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51 Cards in this Set
- Front
- Back
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Newborn Care Should be part of ___?
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Should be part of a continuum with prenatal care (tetanus immunizations, iron/folic acid, nutrition/smoking advice)
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Newborn Care
What is the Most important infant health index ? |
BIRTHWEIGHT--Most important infant health index
WHO Goal: 90% of newborns with birth weight > 2500 gms. |
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Newborn Care - What are the Potential surrogates for birthweight to identify LBW?
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Potential surrogates for birthweight to identify LBW
1. Mid Arm Circumference 2. Mid Thigh Circumference 3. Foot Length |
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Newborn Care- How do Breast Nodules help in assessing LBW?
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Breast Nodule--card with 0.5 cm. diameter hole
Can combine with sole creases to separate LBW and prematurity |
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Newborn Care- What is a Green Breast Nodule Criteria?
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Nodule >0.5 cm. + sole creases > 1/3 length -->
GREEN (full term, normal weight) |
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Newborn Care- What is a Yellow Breast Nodule Criteria?
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Nodule <0.5 cm. + sole creases > 1/3 length -->
YELLOW (full term, low birth weight) |
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Newborn Care- What is a Red Breast Nodule Criteria?
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Nodule <0.5 cm. + sole creases < 1/3 length -->
RED (premature, low birth weight) |
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Newborn Care - what is in a Resuscitation Kit-?
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Resuscitation Kit--Aspirator bulb, gauze pieces (better than mouth-to-mouth due to HIV risks)
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Newborn Care - what is cord care?
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Cord care--Cut after cord stops pulsing
Use boiled or sterilized instruments (blade, scissors) to cut Clean with iodine or other disinfectant |
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Newborn Care - what is infant care?
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Infant care--Immediate cleaning (? reduce transmission HIV)
Wrapping in blanket for warmth Immediate breast feeding (bonding and maternal hemostasis) |
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Newborn Care what are the spring or balance beam colors?
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Spring or beam balance, marked with colors
Red-- < 2 kilos Yellow-- 2-2.5 kilos Green-- >2.5 kilos |
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Physical Exam Cards for Paramedical personnel
- what do the color codes indicate? |
Physical Exam Cards for Paramedical personnel
Color Coded indications for rapid referral: 1) Yellow Baby (jaundice) 2) Pale Baby (anemia) 3) Blue Baby (cyanosis) |
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Newborn Care - what should be on Birth Record Cards?
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Birth Record Cards
1) Should be made in duplicate for mother and health center 2) Document birth date & time, sex, parents, place of delivery, person conducting delivery, weight 3) May aid in obtaining birth certificate |
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Growth Reference Standards - What are the WHO Standards (2003) ?
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WHO Standards (2003) ; gathered from 8440 healthy
breastfed infants and young children from widely diverse ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and USA); all mothers of children selected breastfed and did not smoke Based on state of the art statistical methods |
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Growth Reference Standards - What is the National Center for Health Statistics (NCHS)?
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National Center for Health Statistics (NCHS)
Adapted in 1977, revised in 2000 by CDC Widely used in the US; percentiles based on standard deviations (“z-score”) (eg. 5th % = 2 S.D. below mean) |
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Growth Monitoring - What is weight monitoring?
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2) Weight monitoring
Spring balance APPROPRIATE TARING Nude or lightly clothed Quality control |
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Growth Monitoring - What is Height-monitoring?
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Height--wooden measuring board with headplate and footplate best
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Growth Monitoring - What is Frequency of Monitoring-?
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Frequency of Monitoring--Monthly through age 3 yrs.
Monitoring frequently available but grossly underutilized |
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Growth Monitoring - What is Recordkeeping?
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Recordkeeping
Child Health "Passport" (weight, immunizations, development) Fewer records lost if kept by MOTHER (or mother and clinic) |
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Growth Monitoring - What is the Gomez System?
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Interpretation--Weight for age
Gomez system (J Trop Ped 2:77, 1956) % wt. for age (WHO or CDC/NCHS) >90% = Normal nutrition 75-90% = Mild Malnutrition (1st degree) 60-75% = Moderate Malnutrition (2nd degree) <60% = Severe Malnutrition (3rd degree) |
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Growth Monitoring - what is Interpretation--Weight for age?
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Interpretation--Weight for age
Easiest to determine Varies by ethnic background (although not in red zone) Color coded charts most useful Weight GAIN more important than weight-for-age |
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Growth Monitoring - what is Weight-for-height?
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Weight-for-height: More difficult to determine and interpret
Waterlow scale (Bull W Heal Org 55: 489-498, 1977) Uses weight-for-height (wasting) and height-for-age (stunting), each scaled 0-3 as % of mean Can be determined with chart (columns marked with weight; colored bars above correspond to height) Compared to CDC/NCHS, the new WHO standards result in more stunting throughout childhood, more wasting in infancy, greater incidence of overweight |
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Growth Monitoring - what is the intervention?
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Intervention
INCLUDE MOTHERS IN MONITORING Acknowledge positive growth POINT OUT AND EXPLAIN CONCERNS ACTION REQUIRES COMMUNICATION |
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What is Global Immunization Vision and Strategy (GIVS)?
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In response to challenges in global immunization, WHO and UNICEF developed the Global Immunization Vision and Strategy (GIVS) in 2005. It replaced the former Expanded Programme on Immunization (EPI).
GIVS aims to assist countries to immunize more people, from infants to seniors, with a greater range of vaccines. GIVS is the first ever global ten-year framework to fight vaccine-preventable diseases through immunization. It covers the period 2006 to 2015. |
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What were Expanded Programme on Immunization (EPI) goals?
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EPI Program goal: 80% coverage with
BCG DPT #3 Polio #3 Measles Key Features 1) Integration in routine clinic activities 2) Interaction clinic and community to identify unvaccinated children |
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What are GIVS Goals for 2010 ?
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Increase coverage. Countries will reach at least 90% national vaccination coverage and at least 80% vaccination coverage in every district or equivalent administrative unit.
Reduce measles mortality. Globally, mortality due to measles will have been reduced by 90% compared to the 2000 level. |
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What are GIVS Goals for 2015?
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Sustain coverage.
Reduce morbidity and mortality. Ensure access to vaccines of assured quality. Introduce new vaccines. Ensure capacity for surveillance and monitoring. Strengthen systems. Assure sustainability. |
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Immunization Programs - Describe the Implementation
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Implementation
1) Check vaccination status at each monthly growth monitoring Family Register--useful to monitor population growth and describe regional BIRTH RATE Birth rate estimates are essential to: a) plan vaccines to be obtained b) compare with actual vaccination rate |
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Immunization Programs - What re the educational goals/
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EDUCATIONAL GOAL--AVOID MISSED VACCINATION OPPORTUNITIES
Mild illness is NOT a contraindication to vaccination Annual Surveys: Can be undertaken by clinics in collaboration with MOH, WHO Recommended to identify trouble areas, coverage rates By interview or checking records Small sample needed for valid results |
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Describe Vaccination Campaigns:
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Vaccination Campaigns:
Most successful if done on national level Especially useful if epidemic is occurring One to three day period, weekend, in series Include as many vaccines as possible |
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What is the Essential Drugs Model?
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Model list published by WHO, revised yearly since 1977 (208 drugs) to adapt to local situations
Today's list of 340 medicines treats such priority conditions as malaria, HIV/AIDS, tuberculosis, reproductive health and, increasingly, chronic diseases such as cancer and diabetes. |
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What is the goal of essential drug distribution?
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Goal is PYRAMIDAL DISTRIBUTION of essential drugs
Health post 10-15 Health center 40 District hospital 100 Referral hospital 200 |
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What are the Essential Drugs Recs?
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Recommendations:
1) Use generic names or standard WHO names (eg. INH) (Most essential drugs not patented) 2) Limitation in drug supplies is more economical, avoids duplication, and facilitates storage 3) Concise, accurate dosing--WRITE THE DOSE 4) Local physicians/authorities should decide level of expertise required for each drug 5) Quality Assurance--national drug regulatory authority, to work with drug procurement agencies |
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Choice of Essential Drugs based on:
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Choice of Essential Drugs based on:
Prevalence of Disease Training of Health Care Worker Cost Bioavailability Environmental/Storage Conditions Stability |
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What are the Essential Drugs other concerns?
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Other Concerns:
Most are SINGLE AGENT--Fixed combinations recommended only when dosing of each is acceptable and combination offers advantages (eg. TMP/SMX) 2) Previously determined dose range facilitates administration by HCW is precise dosing not needed (esp. for scored tablets) 3) FIRST LINE DRUGS and RESERVE DRUGS eg. TMP/SMX for minor infections Quinolone or Third Gen. Cephalosporin for resistant Salmonella, severe shigellosis, GC, nosocomial gram negative infections) |
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What are some educational goals of child health in developing countires?
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1) Vitamin A-Supplementation every 6 months, dietary counseling
2) Exclusive breast feeding for 4-6 months 3) Knowledge of ORT 4) Importance of vaccinations and growth monitoring |
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What is the WHO child health Intergrated management of childhood illnesses? (IMC)
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initiated in 1990
Algorithmic approach to clinical management of common childhood illnesses based on 4 steps. 1) assess 2) classify 3) identify treatment 4) counsel |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - Explain the Assess component |
ASK THE MOTHER WHAT THE CHILD’S PROBLEMS ARE
• Determine whether this is an initial or follow-up visit for this problem. CHECK FOR GENERAL DANGER SIGNS ASK: • Is the child able to drink or breastfeed? • Does the child vomit everything? • Has the child had convulsions? LOOK: • See if the child is lethargic or unconscious. • Is the child convulsing now? THEN ASK ABOUT MAIN SYMPTOMS: Does the child have cough or difficult breathing? |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - Explain the CLASSIFY component |
Classify COUGH or DIFFICULT BREATHING
What are the signs? • Any general danger sign or • Chest indrawing or • Stridor in a calm child Then CLASSIFY AS SEVERE PNEUMONIA OR VERY SEVERE DISEASE - RED PNEUMONIA - Yellow COUGH OR COLD - green |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - Explain the Treament component |
If red zone -
Give first dose of an appropriate antibiotic Refer URGENTLY to hospital* if yellow zone: Give oral antibiotic for 3 days If wheezing (even if it disappeared after rapidly acting bronchodilator) give an inhaled bronchodilator for 5 days** Soothe the throat and relieve the cough with a safe remedy If coughing for more than 3 weeks or if having recurrent wheezing, refer for assessment for TB or asthma Advise the mother when to return immediately Follow-up in 2 days if green zone: If wheezing (even if it disappeared after rapidly acting bronchodilator) give an inhaled bronchodilator for 5 days** Soothe the throat and relieve the cough with a safe remedy If coughing for more than 3 weeks or if having recurrent wheezing, refer for assessment for TB or asthma Advise mother when to return immediately Follow up in 5 days if not improving |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - What is the immunization schedule? |
Follow national guidelines
VACCINE Birth: BCG OPV-0 6 weeks: DPT+HIB-1 OPV-1 Hepatitis B1 10 weeks: DPT+HIB-2 OPV-2 Hepatitis B2 14weeks : DPT+HIB-3 OPV-3 Hepatitis B3 9 months: Measles* * Second dose of measles vaccine may be given at any opportunistic moment during periodic supplementary immunisation activities as early as one month following the first dose |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - what is VITAMIN A SUPPLEMENTATION recs? |
VITAMIN A SUPPLEMENTATION
Give every child a dose of Vitamin A every six months from the age of 6 months. Record the dose on the child’s card. |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - what is ROUTINE WORM TREATMENT? |
ROUTINE WORM TREATMENT
Give every child mebendazole every 6 months from the age of one year. Record the dose on the child’s card. |
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS - how do you counsel? |
TEACH THE MOTHER TO GIVE ORAL DRUGS AT
HOME Follow the instructions below for every oral drug to be given at home. Also follow the instructions listed with each drug’s dosage table. Determine the appropriate drugs and dosage for the child’s age or weight Tell the mother the reason for giving the drug to the child Demonstrate how to measure a dose Watch the mother practise measuring a dose by herself Ask the mother to give the first dose to her child Explain carefully how to give the drug, then label and package the drug. If more than one drug will be given, collect, count and package each drug separately Explain that all the tablets or syrup must be used to finish the course of treatment, even if the child gets better Check the mother’s understanding before she leaves the clinic |
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Issues of IMCI -
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complicate the primary
immunisation schedule if added as another vaccine routinely. To aid global efforts to control hepatitis B infection, an alternative strategy is the use of the vaccine in the early teenage years as part of a programme of immunisation early in the second decade of life, and, at least in Fife (in Scotland), this approach would be acceptable to parents and pupils.20 Such a programme could be expanded to include new vaccines to protect against diseases of adulthood such as the human papilloma virus (HPV) |
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Describe the Gomez Classification System
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Gomez Classification: The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations.
percent of reference weight for age = ((patient weight) / (weight of normal child of same age)) * 100 % of referenced wt for age >90% = Normal nutrition 75-90% = Mild Malnutrition (1st degree) 60-75% = Moderate Malnutrition (2nd degree) <60% = Severe Malnutrition (3rd degree) |
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Describe the Waterlow Classification System
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Waterlow Classification: Chronic malnutrition results in stunting. Malnutrition also affects the child's body proportions eventually resulting in body wastage.
percent weight for height = ((weight of patient) / (weight of a normal child of the same height)) * 100percent height for age = ((height of patient) / (height of a normal child of the same age)) * 100 |
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Describe the Waterlow Classification System
What is Normal |
Weight for Height (wasting) >90
Height for Age (stunting) >95 |
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Describe the Waterlow Classification System
What is Mild |
Weight for Height (wasting) 80-90
Height for Age (stunting) 90-95 |
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Describe the Waterlow Classification System
What is Moderate |
Weight for Height (wasting) 70-80
Height for Age (stunting) 85-90 |
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Describe the Waterlow Classification System
What is Severe? |
Weight for Height (wasting) <70
Height for Age (stunting) <85 |
