling; less breastmilk will be

produced

Breastfeed frequently, day

and night

Breastfeed the baby often, at least 8-12 times for a newborn, and 8 or more times

after breastfeeding is well-established, day and night, to produce lots of breastmilk

More suckling (with good attachment) makes more breastmilk

Breastfeed on demand (or

cue)every time the baby

asks to breastfeed

Crying is a late sign of hunger.

Early signs that baby wants to breastfeed:

Restlessness

Opening mouth and turning head from side to side

Putting tongue in and out

Sucking on fingers or fists

P l b f ll


69/103

Postnatal newborn follow-ups

Postnatal follow-ups will be perform on day 2,

6, 13, 20, 27, 34, 41, 48 and 49

CRF 4 will be filled on each follow-up

Danger sign: Not able to feed since


70/103

Danger sign: Not able to feed since

birth, or stopped feeding well If the baby is not able to suckle at the breast

even when the mother has tried to put the babyto the breast several times over a few hours, thisindicates the baby may have a severe illness, andis therefore a danger sign. You have alreadyobserved the baby at the breast while trying to

help the mother initiate and sustainbreastfeeding.

If the mother tells you that the baby was feedingwell after birth but has stopped feeding well now,this indicates that the baby may have a severeinfection. This is also a danger sign.

A baby with a danger sign should be referred to ahealth facility immediately. If the CHW finds adanger sign, there is no need to spend time tocomplete the rest of the assessment; instead theCHW should make urgent arrangements forreferral.

Danger sign: Convulsions or fits


71/103

Danger sign: Convulsions or fits

A convulsion or fit indicates severeillness in the baby and is therefore adanger sign.

During a fit, the baby's arms and legsmay become stiff. The baby may stopbreathing and become blue. Manytimes there may only be a recurringmovement of a part of the body, suchas twitching of the mouth or blinkingof eyes.

When you ask the mother "Has the

baby convulsed or fitted since birth?"and she says yes, this is a dangersign. If she does not understand whata fit is, explain. If she says the babydid not have a fit, do not ask anyfurther questions.

D i F t b thi


72/103

Danger signs: Fast breathing

Fast breathing: Counting breaths the newborntakes in one minute

What is a full breath?

Breathing is taking air in and out of the body

through the mouth or nose. Breaths can be counted

by looking at the breathing movements. The chest

and abdomen move out when we breathe in, andmove in when we breathe out. One outward and

inward movement of the chest and abdomen

together makes one breath.

What is fast breathing in a newborn

If the breathing rate of a newborn is 60 per minuteor more the first time, the

CHW should repeat the count.

If the second count is still 60 breaths per minute or

more, the newborn has "fast breathing", which is a

danger sign. A baby with fast breathing should be

REFERRED to a hospital.

How to count breathing rate in a


73/103

g

newborn?

Wait for the newborn to be calm (orsleeping). Do not count when the babyis breastfeeding.

Make sure that there is enough light tosee the breathing movements.

Gently lift the baby's shirt so you cansee breathing movements. The chestand abdomen rising and falling oncemakes one breath.

Watch a few breaths until you are surewhen the baby is breathing in and out.

Start the timer and count the breaths

for one full minute (until the final beep,which is at the end of one minute).

Record the number of breaths.

If there are 60 breaths per minute ormore, repeat the count and record thenumber of breaths counted the secondtime

What are the common errors in counting


74/103

g

breaths?

Counting when the baby is not calm or is breastfeeding Generating your own rhythm of respiratory movements

and not actually observing the abdomen of the baby

Counting for less than a minute and multiplying the result.It does not take account of irregular breathing which isnormal in newborn babies

Counting breaths loud and slower than the actualmovement of the abdomen

Counting up and down movements of chest and abdomen

as 2 breaths instead of one. Not repeating the count when the first count is 60 or more.

Danger signs:


75/103

g g

Chest in drawing

Normally the abdomen and chest moveout when the baby breathes in. Both

the upper and lower part of the chest

move out when the baby breathes in.

When the baby has a problem with hislungs, the LOWER chest wall goes IN

when the child breathes IN. At the

same time, the upper chest and

abdomen move out. You can therefore

see a groove forming between thechest and abdomen. Chest indrawing is

a danger sign. A newborn with chest

indrawing should be referred urgently

to a hospital.

why should the baby be calm and not


76/103

y ybreastfeeding when you look for chest

indrawing

Even normal babies can seem to have chest

indrawing when they are breastfeeding or arecrying. The baby should therefore be calm and

not breastfeeding when you look for chest

indrawing

H l k f h i d i


77/103

How to look for chest indrawing

: Steps in looking for chest indrawing To look for chest indrawing, the child must be calm. The

child should not be breastfeeding.

Ask the caregiver to raise the childs clothing above thechest just like while counting breaths.

Look at the lower chest wall when the child breathes IN.

For chest indrawing to be present, it must be clearly visibleand present at every breath.

If you see chest indrawing only when the baby is crying or

feeding, the baby does not have chest indrawing. If you areunsure, decide that the baby does not have chestindrawing.

Danger signs: High or very low


78/103

g g g ytemperature

WHY SHOULD A CHW MEASURE TEMPERATURE OF A NEWBORN?

In a previous unit, you learnt about the importance of keeping babies

warm. If a baby gets cold, he has problems in suckling at the breast, can

get sick easily and is more likely to die.

A well baby is neither hot nor too cold. When a newborn has a serious

infection, his body can become very cold. In some cases, the baby may

have fever instead. Thus, both very low temperature and high

temperature are danger signs indicating severe illness in a baby.

It can be difficult to tell whether the baby is too hot or too cold just by

touching them. The best way to knowing is to use a thermometer to

measure temperature.

Measuring temperature


79/103

Measuring temperature

Take thermometer out of the box, hold at broad end Wash the area from the tip of the thermometer extending 4 cm

(the length of half a finger), with warm (not hot) soapy water. Airdry thoroughly before using.

Press the "on" button once to turn the thermometer on.

Hold the thermometer upward and place the shining tip in thecentre of the armpit. Press the arm against the side of the baby. Donot change the position.

When you hear 3 short beeps, and the numbers stop changing,remove the thermometer (this will take a few minutes).

Remove the thermometer and read the number in the displaywindow. Record the temperature reading.

Turn the thermometer off; clean the shining tip with warm soapywater, air dry, and place it in the storage case.

Common errors in temperature


80/103

p

measurement

Thermometer not properly placed in the armpitso that the tip juts out at the other end of thearmpit of the baby.

Thermometer not held firmly in the armpit of thebaby.

Removing the thermometer from the armpitwithout hearing the three beeps, because you

think it has been there for a long time. Not recording the temperature immediately after

measuring it.

How to interpret temperature?


81/103

How to interpret temperature?

If a baby's temperature is:

38 0C or more: the baby has hightemperature (fever) -- this is adanger sign and the baby should beURGENTLY referred to a hospital fortreatment and care.

35.5 0C or less: the baby has verylow temperature and this is a dangersign and the baby should beURGENTLY referred to a hospital fortreatment and care.

A baby with temperature between

35.60C and 37.90C does NOT have adanger sign. However, the family of ababy with temperature between35.60C and 37.40C should bespecially counseled on keeping thebaby warm.

38.5

Danger signs: Movement


82/103

Babies often sleep most of the time, and this is not a

sign of illness. Observe the baby's movements whileyou do the assessment. If a baby does not wake upduring the assessment, ask the mother to wakehim/her.

A baby who is awake will normally move his/her armsor legs or turn his/her head several times in a minute ifyou watch him closely. If you see the baby moving onhis/her own, he/she does not have the danger sign

"Movement only on stimulation or no movement evenon stimulation".

If the baby is awake but does not move on his own,gently stimulate the baby by tapping or flicking thesole. If the baby moves only when stimulated and thenstops moving, he/she has a danger sign.

If the baby does not move at all even after stimulation,this is also a danger sign. A baby who cannot be wokenup even after several efforts to wake him/her up alsohas this danger sign.

A baby who moves only on stimulation or does notmove at all should be

URGENTLY taken to a hospital for care.

Danger signs: Movement

Danger sign: signs of local infection


83/103

Danger sign: signs of local infection

Most common local infections occur onskin, umbilicus and eyes. Pus andredness are signs of local infection. Youshould therefore look at the:

Umbilicus: Is there pus coming out ofumbilical stump? Is the skin around the

umbilical stump red? Skin: Are there skin boils filled with

pus? Look at the whole body includingthe back, armpits and groin area.

Eyes: Is pus coming out from the eyes?

Look at both the eyes. A baby with any local infection needs

treatment because local infection mayprogress to a severe infection if it is nottreated. Refer a baby with a localinfection to a health facility.

Some important to remember for


84/103

newborn


85/103

Parents Guide to Childhood


86/103

Immunizations

As parents, we all want our children to grow uphealthy and free from the effects of seriousdisease.

One of the easiest and most effective steps wecan take to help achieve this goal is to makesure that our children receive all the

recommended childhood immunizations It is strongly recommended that immunizing all

healthy children against the 10 vaccine-preventable childhood diseases.

Children who are immunized are not the only

ones to benefit from the protection thesevaccinations give. Immunizations alsocontribute to the well-being of everyone byreducing the chance for diseases to spread.

Why should my child be immunized?


87/103

Why should my child be immunized?

Children need immunizations (shots) to protect them fromdangerous childhood diseases.

These diseases have serious complications and can even killchildren.

Newborn babies have antibodies from their mothers and

are immune to many diseases. However, this immunity does not last and quickly wears off

in the first year of life.

By immunizing children at the recommended times, yougive their immune systems a chance to make protectiveantibodies that help fight against disease and illness.

Children who are not immunized run the risk of beingexposed to germs too strong for them to fight.

Are these diseases very serious?


88/103

Are these diseases very serious?

Today we might not think of these diseases asbeing very serious because, thanks to vaccines,

we don't see them as often as we used to.

But the fact is they still exist and may lead topneumonia, choking, brain damage, heart

problems, blindness and death in children who

are not protected.

Wh t di d i t?


89/103

What diseases do vaccines prevent?

Immunizations protect children against Diphtheria Tetanus (Lockjaw) Pertussis (Whooping cough)

Polio Measles Mumps Rubella (German measles) Haemophilus Influenzae Type B (Hib) Hepatitis B Pneumococcal infections

H h t d hild d?


90/103

How many shots does my child need?

The following vaccinations are recommended byage 5 and can be given in five visits to a doctor orpublic health clinic:

1 vaccination against BCG

15 times 2 polio drops

3 vaccinations against Hib

3 vaccinations against diphtheria, tetanus andpertussis (DTP)

3 vaccinations against hepatitis B

3 vaccination against Pneumococcal

2 vaccination against measles/mumps/rubella (MMR)

Can my child receive many


91/103

vaccinations at the same time?

Vaccines are as useful when combined with othervaccines as they are alone and carry no greater risk forharmful side effects.

In addition to being safe, there are two reasons forgiving children multiple vaccinations during the samevisit.

First, we want to immunize children early to protectthem at a time when they are more likely to becomesick.

Second, giving several vaccinations at one time meansfewer trips to your health care provider and may beless traumatic for your child.

Can my child be immunized if he or


92/103

she is sick?

Even if your child has a slight fever, cold or runnynose, upset stomach, ear infection, or is taking

antibiotics, he or she can still be immunized

safely. There is no greater risk of harmful events when

immunizations are given during a minor illness.

However, if a fever or other symptoms suggest a

moderate or serious illness, your child should not

be vaccinated until the symptoms improve.

Are the vaccines safe?


93/103

Are the vaccines safe?

Yes, very safe. But, like any medicine, they canoccasionally cause mild reactions for example, aslight fever, a sore arm or a mild rash that don't lastlong.

Serious reactions are rare, but they can happen.

Overall, vaccines are among our safest and mosteffective medicines, and most medical experts agreethat, for almost all children, the benefits of completeimmunization far outweigh the risks.

There are rare circumstances under which a childshould not receive certain vaccines, or should havevaccinations delayed. Your doctor will discuss thesecircumstances with you before giving the shots.

What will happen if my child doesn't


94/103

pp y

get the shots?

Maybe nothing, if your child is never exposed todisease.

But children are often exposed to diseases. Allbut one of these diseases (tetanus) are spread

easily from person to person. If your child has not had her shots and she is

around someone who has measles, whoopingcough or one of the other childhood diseases, she

will probably get sick, too. We are here to vaccinate the child, if your child is

not vaccinated

Is it important to keep a record of my


95/103

child's immunizations? An immunization record helps you and

your health care provider keep your

child on schedule by reminding you

when his next immunizations are due.

A record should be started when your

child gets his first shot and updatedeach time he receives an immunization.

This information will be helpful if you

move or change health care providers,

and will be needed when your child

starts day care or school.

Your child's immunization record should

be treated like a birth certificate or any

other important paper, stored in a safe

place where you can find it easily.

Have you heard that vaccine causes anyid ff t th i ?


96/103

side effects, are they serious?

Possible side effects Is that serious?Soreness, redness, or swelling at

the site of the injection

No, it will resolve with in few days and it is very

mild

Fever No, only occur in very few women and it will

resolve with in few days and it is very mild

Headache or body aches No, very rare and mild

Fatigue No, very rare and mild

All side effects are mild and reversible they

occur very rarely

RATHER

Any of the disease has very serious

consequences - death

Any myths related to vaccine?


97/103

y y

Myth

What do

you think,is it right

or wrong

Why not true?

Better hygiene and

sanitation will make

diseases disappear

vaccines are notnecessary?

Wrong

If we do not vaccinate our woman and children, the disease

will attack them - better hygiene, hand washing and clean

water help protect people from infectious diseases, many

infections can spread regardless of how clean we are.

Vaccine cause infertility,

children or woman who

are vaccinated are not

able to give birth to the

child?

Wrong

None of the vaccine has this side effects, many of you sitting

here and may be your family members, e may have received

the vaccine doses, you all have kid.

Have you heard of population of China, India and even Pakistan

if vaccine has this effect, than there were not so populated

Vaccine is against Islam

or religion?

Wrong Vaccine is not prohibited in any religion. All Islamic clerics and

scholars around the world, urged in the Fatwa that vaccine is

safe and it should be give to prevent the dangerous diseases.

Are immunizations costly?


98/103

Are immunizations costly?

Local health departments providesvaccinations for children at no cost or very low

cost

And will not deny childhood vaccinations forthose who cannot pay.

Care of Infants and Children


99/103

Care of Infants and Children

Infant and child follow-up


100/103

Infant and child follow up

Form 4a will be used to register all childrenbetween age 3-59 months, in the project

Child aged between 60 days to 6 months will

be followed every 15 days and CRF 5 will befilled

Child aged between 6 months to 59 months

will be followed every 2 months and CRF 6 willbe filled

History of illness in infants and children


101/103

History of illness in infants and children

CHW will ask the mother about history of any illness is lastfew days for which care was sought

The illnesses include Not feeding well/unable to feed

Convulsions

Lethargy/unconscious

Vomit everything

Cough Cold/running nose

Fast breathing

Fever

Hypothermia Skin pustules

Ear pain or discharge

Sore Throat

Diarrhea

Irritability

Urgent referral if the child has any


102/103

problem

Physician will fill CRF 7 after assessment of the child whether self referral or

referred by any CHW

Recommended complementary


103/103

feeding practicesAge Frequency(per day) Amount of food an averagechild will usually eat at each

serving (in addition to

breastmilk)

Texture(thickness/

consistency)

Variety

6 - 8

months

2 - 3 times

food

2 - 3 tablespoons Tastes up to

cup (250 ml)

Thick

porridge/pap

Mashed/

pureed

family foods

Breastfeeding

+

Staples (porridge, other local

examples) Legumes (local

examples) Vegetables/

Fruits (local examples)

Animal foods (local examples)9-11 months 4 times

foods and

snacks

cup/bowl (250 ml) Finely chopped

Family foods

Finger foods

Sliced foods

12-23 months 5 times

foods and

snacks

-1 cup/bowl (250 ml) Finely chopped

Family foods

Finger foods

Sliced foods

Note: If baby is

Not breastfed

Add 1-2 extra times

food and snacks

Add 1-2 cups of milk per day

Responsive/Active feeding Be patient and actively encourage your baby to eat

Hygiene Feed your baby using a clean cup and spoon never a bottle as this is difficult to clean and

mother and child health â€“ saving children lives

Documents