The current practice to give ventilation 40 per minute is by using chronograph.
Integrating Newborn Interventions into Community Case Management in Rural South Sudan: iCCM Plus_Alfonso Rosales_4.25.13
CORE Spring Meeting, April 2013Baltimore, MD
About 40% of deaths in children younger than 5 years occurred in theneonatal period, most often because of preterm birth complications(14%), intrapartum related complications (9%), and neonatal sepsis ormeningitis (5%).Average Density of Health Worker incountries with highest U5MR = 5.2 per10,000 pop22% of WHOrecommendationiCCMPlus is apriority
FormativeResearch• Literaturereview• KeyInformantInterviews• FocalGroupsDiscussionsTraining methodand tooldevelopment• 5-days initialtraining plusweeklysupportivesupervisionfor 3-months• iCCM PluspackageSupportiveSupervision• Completion ofdata captured• Medicineadministration• Medicine andequipmentstorage• Assessmentand follow-upof a sample ofsick child• Testing of onecomponent ofalgorithm
Newborn CareLook/AskIs the baby newly born?Is the baby crying?What To Do?• Dry the baby with a cleancloth and check to see if hismouth and nose are clear.• Place baby on the mother’sabdomen and cover with adry cloth, including thehead.• Dab the umbilicalcord, including the base ofthe cord, with 4%chlorhexidine• Initiate breastfeeding• Eye care- apply tetracyclineeye ointment within 1 hourIf the baby is not crying or breathingwell after drying, you will need to helpthe baby to breathe within the firstminute.Go to “Helping a Newborn Breathe”If YEStothesesignsInformation and images on this and following pages adapted from Helping Babies Breathe, American Academy of Pediatrics, 2010.
Helping a Newborn BreatheLook/Ask• Is the baby newly born?• Is the baby NOT crying?• This baby needs help to breathe.What To Do?Within one minute,• Keep the baby warm• Position the head• Aspirate (clean) the mouth andnose• Stimulate breathing by rubbingthe backIf baby is still not breathing well:• Ventilate with bag mask• Give 40 breaths per minute• Observe once per minute forcrying or breathingContinue until newborn is breathing well or declare as stillbirth ifthe there is no breathing within 10 minutes. All newbornsneeding help to breathe need urgent referral to a hospital orhealth center after they are breathing normally.IfYEStoANYSign
Preliminary assumption: based on these results CCM-relatedcontent of the iCCM Plus tool seems to be appropriate in thetraining of illiterate community-based staff with no healthbackground
Preliminary conclusions• Supervision approach seems tobe working– 100% referral forms @PHCU– In creased referral of ARI– HHP’s controlling stocks of drugs andequipment– Progressively fewer need on formassistance– Weekly Skype discussion vital• Challenges• Transportation• Due to distance weekly supervisionnon-feasible• Administrative issues• Referral forms need to be simplified• Language barriers