Lady Health Workers Guide
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Lady Health Workers Guide Document Transcript

  • 1. © 2007 MKFC Stockholm College Lady Health Workers Guide Lady Health Workers Guide
  • 2. © 2007 MKFC Stockholm College Lady Health Workers Guide contents 3 our Pakistan – 8 How to avoid – what should we know our community takes action 8 20 days cord care is needed 3 current situation 3 Health Care System in Pakistan 9 vaccination / immunization 3 Lady Health Workers 9 immunization 3 Improving family and community practices 9 Why, When, Where 3 National Program for Family Planning and Primary Health Care 9 Immunization is urgent 3 Childhood mortality is high in Pakistan 9 Age Immunizations to be given 3 Hiv/Aids 10 sterile needles 3 Women’s Health 10 secure the child’s life: vaccinate 3 Our Goals 10 Immunization protects against several dangerous diseases 10 Measles cause deaths 4 maternal care 10 Polio disables and children’s health 10 Breastmilk protects too 4 the major Problems causing neonatal death 10 Vitamin A – No blindness 4 mother and child health services needed 4 Guidelines for postnatal care (WHO 1998) 11 hygiene 4 Our Community makes the difference 11 hygiene Practice 11 Co-operation upon good. 5 better nutrition – for health and develoPment 11 clean Water 5 Challenges 11 Families and communities 5 Why breastfeeding 11 can protect their water supply 5 Breastfeeding benefits 11 Families can keep water clean in the home 6 good Practice With breastfeeding 11 Washing hands 6 Signs that the baby is in a good position for breastfeeding 6 Signs that the baby is feeding well 13 diarrhoea 6 Almost every mother can produce enough milk 13 Why diarrhoea is dangerous 6 Substitutes with clean water 13 Recommended drinks for a child with diarrhoea 7 the umbilical cord – hoW to Protect 14 no blindness – Wash the face 7 cutting the cord sterile 7 tie tightly before 7 Length of the cord stump: 2–3 cm 7 How to tie the cord 7 cord care – traditional Practices 7 Unclean substances dangerous 8 Traditional cord practices causes infections and death 8 signs of infection in cord 8 Clean hands are important! 8 neonatal deaths 2
  • 3. © 2007 MKFC Stockholm College Lady Health Workers Guide our Pakistan – our community takes action current situation implementation of different primary health Pakistan is a rapidly developing country. Rec c care activities. cently, big economic reforms have resulted in a stronger economic outlook and given growth Major challenges remain and childhood mortalc c especially in the manufacturing and financial ity and morbidity rates are unacceptably high services sectors. in Pakistan. Health Care System in Pakistan Hiv/Aids Health care in Pakistan is provided by both HIV is not a dominant epidemic in the adult public and private systems. population of Pakistan. Nevertheless, coupled with an extremely low awareness of HIV/AIDS Lady Health Workers in Pakistan, as well as a growing number of An example of a promising recent initiative is cases, the AIDS epidemic is poised to take a the lady health worker (LHW) communitycbased hold in Pakistan. The government estimates the program, which is bringing health information number of HIV/AIDS cases between 70,000 and to the communities. Presently, 3,000 women 80,000. are serving as LHWs in their home villages. Women’s Health The lady workers shall get training in checking The Government has signed CEDAW (Convenc c weight for age, management of the diarrhoea, tion on the Elimination of All Forms of Disc c counseling on breast feeding and nutrition. crimination Against Women) on 29 February, 1996, and CRC (Child Registration Certificate) Improving family and community practices and Health and Education issues have become Families have major responsibilities for caring important. their children. Improving family and commuc c nity practices is very important in the health Our Goals work: to reinforce practices that are important Our Pakistan is committed to the goal of for child survival. making population in Pakistan healthier, as evidenced by the continuing strong support National Program for for the Social Action Program (SAP) in the Family Planning and Primary Health Care government’s National Health Policy Guidec c The Implementation of the National Proc c lines up to 2010. gramme for Family Planning and Primary Health Care with a communitycbased approach is sound. Childhood mortality is high in Pakistan In the past progress has been made to reduce childhood mortality and morbidity through 3
  • 4. © 2007 MKFC Stockholm College Lady Health Workers Guide maternal care and children’s health The postnatal period (especially the first 24 • Sexually Transmitted Diseases hours) is the most critical time: twocthirds of (STD prevention) newborn deaths and also of all maternal deaths occur in this period. Maternal health problems For Children: are also widespread, complicated in part by frec c • Immunisation/vaccination. quent births. The fertility remains high, at 5.3 • Primary health care. births per woman, and population growth rates • Nutrition programme. are much higher than elsewhere in South Asia. • Providing free milk, monthly check up of weight, general conditions of children. • Of every 38 women who give birth, one dies. • The infant mortality rate is 101 per 1,000 and Guidelines for postnatal care (WHO 1998) • The mortality rate for children under age For the baby five is 140 per 1,000 births. Acute respiratory • immediate and exclusive breastfeeding infections and diarrhoeal diseases are the • warming of the infant leading causes of mortality. • hygienic care of the umbilical cord • Annually 500,000 children die from pneumoc c • identification of danger signs nia or diarrhoeal diseases. For the mother the major Problems • monitoring and referral for complications causing neonatal death such as excessive bleeding, pain, and infecc c Other than diseases, malnutrition causes many tion deaths. Malnutrition is not not eating enough. • counseling on breastfeeding You can be malnourished if you eat the wrong • advice on nutrition, newborn care practices foods – for example too much sugar or not and family planning enough vitamins. • Maternal and newborn postnatal care during the the first few days after delivery to imc c In 1987 Ministry of Health in Pakistan reported prove survival of both. 51.5% children under 5 years were chronically • A contact with health services malnourished. • Healthy household practices mother and child Our Community makes the difference health services needed: The underlying problems that affect For Mothers: health are poverty, illiteracy, women’s • Family planning and emphasis on small famc c low status, inadequate water supplies and ily norm. sanitation persist. • Antenatal care. • Postnatal care. The goal in our community is to take acc c • Safe mother hood. tion for better lives for all of us. • Promotion of breast feeding. 4
  • 5. © 2007 MKFC Stockholm College Lady Health Workers Guide better nutrition – for health and develoPment Better nutrition is a prime entry point to endc c Breastfeeding benefits ing poverty and a milestone to achieving better 1. Breastmilk alone is the only food and drink quality of life. Better nutrition means: an infant needs for the first six months. No other food or drink, not even water, is usuc c • stronger immune systems, ally needed during this period. • less illness and • better health. 2. There is a risk that a woman infected with HIV can pass the disease on to her infant Healthy children learn better. Healthy people through breastfeeding. Women who are inc c are stronger, are more able to create opportunicc fected or suspect that they may be infected ties to break the cycles of poverty and hunger. should consult a trained health worker for testing. Challenges • Poor nutrition contributes to 1 out of 2 3. Newborn babies should be kept close to deaths their mothers and begin breastfeeding • 1 out of 4 preschool children suffers from within one hour of birth. undercnutrition, which can severely affect a child’s mental and physical developc c 4. Frequent breastfeeding causes more milk ment to be produced. Almost every mother can • Undercnutrition among pregnant women breastfeed successfully. leads to 1 out of 6 infants born with low birth weight. 5. Breastfeeding helps protect babies and • Inappropriate feeding of infants and young children against dangerous illnesses. young children are responsible for onec third of the cases of malnutrition. 6. A woman employed away from her home can continue to breastfeed her child as ofc c ten as possible when she is with the infant. Why breastfeeding Babies who are breastfed have fewer illnesses 7. Exclusive breastfeeding can give a woman and are better nourished than those who are more than 98 per cent protection against fed other drinks and foods. pregnancy for six months after giving birth – if her menstrual periods have not rec c Almost every mother can breastfeed successc c sumed. fully. Those who might lack the confidence to breastfeed need practical support of the baby’s father and their family, friends and relatives. 5
  • 6. © 2007 MKFC Stockholm College Lady Health Workers Guide good Practice With breastfeeding Almost every mother can A newborn baby needs to remain in skinctocskin produce enough milk when: contact with the mother as much as possible. It • she breastfeeds exclusively is best for the mother and baby to stay together • the baby is in a good position and has the in the same room or bed. breast well in the mouth • the baby feeds as often and for as long Having the baby start to breastfeed soon after as he or she wants, including during the birth stimulates the production of the mother’s night. breastmilk. Many new mothers need encouragement and Breastmilk is the baby’s ‘first immunization’. It help to begin breastfeeding. Another woman helps to protect against diarrhoea, ear and who has successfully breastfed or a family chest infections and other health problems. member, friend or member of a women’s The protection is greatest when breastmilk breastfeeding support group can help a mother alone is given for the first six months and overcome uncertainties and prevent difficulc c breastfeeding continues well into the second ties. year and beyond. No other drinks or foods can provide this protection. How the mother holds her baby and how the baby takes the breast in the mouth are very Substitutes with clean water important. Using breastmilk substitutes, such as infant formula or animal’s milk, can be a threat to Signs that the baby is in infants’ health. This is particularly the case a good position for breastfeeding are: if parents cannot afford sufficient substicc • the baby’s whole body is turned towards tutes, which are quite expensive, or do not the mother always have clean water with which to mix • the baby is close to the mother them. • the baby is relaxed and happy. Signs that the baby is feeding well: • the baby’s mouth is wide open • the baby’s chin is touching the mother’s breast • more of the dark skin around the mothc c er’s nipple can be seen above the baby’s mouth than below it • the baby takes long, deep sucks • the mother does not feel any pain in the nipple. 6
  • 7. © 2007 MKFC Stockholm College Lady Health Workers Guide the umbilical cord – hoW to Protect The umbilical cord is a unique tissue in a huc c connected to the infant’s blood stream (Figure man body. It consists of two arteries and one 1); it therefore needs to be sterile to avoid infecc c vein. During pregnancy, the placenta supplies tion. all material for fetal growth and removes waste products. Blood flowing through the tie tightly before cord brings nutrients and oxygen to the fetus A sterile and sharp instrument, such as a new and carries away carbon dioxide and metabolic razor blade or scissors, is usually recommended wastes. for cutting the cord. Experience with a blunter instrument resulted in more vessel spasm and thus less blood loss. Using a blunt instrument could possibly result in an increased incidence of infection due to more trauma to the tissues. The cord must always be clamped or tied tightc c ly before cutting. Length of the cord stump: 2–3 cm The recommended length of the stump after cutting is usually 2 or 3 cm. The importance of keeping the cord clean and dry and of not letting it come in contact with urine and faeces should be explained to the family. How to tie the cord The cord must be always be tied or clamped at the baby’s side before the cutting, since leaving Figure 1: A transection of the abdominal wall: a cord it untied can cause excessive bleeding. stump with one vein (a) and two arteries (b) entering the abdominal wall cord care – traditional Practices A wide variety of traditional practices and When the cord stops pulsating, the umbilical beliefs are associated with care of the umbilical vessels are constricted but are not yet obliterc c cord. These traditional beliefs must be taken ated. Therefore the cord has to be tied/clamped into account when introducing clean cord care tightly in order to keep the umbilical vessels occ programmes in a community since these bec c c cluded and prevent bleeding. liefs may conflict with programme recommenc c dations. cutting the cord sterile To separate the newborn from the placenta, Unclean substances dangerous the cord must be cut. The instrument used cuts Some traditional practices such as applying through living tissue and vessels that are still unclean substances to the cord are dangerous 7
  • 8. © 2007 MKFC Stockholm College Lady Health Workers Guide and should be discouraged or replaced with must be treated as for severe bacterial infecc c safer alternatives. Practices will not change uncc tion and antibiotics should preferably be given less people are convinced that the new practice intravenously. The diagnosis of cord infection is indeed better. Some traditional practices are is uncertain: the cord may appear unusually beneficial and should be promoted, while othc c moist or smelly, with or without discharge, but ers may be ignored. there are no other signs. Sometimes there are no obvious outward signs of infection. Traditional cord practices causes infections and death Clean hands are important! • In some areas, no tie is used or the cord is The newborn baby has no protective flora tied only if bleeding occurs. This practice inc c at birth. Normal skin flora begin to be creases the risk of bleeding from the stump. acquired within 24 hours. The umbilicus is colonized by bacteria from environmental • A variety of tools are used to cut the cord. sources such as the mother and the hands They are usually items that are available of caregivers. in the house, or that relate to the father’s trade, such as scissors, knives, broken glass or stones. These are rarely cleaned or boiled bec c neonatal deaths fore use and are dangerous sources of infecc c Many infections that leads to death are due to tion. cord infections. In most cultures, some kind of substance is apc c How to avoid – what should we know plied to the cord stump. Ash, oil, butter, spice • Current medical practices regarding pastes, herbs and mud are substances that are when and how to cut the cord, commonly used. These substances are often • the length of the remaining stump, contaminated with bacteria and spores and • the choice of cord ties and the applicac c thus increase the risk of infection. One of the tion of antimicrobials on the stump are most dangerous practices is the application of identified. cow, chicken or rat dung to the stump; this is associated with a high risk of neonatal tetanus. 20 days cord care is needed The cord normally falls off between 5 and In many cultures it is common to bind the newcc 15 days after birth. After the cord separates, born’s abdomen with cloth or bandages. This the umbilicus continues to elaborate small practice keeps the stump moist, thus delaying amounts of mucoid material until complete healing and increasing the risk of infection, healing takes place, usually a few days after especially if the material used is unclean. separation. During this time the umbilicus is still susceptible to infections, although less so signs of infection in cord than in the first 2–3 days. Infection may delay When the newborn has systemic signs of infecc c healing, causing the umbilicus to stay moist for tion such as fever, lethargy or poor feeding, it longer periods. 8
  • 9. © 2007 MKFC Stockholm College Lady Health Workers Guide vaccination / immunization Children who are immunized are protected • It is safe to immunize a child who has a from these dangerous diseases. All children minor illness, a disability or who is malnourc c have the right to this protection. ished. immunization • All pregnant women need to be protected Every girl and boy needs to be immunized. And against tetanus. Even if the woman was imc c pregnant women need to be immunized to proc c munized earlier, she may need additional tect themselves and their infants. tetanus toxoid vaccinations. Why, When, Where • Disease can spread quickly when people It is essential that all parents know why, when, are crowded together. All children living in where and how many times the child should be congested conditions, particularly in refugee immunized. Parents also need to know that it or disaster situations, should be immunized is safe to immunize the child even if the child immediately, especially against measles. has an illness or a disability or is suffering from malnutrition. Age Immunizations to be given Immunization is urgent! At birth Every child needs a series of immunizations BCG**, polio and, in some countries, hepatic c during the first year of life. It is essential tis B that infants complete the full number of immunizations – otherwise the vaccines 6 weeks may not work. DPT**, polio and, in some countries, hepatic c tis B and Hib • Immunization protects against several danc c 10 weeks gerous diseases. A child who is not immuc c DPT, polio and, in some countries, hepatitis nized is more likely to suffer illness, become B and Hib permanently disabled or become undernourc c 14 weeks ished and die. DPT, polio and, in some countries, hepatitis B and Hib • All children, including those who are disac c bled, need to be vaccinated. The vaccines 9 months work by building up the child’s defences Measles (12c15 months in industrialized against disease. Immunization only works if countries) and, in some countries, yellow given before the disease strikes. fever, mumps and rubella. 9
  • 10. © 2007 MKFC Stockholm College Lady Health Workers Guide *National immunization schedules may difc c Polio disables fer slightly from country to country. All children, everywhere, need to be immuc c **BCG offers partial protection against some nized against polio. The signs of polio are a forms of tuberculosis and leprosy; DPT proc c floppy limb or the inability to move. For every tects against diphtheria, pertussis (whoopc c 200 children who are infected, one will be disacc ing cough) and tetanus. bled for life. sterile needles Breastmilk protects too A new or sterile needle and syringe must be Breastmilk and colostrum, the thick yellow used for every person being immunized. People milk produced during the first few days after should insist on this. birth, provide protection against pneumonia, diarrhoea and other diseases. Protection lasts secure the child’s life: vaccinate for as long as the child is breastfed. Immunization protects against several dangerous diseases Vitamin A – No blindness A child who is not immunized is more likely to Vitamin A helps children fight infections and suffer illness, become permanently disabled or prevents blindness. Vitamin A is found in become undernourished and die. breastmilk, liver, fish, dairy products, some orange and yellow fruits and vegetables, and Immunization protects children against some some green leafy vegetables. In areas of vitacc of the most dangerous diseases of childhood. min A deficiency, children aged six months All children, including those who are disabled, and older should be given vitamin A capsules need to be vaccinated. A child is immunized by or liquid when they are immunized or during vaccines, which are injected or given by mouth. National Immunization Days. Vitamin A is also The vaccines work by building up the child’s an important part of measles treatment. defences against disease. Immunization only works if given before the disease strikes. More than half of all illnesses and deaths among young children are caused by germs Measles cause deaths that get into their mouths through food or wac c All children need to be immunized against ter or dirty hands. Many of these germs come measles, which is a major cause of malnutricc from human and animal faeces. tion, poor mental development, and hearing and visual impairments. The signs that a child has measles are a fever and rash that have lasted for three days or more, together with a cough, a runny nose or red eyes. Measles can cause death. 10
  • 11. © 2007 MKFC Stockholm College Lady Health Workers Guide hygiene hygiene Practice • Only use water that is from a safe source or Many illnesses, especially diarrhoea, can be is purified. Water containers need to be kept prevented by good hygiene practices: covered to keep the water clean. • putting all faeces in a toilet or latrine; • washing hands with soap and water or ash clean Water and water after defecating or handling chilcc Only use water that is from a safe source or is dren’s faeces, and before feeding children or purified. Water containers need to be kept covc c touching food; and ered to keep the water clean. • ensuring that animal faeces are kept away from the house, paths, wells and children’s Families and communities play areas. can protect their water supply by: • keeping wells covered and installing a handc c Co-operation upon good. pump Everyone in the community needs to work • disposing of faeces and waste water (especialc c together to build and use toilets and lac c ly from latrines and household cleaning) well trines, protect water sources, and safely away from any water source used for cookc c dispose of waste water and garbage. It is ing, drinking or washing important for governments to support • building latrines at least 15 metres away and communities by providing information on downhill from a water source lowccost latrines and toilet facilities that all families can afford. In urban areas, governc c Families can keep water clean in the home by: ment support is needed for lowccost sanitac c • storing drinking water in a clean, covered tion and drainage systems, improved drinkc c container ing water supply, and garbage collection. • avoid touching clean water with unclean hands • taking water out of the container with a • All family members, including children, need clean ladle or cup to wash their hands thoroughly with soap and water or ash and water after contact Washing hands with faeces, before touching food, and before feeding children. All family members, including children, need to wash their hands thoroughly with • Washing the face with soap and water every soap and water or ash and water after concc day helps to prevent eye infections. In some tact with faeces, before touching food, and parts of the world, eye infections can lead to before feeding children. trachoma, which can cause blindness. 11
  • 12. © 2007 MKFC Stockholm College Lady Health Workers Guide Soap and water or ash and water should be placed conveniently near the latrine or toilet. • It is especially important to wash the hands after defecating and after cleaning the botcc tom of a baby or child who has just defecatc c ed. It is also important to wash hands after handling animals and raw foods. • Hands should always be washed before prec c paring, serving or eating food, and before feeding children. Children should be taught to wash both hands after defecating and bec c fore eating to help protect themfrom illness. Children often put their hands into their mouths, so it is important to wash a child’s hands often, especially after they have been playing in dirt or with animals. Children are easily infected with worms, which deplete the body’s nutrients. Children should not play near the latrine or toilet. Shoes should be worn near latrines to prevent worms from entering the body through the skin of the feet. Children living in areas where worms are common should be treated two to three times per year with a recommended anticc helmenthic medication. 12
  • 13. © 2007 MKFC Stockholm College Lady Health Workers Guide diarrhoea Diarrhoea is caused by germs that are swalc c Some people think that drinking liquids makes lowed, especially germs from faeces. diarrhoea worse. This is not true. • Diarrhoea kills children by draining liquid from the body, thus dehydrating the child. Recommended drinks As soon as diarrhoea starts, it is essential that for a child with diarrhoea: the child be given extra fluids as well as reguc c • breastmilk more often than usual lar foods and fluids. • soups • rice water • A child’s life is in danger if there are several wac c • fresh fruit juices tery stools within an hour or if there is blood • weak tea with a little sugar in the faeces. Immediate help from a trained • clean water from a safe source. If there health worker is needed. is a possibility the water is not clean, it should be purified by boiling or filtering. • Breastfeeding can reduce the severity and • oral rehydration salts (ORS) mixed with frequency of diarrhoea. the proper amount of clean water. • A child with diarrhoea needs to continue eating regularly. While recovering from diarc c Drinks should be given from a clean cup. A rhoea, the child needs at least an extra meal feeding bottle should never be used. every day for at least two weeks The child should be given extra liquids uncc • If the child is dehydrated with severe or perc c til the diarrhoea has stopped. sistent diarrhoea, only oral rehydration soluc c After 1 week revisit to health worker revisit. tion or medicines recommended by a trained health worker should be used. Diarrhoea usually stops after three or four days. If it lasts longer, caregivers should seek Why diarrhoea is dangerous help from a trained health worker. Diarrhoea kills children by draining liquid from the body, thus dehydrating the child. As soon as diarrhoea starts, it is essential that the child be given extra fluids as well as regular foods and fluids. A child has diarrhoea when he or she passes three or more watery stools a day. The more numerous the watery stools, the more dangercc ous the diarrhoea. 13
  • 14. © 2007 MKFC Stockholm College Lady Health Workers Guide no blindness – Wash the face Washing the face with soap and water every day helps to prevent eye infections. In some parts of the world, eye infections can lead to trachoma, which can cause blindness. A dirty face attracts flies, spreading the germs they carry from person to person. The eyes may become sore or infected and vision may be imc c paired or lost if the eyes are not kept clean and healthy. 14