For reference: Pictures to stimulate discussion - Neonatal preventative factors

NEONATAL PREVENTATIVE FACTORS – DEALING WITH THE PROBLEMS’ ROOTS

1.    Keeping the baby warm:

Babies get cold very quickly, if not dried thoroughly at birth, then wrapped warmly and put inside the mother’s clothes to keep warm. Bathing the baby before one day old causes it to get very cold. Avoiding these things helps prevent hypothermia, and so helps prevent brain damage or death of the baby.

2.    Breast-feeding without other feeds for six months:

Doing this can mean that:

·         The baby is more less likely to die of diarrhoea.

·         The baby is much less likely to get malnutrition.

·         The baby is much less likely to die of infection.

3.    Having a good diet after 6 months:

A good diet means not only getting enough food, but also getting foods with proteins and vitamins, (milk; beans; fish; meat; nuts; fruit; vegetables; seeds.) This can deal with the root of problems in the following ways:

·         It makes the infant strong and much less likely to die of infection.

·         It makes the baby resistant to other deadly illnesses such as TB and diarrhoea.

4.    Living in an healthy living environment:

Particular attention in the living environment should be given to:

·         Avoiding too much smoke, which causes babies to die of croup or pneumonia

·         Avoiding coughing and spitting indoors, which helps prevent spread of TB and other coughs.

·         Having a very clean environment when the baby still has an umbilical cord scab, so that it does not die of tetanus.

·         Avoiding contamination of food with faeces or other germs, thus preventing diarrhoea and worms.

5.     Receiving immunisations and Vitamin A:

This is a really helpful way of preventing death of the infant or child from TB; Diphtheria; Whooping cough; Tetanus; or Hepatitis.

Additionally, Measles is a particular killer of young children, and measles vaccine plus Vitamin A supplement help prevent it.

Polio can cause the child to become partly paralysed, and immunisation prevents it happening.

6.    Drinking clean water and getting appropriate rehydration if diarrhoea:

Babies should be only breast fed up to 6 months. This very much erduces the chance of death from diarrhoea.

If the infant does get diarrhoea, safe ways of rehydrating include breast feeding, and, for infants over 6 months, use of boiled water, (or boiled rice water). These should be given with a cup and spoon, not a bottle, as it is difficult to clean a bottle thoroughly.

If Oral Rehydration Solution is available, and can be made with clean water, this is the best way to rehydrate in the presence of diarrhoea. 

For reference: Picture cards to stimulate discussion - Maternal Preventative factors

MATERNAL PREVENTATIVE FACTORS – DEALING WITH THE PROBLEMS’ ROOTS

1.    Going to Antenatal clinic:

This can help deal with the roots of problems in the following ways:

·         Checking BP helps prevent eclampsia

·         Tetanus injection stops the baby dying of tetanus

·         Taking iron prevents anaemia – and reduces likelihood of death from bleeding

·         Getting HIV check prevents HIV developing into AIDS – and helps plan to prevent transmission of HIV to the baby.

·         Getting checked for other sexually-transmitted disease – eg Chlamydia – gets infections treated and helps prevent complications such as premature labour.

·         Detecting problems such as breech presentation helps plan safe delivery.

·         Some women are more likely to bleed to death – eg those with placenta praevia or those in their 5^th and subsequent pregnancies. At ANC, they would arrange for these to deliver in hospital.

2.    Having a good diet:

A good diet is one where there is enough food, AND enough colour and variety in the food. This can deal with the root of problems in the following ways:

·         It prevents anaemia and reduces the chance of dying from bleeding.

·         It reduces the chance of infections, such as TB and other respiratory infections, as well as infections which cause diarrhoea and other illnesses.

·         It reduces the chance of premature birth, which may cause the baby to be damaged or to die.

·         It prevents chronic malnutrition, (which can cause a woman to be too small to deliver the baby.)

3.    Taking malaria precautions:

Pregnant women and children should sleep under nets which have been regularly dipped in insecticide. The community should have cleared standing water pools from the village. Doing these things will very much reduce the risk of malaria in pregnancy, preventing problems such as:

·         Malaria can kill mothers and babies

·         If it does not kill, it can lead to anaemia and more risk of death from bleeding.

·         It can also lead to premature birth.

·         Catching malaria makes you weak and unable to do things, and costs money to get treatment.

4.    Avoiding domestic abuse or neglect:

Avoiding abuse and extreme overwork in pregnancy can reduce the risk of:

·         Early labour.

·         Exhaustion, (which can increase especially of bleeding after delivery).

5.    Safe sexual behaviour:

Keeping faithful to your partner and using condoms will help prevent all sexually transmitted diseases – especially HIV. If already HIV positive, then taking HIV medication helps prevent AIDS, and reduces the risk of passing HIV to the baby.

6.    Having a skilled birth attendant in a Health Centre or hospital:

This help deal with the roots of problems in the following ways:

·         Women with obstructed labour get a caesarean so saving their lives.

·         Women who bleed can get treatments to save them.

·         The birth is conducted in a clean environment, and so prevents the woman or baby dying of infection.

·         If the placenta does not come out, it is often easily dealt with.

·         If the birth is not a straightforward head-first delivery, a caesarean can save the life of the mother and baby.

·         If the cord is cut cleanly, the baby will not die of tetanus.

7.    Going to Postnatal clinic:

This can deal with the root of problems in the following ways:

·         Infections will get treatment – especially infection of the womb, which can kill.

·         Getting the baby checked for HIV means the baby can get treatment if needed

·         Getting family planning help means not getting pregnant too soon, and reducing the risk of sexual and other infections by use of condoms.

8.    Practising family planning:

Family planning helps prevent getting pregnant when very young, or when you already have enough children, or when your most recent child is still a baby. This can help prevent the following serious complications:

·         Having more than 4 children significantly increases the risk of mothers dying from bleeding in labour.

·         Young girls are not fully developed and may not be big enough to deliver the baby, and so may die of obstructed labour.

·         Having too many children means you cannot feed and educate them all.

·         Malnutrition is a particular risk the more children you have under 5 years old.

9.    Community support and transport:

All of the above prevenatative activities will be more likely to happen, and more likely to be effective, if not just the women, but the men and the whole community supports each idea. Otherwise the women is fighting a difficult battle and trying to do it alone.

This increased awareness would also go along with the community being ready and prepared to give support such as transport to hospital to deal with problems if they happen.

For reference: Picture cards to stimulate discussion - Neonatal contributing factors

NEONATAL & INFANT CONTRIBUTING FACTORS – ROOTS OF SOME PROBLEMS

1.    Not keeping the baby warm:

Babies get cold very quickly, if not dried thoroughly at birth, then wrapped warmly and put inside the mother’s clothes to keep warm. Bathing the baby before one day old causes it to get very cold. These things lead to hypothermia, which can cause brain damage or death of the baby.

2.    Not breast-feeding for long enough:

Ideally the woman should breast-feed the baby for 6 months, without giving any other food. Not doing so can be at the root of problems because:

·         The baby is more much likely to die of diarrhoea

·         The baby is much more likely to get malnutrition, and then die of infection.

3.    Living in an unhealthy living environment:

Particular problems with the living environment can be:

·         Too much smoke, causing babies to die of croup or pneumonia

·         Coughing and spitting indoors, causing others to catch the germs – especially TB

·         Too much soil around, causing the baby to catch tetanus through its umbilical cord scab.

·         Contamination of food with faeces or other germs, causing diarrhoea and worms.

4.     Not receiving immunisations:

This can be at the root of problems because:

·         the baby can die from TB, Diphtheria, Whooping cough, Tetanus, Hepatitis

·         measles is a particular killer of young children, and measle vaccine plus Vitamin A supplement help prevent it.

·         Polio can cause the child to become partly paralysed.

·         Worms can cause the child to be weak and vulnerable.

5.    Drinking contaminated drinks:

River water often has germs which cause diarrhoea, and so bottle-feeds made with river water are an important cause of death from diarrhoea.

When the child already has diarrhoea, continuing to give contaminated fluids makes the problem worse, and the child gets dehydrated and can die.

For reference: Picture cards to stimulate discussion - Maternal contributing factors

MATERNAL CONTRIBUTING FACTORS – ROOTS OF SOME PROBLEMS

1.    Not going to Antenatal clinic:

This can be at the root of problems in the following ways:

·         Failure to check BP leading to eclampsia

·         No tetanus injection and baby dies of tetanus

·         Not taking iron, so becoming anaemic – and more likely to die from bleeding

·         Not getting HIV check, and so developing AIDS – both mother and baby

·         Not getting checked for other sexually-transmitted disease – eg Chlamydia – and going into premature labour. Premature babies can end up brain-damaged.

·         Not detecting problems such as breech presentation. Babies being born bottom-first in the community are more likely to die or be brain-damaged.

·         Some women are more likely to bleed to death – eg those with placenta praevia or those in their 5^th and subsequent pregnancies. At ANC, they would arrange for these to deliver in hospital.

2.    Having a poor diet:

The diet may be poor because there is not enough food, or not enough colour and variety in the food. This can be at the root of problems in the following ways:

·         It leads to anaemia which makes women weak and tired … and more likely to die from bleeding.

·         It increases the chance of infections, such as TB and other respiratory infections, as well as infections which cause diarrhoea and other illnesses.

·         It increases the chance of premature birth, which may cause the baby to be damaged or to die.

·         If long-term, then malnutrition can cause a woman to be too small to deliver the baby.

3.    Not taking malaria precautions:

Pregnant women and children should sleep under nets which have been regularly dipped in insecticide. The community should have cleared standing water pools from the village. This can be at the root of problems in the following ways:

·         Malaria can kill mothers and babies

·         If it does not kill, it can lead to anaemia and more risk of death from bleeding.

·         It can also lead to premature birth.

·         Catching malaria makes you weak and unable to do things, and costs money to get treatment.

4.    Being subjected to domestic abuse or neglect:

It is also an abuse to expect pregnant women to work too hard or carry heavy loads. Abuse can be at the root of problems in the following ways:

·         Working extremely hard in pregnancy can lead to early labour.

·         Exhaustion can increase risk of problems in labour, and of bleeding afterwards.

5.    Risky sexual behaviour:

This includes both unfaithfulness, as well as failure to use condoms – especially if HIV positive. Also, failure to take HIV medication risks developing AIDS, and risks passing HIV to the baby. All this can be at the root of problems in the following ways:

·         The mother may develop AIDS.

·         The baby may develop HIV or AIDS.

·         There may be premature birth, with brain damage or death of the baby.

6.    Not having a skilled birth attendant in a clean setting:

This can be at the root of problems in the following ways:

·         Women with obstructed labour can be left in labour too long, until they die of exhaustion or bleeding. (Or it is too late to get to hospital)

·         TBAs may give medicines which rupture the uterus and kill the woman.

·         Women who bleed are far from help, and simple treatments in hospital would have saved them.

·         If the woman gets dirt or germs inside her, (eg if the TBA has dirty hands and no gloves, or delivering on the ground with no sheet, or not being able to wash after birth), she can die of uterine infection.

·         If the placenta does not come out, the woman can die of bleeding.

·         If the birth is not a straightforward head-first delivery, the baby might die or be brain damaged.

·         If the cord is not cut cleanly, (eg with a razor blade cleaned in boiling water), the baby can die – eg of tetanus.

7.    Not going to Postnatal clinic:

This can be at the root of problems in the following ways:

·         Not getting treatment of any infections – some of which can kill

·         Not getting the baby checked for HIV means the baby can get AIDS

·         Not getting family planning help, so getting pregnant again

8.    Not practising family planning:

Family planning helps prevent getting pregnant when very young, or when you already have enough children, or when your most recent child is still a baby. This can be at the root of problems in the following ways:

·         Having more than 4 children significantly increases the risk of mothers dying from bleeding in labour.

·         Young girls are not fully developed and may not be big enough to deliver the baby, and so may die of obstructed labour.

·         Having too many children means you cannot feed and educate them all.

·         Malnutrition is a particular risk the more children you have under 5 years old.

For reference: Picture cards to stimulate discussion - Neonatal problems

NEONATAL PROBLEMS

1.    Neonatal problem: Infection - including tetanus

Sign & symptoms can include that the baby is:

·         Limp

·         Refusing to feed

·         Having difficulty breathing

·         Yellow

·         Very hot … or very cold

The umbilical cord might:

·         Be red around the base

·         Be swollen

·         Have a foul-smelling discharge

2.    Neonatal problem: Pre-term birth – when the baby is before at 8 months or before

Sign & symptoms can include that the baby is:

·         Very small

·         Red in colour

·         Covered in fine hair

·         Floppy and cannot feed well

·         Breathing too fast, and cannot breathe well

·         Getting cold easily

3.    Neonatal problem: Neonatal asphyxia

Sign & symptoms can include that the baby is:

·         Pale, floppy and not properly conscious

·         Gasping irregularly

·         Having convulsions

·         Unable to suck

4.    Neonatal problem: Diarrhoea

Sign & symptoms can include that the baby:

·         Is passing stool frequently

·         Is passing stools that are very yellow or watery

·         Is passing stools with blood in them

·         Is initially crying, later drowsy

·         Later still has a dry mouth, dry skin and a sunken fontanelle

5.    Neonatal problem: Pneumonia

Sign & symptoms can include that the baby:

·         Is short of breath, and making a lot of effort to breathe

·         Is coughing

·         Has a high fever

·         Gets cold sweats accompanied by shaking

·         Cannot feed well

  

6.    Neonatal problem: Hypothermia

Sign & symptoms can include that the baby is:

·         Cold and limp

·         Unable to feed properly

·         Drowsy, crying quietly or not at all, or even unconscious

NEONATAL & MATERNAL PROBLEMS

1.    Neonatal and/or maternal problem: HIV AIDS

Sign & symptoms can include:

·         Losing weight, generally unwell

·         Susceptible to infections

·         Suffering from an infection that does not respond to treatment

Note that for months or even years, there may be no symptoms, and that the only way to know for sure is to have the HIV test

2.    Maternal and neonatal problem: Malnutrition

Sign symptoms can include:

·         Being thin

·         But sometimes children ae swollen, with swollen hands, feet, and tummy

·         Especially in children, the skin may have depigmentation, and the hair may turn reddish

3.    Maternal and neonatal problem: Malaria

Sign symptoms can include that the affected person:

·         Has a high fever and shaking

·         Sometimes goes cold and sweaty and feels very cold

·         Unlike uterine infection, has headache and pains in the joints or whole body

·         Feels weak and ill

·         Vomits

·         Maybe has convulsions – very similar to meningitis

If the only sign is fever, especially with headache, treat as malaria … but in neonates you might also want to treat for meningitis.