The document summarizes presentations from a malaria control conference. It discusses improving prevention of malaria in pregnancy through promoting early administration of IPTp-SP in the second trimester per WHO guidelines. It also discusses trends in anemia globally and programs to address it, focusing on integrated community case management of malaria. The final presentation discusses challenges determining gestational age for first IPTp-SP dose and importance of combining intermittent preventive treatment with folic acid and insecticide-treated bed nets to control malaria and anemia in pregnant women and children.
How to manage malaria in a outpatient clinic in ethiopiaDino Sgarabotto
This document provides guidance on managing malaria in an outpatient clinic in Ethiopia. It describes the different Plasmodium species that cause malaria, with P. falciparum being the most severe and life-threatening. For uncomplicated P. falciparum malaria, the first-line treatment is artemether + lumefantrine taken twice daily for 3 days. For severe or complicated cases, the treatment is intravenous quinine followed by a complete oral course of artemether + lumefantrine once the patient has improved. P. vivax is generally not life-threatening but should be treated with chloroquine, followed by primaquine to prevent relapse. Proper diagnosis, treatment, and
Antenatal care involves educating pregnant women, screening for health issues, monitoring the mother and fetus, and promoting well-being. The goal is to help women stay healthy and address any problems early. Focused antenatal care emphasizes quality over quantity by scheduling fewer visits and targeting screening and tests to high-risk women. It follows principles of being woman-friendly, convenient, and providing basic yet effective care through four scheduled visits between 8-38 weeks of pregnancy.
This document discusses preconception counseling, which aims to identify and address risks to a woman's health or pregnancy outcomes through preventative measures and management. It is important as it can improve reproductive health outcomes, reduce maternal morbidity/mortality, and prevent low birth weight, preterm birth, and infant mortality. Preconception care should be provided at various healthcare visits. The goals are screening for high-risk factors, medical/obstetric history, physical exam, and lab testing. Preventive measures include folic acid, maintaining a healthy weight, vaccinations, screening/treating infections, and managing chronic illnesses and addictions.
The document provides guidance on evaluating and managing pregnancy. Key points include:
1) Urine pregnancy tests can detect hCG hormone and have 99% accuracy when used correctly. Ultrasound is needed to confirm pregnancy location.
2) Risk factors like medical history, obstetric history, and current symptoms determine if a pregnancy is high or low risk. High risk pregnancies require specialized care.
3) Routine prenatal visits include checking vitals, fetal heart rate, size, and position. Labs and tests are interpreted to monitor mother and baby's health. Referrals are made for concerning issues or late pregnancy.
This document discusses antenatal care provided by Dr. Rushabh Mehta. It defines antenatal care as the systemic supervision of a woman during pregnancy, starting at the beginning of pregnancy until delivery. The aims of antenatal care include screening for high-risk pregnancies, preventing and treating complications, continuing medical surveillance, and educating mothers. Procedures during antenatal care visits include taking medical history, conducting examinations, performing routine tests, providing ultrasounds, and giving advice. The goals are a healthy mother and baby.
This document discusses the scientific basis for antenatal care. It outlines that antenatal care aims to promote, protect and maintain the health of the mother through regular checkups. During checkups, high-risk pregnancies are detected and treated. The document also discusses trends in antenatal care like a focus on community-based and integrated health services. Key components of antenatal care include history collection, examinations, screening tests, immunizations and nutritional supplementation.
This document discusses the use of insulin in managing hyperglycemia during pregnancy. It begins by defining failure to manage blood glucose levels through medical nutrition therapy alone as an indication for insulin therapy. Guidelines recommend starting insulin if targets are not met within 2 weeks of nutrition management or if safety and growth parameters like weight gain are not being met. The document reviews types of insulin including human and analog varieties, providing evidence that various insulins can safely achieve targets when used as part of a basal-bolus regimen individualized to the patient's condition and blood glucose levels. The overall goal of insulin therapy in pregnancy is to maintain blood glucose within defined targets to support fetal and maternal health.
This document outlines important aspects of antenatal care based on NICE/RCOG guidelines. It discusses the aims and timeline of antenatal visits, including initial screening and testing at 10 weeks to check pregnancy and general health. Regular checks are recommended to monitor pregnancy progress and detect any issues. The document also describes screening protocols for common conditions like anemia, gestational diabetes, and infections. Common symptoms are discussed along with lifestyle and treatment recommendations. Interventions not routinely needed are also noted.
How to manage malaria in a outpatient clinic in ethiopiaDino Sgarabotto
This document provides guidance on managing malaria in an outpatient clinic in Ethiopia. It describes the different Plasmodium species that cause malaria, with P. falciparum being the most severe and life-threatening. For uncomplicated P. falciparum malaria, the first-line treatment is artemether + lumefantrine taken twice daily for 3 days. For severe or complicated cases, the treatment is intravenous quinine followed by a complete oral course of artemether + lumefantrine once the patient has improved. P. vivax is generally not life-threatening but should be treated with chloroquine, followed by primaquine to prevent relapse. Proper diagnosis, treatment, and
Antenatal care involves educating pregnant women, screening for health issues, monitoring the mother and fetus, and promoting well-being. The goal is to help women stay healthy and address any problems early. Focused antenatal care emphasizes quality over quantity by scheduling fewer visits and targeting screening and tests to high-risk women. It follows principles of being woman-friendly, convenient, and providing basic yet effective care through four scheduled visits between 8-38 weeks of pregnancy.
This document discusses preconception counseling, which aims to identify and address risks to a woman's health or pregnancy outcomes through preventative measures and management. It is important as it can improve reproductive health outcomes, reduce maternal morbidity/mortality, and prevent low birth weight, preterm birth, and infant mortality. Preconception care should be provided at various healthcare visits. The goals are screening for high-risk factors, medical/obstetric history, physical exam, and lab testing. Preventive measures include folic acid, maintaining a healthy weight, vaccinations, screening/treating infections, and managing chronic illnesses and addictions.
The document provides guidance on evaluating and managing pregnancy. Key points include:
1) Urine pregnancy tests can detect hCG hormone and have 99% accuracy when used correctly. Ultrasound is needed to confirm pregnancy location.
2) Risk factors like medical history, obstetric history, and current symptoms determine if a pregnancy is high or low risk. High risk pregnancies require specialized care.
3) Routine prenatal visits include checking vitals, fetal heart rate, size, and position. Labs and tests are interpreted to monitor mother and baby's health. Referrals are made for concerning issues or late pregnancy.
This document discusses antenatal care provided by Dr. Rushabh Mehta. It defines antenatal care as the systemic supervision of a woman during pregnancy, starting at the beginning of pregnancy until delivery. The aims of antenatal care include screening for high-risk pregnancies, preventing and treating complications, continuing medical surveillance, and educating mothers. Procedures during antenatal care visits include taking medical history, conducting examinations, performing routine tests, providing ultrasounds, and giving advice. The goals are a healthy mother and baby.
This document discusses the scientific basis for antenatal care. It outlines that antenatal care aims to promote, protect and maintain the health of the mother through regular checkups. During checkups, high-risk pregnancies are detected and treated. The document also discusses trends in antenatal care like a focus on community-based and integrated health services. Key components of antenatal care include history collection, examinations, screening tests, immunizations and nutritional supplementation.
This document discusses the use of insulin in managing hyperglycemia during pregnancy. It begins by defining failure to manage blood glucose levels through medical nutrition therapy alone as an indication for insulin therapy. Guidelines recommend starting insulin if targets are not met within 2 weeks of nutrition management or if safety and growth parameters like weight gain are not being met. The document reviews types of insulin including human and analog varieties, providing evidence that various insulins can safely achieve targets when used as part of a basal-bolus regimen individualized to the patient's condition and blood glucose levels. The overall goal of insulin therapy in pregnancy is to maintain blood glucose within defined targets to support fetal and maternal health.
This document outlines important aspects of antenatal care based on NICE/RCOG guidelines. It discusses the aims and timeline of antenatal visits, including initial screening and testing at 10 weeks to check pregnancy and general health. Regular checks are recommended to monitor pregnancy progress and detect any issues. The document also describes screening protocols for common conditions like anemia, gestational diabetes, and infections. Common symptoms are discussed along with lifestyle and treatment recommendations. Interventions not routinely needed are also noted.
Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
This document discusses gestational diabetes mellitus (GDM). It defines GDM as glucose intolerance that begins during pregnancy and usually disappears after delivery. Risk factors for GDM include family history of diabetes, obesity, and previous GDM. Women at high risk should be screened between 16-18 weeks of pregnancy using a glucose challenge test, and all pregnant women should be screened between 24-28 weeks. Diagnosis is made if two or more values on an oral glucose tolerance test are abnormal. Management involves medical nutrition therapy, blood glucose monitoring, and possibly insulin therapy to control blood sugar levels and minimize risks to both mother and baby.
This document provides guidance on antenatal care during the second trimester of pregnancy. It discusses the goals and aims of antenatal care, the timing and frequency of visits, assessments and screenings to be performed, common discomforts experienced and their management, and counseling of patients. The key aspects covered are initial evaluation if the first visit is in the second trimester, ongoing assessments at follow-up visits, screening tests and their timing, and identifying and managing high-risk pregnancies.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
This document discusses diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
Skilled attendant or TBA
Transportation: Means and funds for transport in case of emergency
Money: Funds for delivery and emergency care
Blood Donor: Identified in case of emergency
Supplies: Clean delivery kit, clean cloths, warm clothes for baby
Danger Signs: Recognizing signs of complications and knowing when to seek care
Support: Who will care for family and do chores in woman’s absence
Companion: Who will accompany woman during labor and birth
40
Berhanu M
Interpersonal Skills
Build trust and rapport
Active listening
Respectful treatment
Ensure privacy and confidentiality
Informed choice and shared decision making
This document discusses the postpartum care of mothers who had gestational diabetes during pregnancy and their infants. It outlines that infants should be monitored for hypoglycemia after delivery and breastfeeding should be encouraged. Mothers' blood glucose levels should be checked within 48 hours to rule out diabetes, and a glucose tolerance test is recommended at 6-12 weeks postpartum since many women develop impaired glucose tolerance or type 2 diabetes. Ongoing education on weight management, family planning, screening and risk factor control is important given the high risk of future diabetes.
This document summarizes guidelines for the management of gestational diabetes mellitus (GDM). It discusses the prevalence and implications of GDM, diagnostic criteria, treatment approaches including lifestyle modifications and medication. Screening approaches and glycemic targets are outlined. The importance of active intervention through diet, exercise and medication to improve maternal and fetal outcomes is emphasized. Controversies in the Malaysian context regarding screening methods are also addressed.
This document contains lecture notes on various topics related to metabolism and digestive disorders. It discusses the different types and functions of metabolism. It provides an overview and classification of digestive disorders, focusing on the upper and lower gastrointestinal tract. It also covers specific digestive issues like gastrointestinal obstruction, cleft lip and palate, and infantile hypertrophic pyloric stenosis. Treatment options for various digestive disorders are presented.
This document outlines the key aspects of antenatal care (ANC), including its goals of ensuring a healthy birth for both mother and baby. ANC involves education, counseling, screening, and treatment throughout pregnancy. It can be managed by midwives or obstetricians. Visits should occur at least 4 times during pregnancy to monitor the health of the mother and fetus. Prenatal care screening includes medical history, exams, ultrasounds, and lab tests to check for infections, genetic disorders, and nutrition.
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
The goal in managing diabetes during pregnancy is to maintain near-normal glucose levels to decrease risks for the baby. This can be achieved through medical nutrition therapy and insulin as needed. Only certain insulins like NPH, regular human insulin, lispro and aspart are approved for use in pregnancy. Lispro and aspart are preferred over regular insulin as they provide better post-meal control with fewer side effects. Insulin dosing is adjusted throughout pregnancy based on weight and stage of pregnancy. Near-normal glucose levels are also important during delivery to prevent neonatal hypoglycemia.
This document outlines the objectives and procedures for antenatal care (ANC). ANC aims to promote the health of the mother and baby through periodic supervision from conception until delivery. It involves regular checkups to monitor health, detect risks, educate on nutrition and hygiene, and provide family planning advice. Checkups include medical history, exams of vital signs, abdomen, and fetal development. Tests evaluate conditions like anemia, infections, and gestational age. Women are classified as high or low risk depending on factors like age, height, previous complications. Records are maintained to track pregnancies and care received.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes and protects the health of the mother and baby, detects high-risk cases, and reduces mortality and morbidity.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly thereafter. High-risk cases have more frequent visits.
- The booking visit establishes gestational age and date through examinations and baseline investigations like blood tests and urine analysis.
- Subsequent visits include monitoring weight, blood pressure, urine, and fundal height. Scans are performed to check fetal development.
- Health education covers diet,
Antenatal care involves comprehensive health supervision and monitoring of a pregnant woman from conception until delivery. It aims to ensure the health of both the mother and fetus, and to detect and treat any complications early. Key aspects of antenatal care include regular checkups and assessments of medical history, weight, fetal growth and heart rate. Tests are also performed to monitor conditions like anemia. Education is provided about healthy lifestyle and common discomforts during pregnancy. The schedule of visits increases as the pregnancy progresses.
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
MEASURE Evaluation is a $180M USAID cooperative agreement to strengthen health information systems in countries so they can make better decisions. It coordinates with the Health Data Collaborative (HDC) as their goals overlap in improving collection, analysis and use of health data. MEASURE Evaluation monitors HDC working groups, shares project findings, and identifies joint activities. It collaborates, leads, and shares information with the HDC and countries through various activities to continue strengthening health information systems and sharing lessons learned.
São Tomé e Príncipe has two zones for petroleum resource management: the Joint Development Zone (JDZ) shared with Nigeria, and the Exclusive Economic Zone (EEZ). In the JDZ, four production sharing contracts have been signed for blocks 1, 2, 3, and 4, and exploration is underway. Revenue so far comes only from signature bonuses. The EEZ has not yet seen any petroleum activity but a legal framework is being approved to allow for exploration. São Tomé e Príncipe has also established a Revenue Management Law to ensure transparent and accountable use of future oil revenues through a National Oil Account.
Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
This document discusses gestational diabetes mellitus (GDM). It defines GDM as glucose intolerance that begins during pregnancy and usually disappears after delivery. Risk factors for GDM include family history of diabetes, obesity, and previous GDM. Women at high risk should be screened between 16-18 weeks of pregnancy using a glucose challenge test, and all pregnant women should be screened between 24-28 weeks. Diagnosis is made if two or more values on an oral glucose tolerance test are abnormal. Management involves medical nutrition therapy, blood glucose monitoring, and possibly insulin therapy to control blood sugar levels and minimize risks to both mother and baby.
This document provides guidance on antenatal care during the second trimester of pregnancy. It discusses the goals and aims of antenatal care, the timing and frequency of visits, assessments and screenings to be performed, common discomforts experienced and their management, and counseling of patients. The key aspects covered are initial evaluation if the first visit is in the second trimester, ongoing assessments at follow-up visits, screening tests and their timing, and identifying and managing high-risk pregnancies.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
This document discusses diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
Skilled attendant or TBA
Transportation: Means and funds for transport in case of emergency
Money: Funds for delivery and emergency care
Blood Donor: Identified in case of emergency
Supplies: Clean delivery kit, clean cloths, warm clothes for baby
Danger Signs: Recognizing signs of complications and knowing when to seek care
Support: Who will care for family and do chores in woman’s absence
Companion: Who will accompany woman during labor and birth
40
Berhanu M
Interpersonal Skills
Build trust and rapport
Active listening
Respectful treatment
Ensure privacy and confidentiality
Informed choice and shared decision making
This document discusses the postpartum care of mothers who had gestational diabetes during pregnancy and their infants. It outlines that infants should be monitored for hypoglycemia after delivery and breastfeeding should be encouraged. Mothers' blood glucose levels should be checked within 48 hours to rule out diabetes, and a glucose tolerance test is recommended at 6-12 weeks postpartum since many women develop impaired glucose tolerance or type 2 diabetes. Ongoing education on weight management, family planning, screening and risk factor control is important given the high risk of future diabetes.
This document summarizes guidelines for the management of gestational diabetes mellitus (GDM). It discusses the prevalence and implications of GDM, diagnostic criteria, treatment approaches including lifestyle modifications and medication. Screening approaches and glycemic targets are outlined. The importance of active intervention through diet, exercise and medication to improve maternal and fetal outcomes is emphasized. Controversies in the Malaysian context regarding screening methods are also addressed.
This document contains lecture notes on various topics related to metabolism and digestive disorders. It discusses the different types and functions of metabolism. It provides an overview and classification of digestive disorders, focusing on the upper and lower gastrointestinal tract. It also covers specific digestive issues like gastrointestinal obstruction, cleft lip and palate, and infantile hypertrophic pyloric stenosis. Treatment options for various digestive disorders are presented.
This document outlines the key aspects of antenatal care (ANC), including its goals of ensuring a healthy birth for both mother and baby. ANC involves education, counseling, screening, and treatment throughout pregnancy. It can be managed by midwives or obstetricians. Visits should occur at least 4 times during pregnancy to monitor the health of the mother and fetus. Prenatal care screening includes medical history, exams, ultrasounds, and lab tests to check for infections, genetic disorders, and nutrition.
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
The goal in managing diabetes during pregnancy is to maintain near-normal glucose levels to decrease risks for the baby. This can be achieved through medical nutrition therapy and insulin as needed. Only certain insulins like NPH, regular human insulin, lispro and aspart are approved for use in pregnancy. Lispro and aspart are preferred over regular insulin as they provide better post-meal control with fewer side effects. Insulin dosing is adjusted throughout pregnancy based on weight and stage of pregnancy. Near-normal glucose levels are also important during delivery to prevent neonatal hypoglycemia.
This document outlines the objectives and procedures for antenatal care (ANC). ANC aims to promote the health of the mother and baby through periodic supervision from conception until delivery. It involves regular checkups to monitor health, detect risks, educate on nutrition and hygiene, and provide family planning advice. Checkups include medical history, exams of vital signs, abdomen, and fetal development. Tests evaluate conditions like anemia, infections, and gestational age. Women are classified as high or low risk depending on factors like age, height, previous complications. Records are maintained to track pregnancies and care received.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes and protects the health of the mother and baby, detects high-risk cases, and reduces mortality and morbidity.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly thereafter. High-risk cases have more frequent visits.
- The booking visit establishes gestational age and date through examinations and baseline investigations like blood tests and urine analysis.
- Subsequent visits include monitoring weight, blood pressure, urine, and fundal height. Scans are performed to check fetal development.
- Health education covers diet,
Antenatal care involves comprehensive health supervision and monitoring of a pregnant woman from conception until delivery. It aims to ensure the health of both the mother and fetus, and to detect and treat any complications early. Key aspects of antenatal care include regular checkups and assessments of medical history, weight, fetal growth and heart rate. Tests are also performed to monitor conditions like anemia. Education is provided about healthy lifestyle and common discomforts during pregnancy. The schedule of visits increases as the pregnancy progresses.
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
MEASURE Evaluation is a $180M USAID cooperative agreement to strengthen health information systems in countries so they can make better decisions. It coordinates with the Health Data Collaborative (HDC) as their goals overlap in improving collection, analysis and use of health data. MEASURE Evaluation monitors HDC working groups, shares project findings, and identifies joint activities. It collaborates, leads, and shares information with the HDC and countries through various activities to continue strengthening health information systems and sharing lessons learned.
São Tomé e Príncipe has two zones for petroleum resource management: the Joint Development Zone (JDZ) shared with Nigeria, and the Exclusive Economic Zone (EEZ). In the JDZ, four production sharing contracts have been signed for blocks 1, 2, 3, and 4, and exploration is underway. Revenue so far comes only from signature bonuses. The EEZ has not yet seen any petroleum activity but a legal framework is being approved to allow for exploration. São Tomé e Príncipe has also established a Revenue Management Law to ensure transparent and accountable use of future oil revenues through a National Oil Account.
Presentation by Debbie Gueye, the PMI/Senegal Resident Advisor on the main players in international malaria control for Stomping Out Malaria in Africa's Boot Camp training.
The document discusses sulfonamides, which are antibacterial drugs that work by inhibiting folic acid synthesis in bacteria. It describes their mechanism of action, examples of specific sulfonamide drugs like sulfamethoxazole, and their use to treat conditions like urinary tract infections, pneumonia, and toxoplasmosis. It also covers trimethoprim-sulfamethoxazole combination therapy and potential adverse effects like rash, nausea, and blood disorders that can occur with sulfonamide use.
This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
Fever is an elevation of body temperature above the normal range of 36.6-37.2°C due to a resetting of the body's thermoregulatory system. It is not itself a disease but a response to infection or other pathogens. Studies show fever may be beneficial by aiding the immune system's response. Treatment focuses on staying hydrated and using measures to promote heat loss like wet clothes or baths. Homeopathy treats the individual patient rather than just the fever and matches a remedy based on all symptoms.
1) Normal body temperature is around 36.8°C orally, with variations throughout the day and based on factors like age, sex, and meal consumption. Common sites to take a temperature include the mouth, axilla, rectum and ear.
2) A fever is defined as a temperature above the normal daily variation that occurs with an increased hypothalamic set point. Types of fevers include continuous, intermittent, remittent, relapsing, and irregular.
3) Hyperthermia differs from fever in that the hypothalamic set point is unchanged, resulting in an uncontrolled rise in body temperature beyond what the body can dissipate. Causes include heat stroke, certain drug reactions, and
REVISED FOCUSED ANTENATAL CARE (FANC).pptxJustinMutua
The document outlines the WHO's Focused Antenatal Care (FANC) model and the new 2016 WHO ANC model. It provides details on:
- The components and aims of FANC, including 4 comprehensive antenatal visits between weeks 16-40.
- The contents and services provided in each of the 4 FANC visits.
- Key differences between the previous WHO FANC and ANC models.
- Recommendations of the new 2016 WHO ANC model, including a minimum of 8 contacts starting in the first trimester and interventions provided in each contact.
- Justification for the new 2016 model to improve safety, health system support, and the pregnancy experience.
Here are the key issues and concerns regarding malaria in the postpartum period:
- Women who live in malaria-endemic areas and their newborns are still at risk of malaria infection after delivery. Their immunity is lowered in the postpartum period, making them more vulnerable.
- Newborns born to mothers with malaria during pregnancy are at higher risk of low birth weight and malaria itself in the first few months of life due to loss of maternal antibodies.
- It is important that both mothers and their babies continue using preventive measures like insecticide-treated bed nets even after delivery to avoid malaria infection.
- Mothers must seek prompt treatment if they experience fever or other malaria symptoms during the postpart
Antenatal care aims to ensure a healthy pregnancy and delivery for both mother and baby. It involves regular checkups including medical history, examinations, tests and education. The document outlines the definition, goals, models and process of antenatal care. It discusses the traditional model involving monthly visits and a newer WHO model with a minimum of eight contacts. Key aspects of antenatal care covered include comprehensive maternity services, risk assessment, monitoring of mother and baby, and addressing issues that could impact pregnancy outcomes.
This document provides an outline for a lecture on antenatal care. It defines antenatal care, outlines its objectives and goals which include reducing maternal mortality and morbidity. It describes comprehensive maternity care and different models of antenatal care provision, including traditional and focused antenatal care. The document details the process of antenatal care, including history taking, physical examination, and assessment techniques.
The document provides information about antenatal advice presented by Ms. Komal ekare. It begins with objectives of the class which are to gain in-depth knowledge of antenatal advice and apply skills in clinical and teaching practice. It then defines antenatal care and discusses the aims, objectives, procedures for first and subsequent visits. It describes antenatal advice regarding diet, hygiene, drugs and provides general advice. It discusses values and drawbacks of antenatal care and limitations. It summarizes two research articles, one on knowledge and practices of antenatal care and another on maternal height as a predictor of vaginal delivery.
The document provides background information on the implementation of maternal, newborn, adolescent and child health care services in Myanmar using a continuum of care approach. It was developed in accordance with the National Health Plan and short term strategic plans for reproductive health, child health development and adolescent health development. The services were initially implemented in 10 townships in 2011 and have since expanded to 200 townships. The services are delivered through family-oriented, population-oriented, and individual-oriented channels and coordinated at the national and sub-national levels.
monitoring during pregnancy by diabetesasia.orgDiabetes Asia
Diabetesasia.org is your diabetes resource for asking queries, education, relating and distribution your private diabetes experience or those you care for.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
monitoring During Pregnancy by diabetesasia.orgDiabetes Asia
Monitoring during pregnancy for women with diabetes includes self-monitoring of blood glucose (SMBG), fetal monitoring, and other assessments. SMBG should ideally occur daily but if resources are limited, testing can begin at once weekly and increase to every 1-2 weeks in the third trimester. Target blood glucose levels are less than 95 mg/dl fasting and less than 140 mg/dl one hour after meals. Fetal movement counting and ultrasounds are used to monitor fetal growth and well-being. Additional assessments include blood pressure, urine tests, and biophysical profiles from 36 weeks onward.
This document provides an overview of a presentation on maternal and child health care programs in developing countries. It discusses key concerns like malnutrition, infection, and uncontrolled reproduction. It then outlines components of antenatal care like checkups, nutrition advice, immunizations and preparing for delivery. Maternal health issues like anemia and infections are addressed. The importance of family planning, neonatal care, and reducing mortality rates is also highlighted. Overall the document covers maternal and child health issues and programs in developing nations.
Second Trimester work up and Algorithms by Dr Pratima Mittal NARENDRA C MALHOTRA
The document provides guidance on antenatal care in the second trimester. It recommends ongoing assessments of the health of the mother and fetus between 14 to 28 weeks of gestation, including accurate dating, screening tests, and monitoring for potential complications. Regular visits allow for early detection and treatment of issues. Common discomforts of pregnancy like back pain, nausea, and constipation are also addressed.
This document provides information on antenatal care including definitions, objectives, components, strategies and high risk pregnancies. It begins with defining antenatal care and listing its objectives such as promoting mother and baby health, detecting high-risk cases, preventing complications, reducing mortality and morbidity.
Components of antenatal care include risk identification, preventing/managing pregnancy diseases, and health education. Strategies involve antenatal visits, prenatal advice, specific health protections, mental preparation and family planning. High risk pregnancies are identified based on maternal medical conditions, obstetric history, current pregnancy complications, and certain signs. The document outlines the steps for antenatal exams, tests, advice and identifying warning signs.
Prenatal care involves regular examinations and advice during pregnancy to monitor the health of the mother and fetus. It aims to screen for high-risk cases, prevent or treat complications early, provide health education, and discuss delivery plans. Preconception counseling identifies risks and optimizes health before pregnancy. Prenatal visits assess health status, growth, and provide preventative care. Postnatal care ensures the rapid recovery of both mother and baby and provides family planning services and education.
This document provides information about antenatal care. It discusses the aims of antenatal care including screening for high-risk cases, preventing or detecting complications, educating mothers, and discussing delivery plans. It describes the objectives, components, and process of antenatal care visits including history taking, examinations, investigations, health education, and monitoring for risks. Key aspects of antenatal care covered include physical examinations, lab investigations, health advice, and screening for conditions like preeclampsia.
The document discusses preconception care and antenatal care. Preconception care involves evaluating prospective mothers before pregnancy for medical conditions, genetic disorders, lifestyle factors, and counseling. The conduct of preconception care includes taking a history, examination, investigations, appropriate treatment, and health education. Antenatal care aims to deliver a healthy baby from a healthy mother through risk assessment, monitoring, treatment, and education during pregnancy. Key aspects of antenatal care include routine visits, assessments, identifying and managing risk factors, providing tetanus immunizations and malaria prevention, monitoring weight and fetal growth, and creating a delivery plan.
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DI SEGUITO SONO PUBBLICATI, AI SENSI DELL'ART. 11 DELLA LEGGE N. 3/2019, GLI IMPORTI RICEVUTI DALL'ENTRATA IN VIGORE DELLA SUDDETTA NORMA (31/01/2019) E FINO AL MESE SOLARE ANTECEDENTE QUELLO DELLA PUBBLICAZIONE SUL PRESENTE SITO
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Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
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Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
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1. Malaria Control: Improving
Health Outcomes for Mothers
and Children
CORE Group: Global Health Practitioner Conference
April 17th, 2015
2. Session Objectives
• PresentationTitle: Prevention of Malaria in Pregnancy: Promoting IPTp-SP Early
in the SecondTrimester
• Objectives: Define theWHO policy recommendation for use of IPTp-SP;
describe determination of gestational age through history, lab test and physical
exam, and discuss implications of the policy change at facility and community
levels
• PresentationTitle: Anemia:Trends, causes and programs to address it
• Objectives: Discuss trends in global anemia, major causes of anemia, and
programs to reduce anemia
• PresentationTitle: Integrated Community Case Management: Challenges and
Successes in Diagnosis andTreatment of Malaria in the iCCM and IMCI Platforms
• Objective: Understanding of challenges related to the integration and
updating of several disease-specific guidelines for integrated case management
3. Presenters:
Lisa Noguchi
MCSP Senior Maternal Health Advisor, Jhpiego
Rae Galloway
MCSPTechnical Lead in Nutrition, PATH
Michel Pacqué
MCSPTechnical Lead in Child Health, JSI
Jane Coleman
MCSP Malaria Program Officer II, Jhpiego
4. Prevention of Malaria in
Pregnancy: Promoting IPTp-SP
Early in the SecondTrimester
Update onWHO Policy Recommendations for IPTp-SP
Lisa Noguchi, CNM, PhD
on behalf of the Maternal HealthTeam
5. Objectives
At the end of this module learners will be able
to do the following:
• Define theWHO policy recommendation for
use of IPTp-SP
• Describe determination of gestational age
through history, lab test and physical exam
• Discuss implications of the policy change at
facility and community levels
6. Why is this an important topic? (1/2)
• WHO/AFRO recommended IPTp-SP (2004)
• 1st, 2nd and 3rd dose in SSA is 64%, 38% and 23% respectively*
• Far from universal coverage recommended by Roll Back
Malaria
• Negative consequences associated with malaria in
pregnancy
• Severe malaria, severe anaemia, pre-term delivery, maternal
death, and placental malaria
• Linked to intrauterine growth restriction, stillbirth, and
delivery of low birth weight (LBW) infants**
*WHO. World Malaria Report 2013. Geneva: World Health Organization; 2013.
**Aribodor DN, Nwaorgu OC, Eneanya CI, Okoli I, Etaga HO: Association of low birth
weight and placental malarial infection in Nigeria. J Infect Dev Ctries 2009, 3:620–623.
7. Why is this an important topic? (2/2)
• PreviousWHO guidelines recommended first
dose of IPTp-SP at 16 weeks
• Country guidelines often suggested quickening as
the “benchmark”
• Now need to re-educate MOHs, training
systems, providers, and community decision-
makers about importance of a dose as early
as possible in the 2nd trimester
8. WHO Policy Recommendation for IPTp-SP (1/3)
• Starting as early as possible in second
trimester, which begins at 13 weeks, IPTp-SP is
recommended for all pregnant women at each
scheduled antenatal care (ANC) visit until
the time of delivery, provided that the
doses are given at least one month apart
• SP should not be given during first trimester
of pregnancy; however, last dose of IPTp-SP
can be administered up to time of delivery
without safety concerns
9. WHO Policy Recommendation for IPTp-SP (2/3)
• Should ideally be administered as directly
observed therapy (DOT)
• Three tablets sulfadoxine/pyrimethamine (each tablet
containing 500mg/25mg SP)
• =Total required dosage of 1500mg/75mg SP
• Can be given on empty stomach or with food
• Should not be administered to women
receiving cotrimoxazole prophylaxis due to
higher risk of adverse events
10. WHO Policy Recommendation for IPTp-SP (3/3)
• WHO recommends
administration of folic acid
0.4mg daily
• This dose may be safely used
in conjunction with SP
• Folic acid at daily dose of
5mg or higher should not
be given together with SP
• Counteracts its efficacy as an
antimalarial
11. Side effects of IPTp-SP
• SP for IPTp generally very well
tolerated
• Mild and transient side effects
• N/V, weakness, dizziness
• Most side effects reported with
first dose of SP
• Tend to decrease with further
doses
• Should be discussed openly and
managed in the ANC clinic
12. Implementation of theWHO Policy:
Questions to Consider (1/2)
• What components of theWHO Policy may present challenges
to implementation and scale-up? How can these be resolved?
• Provider/patient barriers, logistics, procurement,
financing for additional doses
• What strategies can be developed to increase access to SP
without increasing risks, e.g., administration in 1st trimester or
inadvertent disclosure of HIV status (cotrimoxazole)?
• How can messages about IPTp be integrated into IEC about
early initiation of ANC / ANC?
• What role can community health workers, communities,
community leaders and other facilitators play in increasing
uptake of IPTp?
13. • Which cadres are competent to determine if gestational
age (GA) is less than 13 weeks and SP should not be
administered?
• Which cadres should be authorized to administer IPTp?
• Should some cadres have only limited authorization to
administer IPTp?
• e.g., when easy to ascertain that pregnancy is NOT 1st trimester
• What strategies can be used to ensure that all providers
are informed of the new policy on IPTp?
Implementation of theWHO Policy:
Questions to Consider (2/2)
14. Determination of Gestational Age (GA) for 1st
SP Dose in Pregnancy - History
• First day of last normal menstrual period
(LNMP)
• Quickening
- Primigravidas note quickening around
18 – 20 weeks
- Multigravidas ~16 weeks (or earlier)
• Potential problems
- LNMP may be uncertain
- Breastfeeding and progestin-only
contraception (can have anovulatory
vaginal bleeding/spotting)
- Quickening varies greatly among
individuals
15. Determination of GA for 1st SP dose in
pregnancy – Physical exam
• Assessment of GA needs to
consider multiple data sources
- Physical exam is just one component
• First trimester
- Uterus grows from lemon to orange
size
- Cannot be palpated abdominally
• Second trimester (13+ weeks)
- Uterus is size of grapefruit and can be
palpated abdominally above symphysis
pubis
NOTE: Pelvic (internal) exams are not
necessary to determine uterine size in 2nd
trimester, but may be needed for other care.
16. Determination of GA for 1st SP dose in
pregnancy - Other
• Pregnancy tests, if available/affordable, can confirm
pregnancy
• Symphysis-pubis fundal height (SFH) measurement
- Generally only used after 20 - 24 weeks’ gestation
• Ultrasound
- Can be superior to dating via LNMP or physical
examination, depending on clinical circumstances
- However
• Dating precision decreases with gestational age
• Controversial if all women should undergo U/S
• Ultrasound machines not universally available
17. Determining Uterine Size and GA (1/3)
• At the beginning of the second trimester (13
weeks), the top of the uterus is usually just
above the mother’s pubic bone (where her
pubic hair begins)
• At about five months (20-22 weeks), the top
of the uterus is usually right at the mother’s
bellybutton (umbilicus or navel)
18. Determining Uterine Size and GA (2/3)
• To feel the uterus, make sure the mother has
emptied her bladder
• Have the mother lie on her back with some
support under her head and ask her to bend
her knees, keeping feet flat on bed
• Explain to her what you are going to do (and
why) before you examine her abdomen
• Your touch should be firm but gentle
19. Determining Uterine Size and GA (3/3)
• Place fingers on the pubic bone and walk them
up the center of the abdomen until you feel
the top of her uterus (fundus) under the skin.
• It will feel like a hard ball
• You can feel the top by curving your fingers gently
into the abdomen
• Uterus palpated a few fingerbreadths above
the pubic bone is compatible with pregnancy
in the second trimester
20. Client Counseling about IPTp-SP (1/2)
• Women are used to starting SP later in pregnancy
• Counsel about importance of earlier dosing
• Malaria parasites can attack in first trimester
• If not cleared with SP, can affect placental development and
fetal growth early in pregnancy
• Women’s concerns must be addressed
• Take SP with or without food
• Folic acid 0.4 mg can be taken with SP
• Not harmful to woman or baby
• Can cause nausea, vomiting or dizziness, but short-lived
and subsides with further doses
21. Client Counseling about IPTp-SP (2/2)
• Pregnant women can receive SP at all
scheduled ANC visits
• Starting at 13 weeks
• As long as doses are at least one month
apart
• Can be taken up to the time of
delivery
22. Client Counseling about Iron/Folic Acid
• Iron and folic acid (IFA)
tablets should be given to
women at all ANC visits
• Folic acid can be taken at the
same time as SP
• WHO-recommended dose is
0.4mg
• Pregnant women should not
receive a dose exceeding 5mg
23. Client Counseling about MIP
• Don’t forget to provide LLIN as
early as possible in pregnancy, or
let her know where she can
obtain one!
• Advise return to facility for
danger signs: fever, headache,
N/V, fatigue, etc.
• Can be signs of malaria
• Must have diagnostic test for
malaria immediately and be treated
if positive
26. Trends in Maternal and Child
Anemia and Control Programs
Presentation at the Core Group
Conference,April 17, 2015
Rae Galloway
TechnicalTeam Lead for Nutrition
MCSP
27. Goals for the Presentation
• Definition,
consequences, causes
• Trends in anemia
• Anemia control &
coverage of
interventions
• Changes in anemia with
at-scale implementation
• What are “at scale”
implementation and
program components?
28. What is Anemia?
• Low hemoglobin in the
blood
• Hemoglobin is carried
in the blood by red
blood cells
• The function of
hemoglobin is to carry
oxygen from the lungs
29. Why is low hemoglobin a significant health
problem?
Oxygen is needed by
almost every cell in the
body to generate energy
(ATP) to support body
functions and life
At the center of
hemoglobin is iron (Fe)
which fixes oxygen in the
lungs
30. What are the consequences of anemia (lack of
oxygen or iron-dependent co-factors)?
• The early sign is fatigue
• The worst case is
cardiovascular arrest
and death
Others consequences:
• Low productivity
• Cognitive damage
• Poor maternal and birth
outcomes-post partum
hemorrhage, LBW
31. What are the causes of anemia?
• Direct causes
• Decreased production of
Hb and RBCs (nutrition
deficiencies), infectious
diseases (malaria,TB)
• RBC destruction
(malaria)
• RBC loss (helminths,
bacterial infections,
reproduction)
• Contributing causes
• Lack of knowledge about
diet and lack of access to
food with iron
• Environmental (lead)
• Poor sanitation and
hygiene
• Lack of access to
services (ANC and IPTp,
trained birth attendants,
bed nets)
32. WHO Guidance on Estimating the Public Health
Significance of Anemia
Anemia Prevalence
≥40%
20-39.9%
5-19.9%
0-4.9%
Public Health
Significance
Severe
Moderate
Mild
Normal
33. What progress are we making in reducing
anemia?
Changes in anemia in pregnant women have
been slow with only 5 out of 10 regions attaining
more than a 5 percentage point change from
1995 to 2011
Regions with≤5 ppts change:
• South Asia (53% to 52%)
• Central andWest Africa (61% to 56%)
• South Africa (34% to 31%)
34. 34
High Income, 1995: 23%High Income, 2011: 22%Central and Eastern Europe, 1995: 30%Central and Eastern Europe, 2011: 24%East and Southeast Asia, 1995: 34%East and Southeast Asia, 2011: 25%South Asia, 1995: 53%South Asia, 2011: 52%Central Asia, Middle East, and North Africa, 1995: 37%Central Asia, Middle East, and North Africa, 2011: 31%Central and West Africa, 1995: 61%Central and West Africa, 2011: 56%East Africa, 1995: 46%East Africa, 2011: 36%Southern Africa, 1995: 34%Southern Africa, 2011: 31%Andean and Central LAC and Caribbean, 1995: 37%Andean and Central LAC and Caribbean, 2011: 27%Southern and Tropical LAC, 1995: 43%Southern and Tropical LAC, 2011: 38%
35. Anemia in Children<5 years 1995 to 2011
The situation is even more alarming with a
decrease in anemia of more than five percentage
points in only three regions--South Asia (12
ppts), Central &West Africa (9 ppts), and East
Africa (19 ppts)
In southern Africa anemia in children increased
from 30% to 46%
36. How many African countries are tracking
maternal and child anemia (DHS)?
• No surveys (7):Angola, Chad, Eritrea, Kenya (women),
Namibia, Nigeria, Zambia
• One survey (10): Burundi, CapeVerde, DRC, Eq. Guinea, Kenya
(MIS-children), Mozambique, Sao Tome & Principe, Senegal,
Sierra Leone, Swaziland
• Two+ surveys (16): Benin, Burkina Faso, Cameroon, Congo
(Brazzaville), Ethiopia, Ghana*, Guinea, Lesotho*, Madagascar,
Malawi, Mali*, Niger, Rwanda,Tanzania, Uganda, Zimbabwe
(*increase in anemia)
36
37. What are the major anemia control
interventions?
• Three major interventions
will address the greatest
burden of the disease
• MIP (IPTp & ITNs)
• ITNs for children
• Nutrition improvement
(dietary & iron-folic acid
supplements)
• Deworming
37
38. What are the trends in coverage of these interventions where
severe anemia in pregnant women has decreased ≥80%?
Country Change in
severe
anemia
ITN/LLINs IPTp 90+ IFA Deworming
Madagascar 80% dec 50% any
46% ITN
48% any; 12% SP 8% 39%
Congo-Brazzaville 87% dec 64% any; 4% ITN 65% any drug;
16%
l’amodiaquine 3%
SP
2% NA
Malawi 89% dec 56% any; 50%
LLIN
78% any;
77% SP
32% 27%
Rwanda 93% dec 73% any; 72%
LLIN
NA 1% 39%
Uganda 100% dec 80% any; 71%
LLIN
66% any; 63% SP 4% NA
38
PROGRESS APPEARS TO BE FROM INCREASED COVERAGE
OF MIP
39. Clearly more can & should be done to increase
coverage of IFA with IPTp
A secondary analysis byTitaley, et al., 2010 of DHS from
19 malaria-endemic countries in sub-Saharan African
countries found:
• The combined effect of IFA and IPTp decreased the risk of
neonatal death by 24% (when women took≥90 IFA) and 18%
(when women took <90 IFA)
• There was no significant protection from neonatal death with
either IFA or IPTp alone
39
40. IFA & IPTp need to be fully complementary:
a word about getting the dose of folic acid right
• Folic acid is an essential nutrient for both humans and the
malaria parasite
• Humans cannot synthesize folic acid; they obtain it from the
diet or from supplements
• Pregnant women are given folic acid to meet increased needs
in pregnancy NOT to prevent neural tube defects which form
within 28 days after conception
• The malaria parasite obtains folic acid by de novo synthesis &
salvaging folic acid from the host (humans) so giving too much
folic acid helps malaria to thrive and multiply
40
41. Giving folic acid ≥5 mg increases risk of treatment
failure with SP in pregnant women (Ouma, et al., 2006)
Tx failure at 14 days with
SP and different doses of
folic acid (FA):
• Placebo: 13.9%
• 0.4 mg FA: 14.5%
• 5 mg FA: 27.1%
• There was no difference
in mean Hb in either FA
group
41
42. As a result of this study,WHO recommends a
dose of folic acid<5 mg
• This is not a problem in most countries which are giving a
combined IFA supplement containing 60 mg of iron and 400
mcg folic acid
• Are some countries still giving the 5 mg dose of folic acid—
yes!
• Countries should reduce stores of the 5 mg dose (which isn’t
needed to meet folic acid requirements) & transition to the
combined IFA supplement with the lower dose of folic acid
42
43. How can we improve programs and obtain at-
scale coverage?
• Get the dose & timing right (first trimester may be important
for IFA to improve birth outcomes)
• Deliver and monitor the integrated package (IPTp and IFA;
deworming?)
• Accurate forecasting & delivery of commodities
• Procure adequate numbers of IFA and SP based on estimated
numbers of pregnant women, not past use
• Counseling messages on why and when to take
• Reach coverage of >80%
43
44. What impact could these interventions have if they
were scaled-up?
Selected effects from controlled studies:
• 38% decrease in severe anemia with IPTp
• 56% decrease in overall anemia with improved iron
intake (IFA tablets; food) & decreased iron loss (deworming)
• 20-40% decrease in LBW with IPTp and 11-18% decrease in
neonatal and 5-19% of infant deaths (pauci- to multi-gravidae)
• 18% decrease in LBW with improved iron status of mothers
and 30-60% decrease in neonatal mortality when mothers take
IFA early in pregnancy and for 6 months
44
48. iCCM
• The good news
• Global Fund New Funding Model
• Challenges
• Fit into larger Health System/political ownership
• Financing and sustainability
• Technical “updates” – quality of care
50. Technical Updates and Quality of Care
Quality of care depends on how well
national guidelines as well as health worker
training and supervisory materials conform
to the most recent World Health
Organization standards.
51. Quality Assessment of Diagnosis and
Treatment of Malaria
Method:
• To assess the level of adherence to WHO standards,
we collected training and supervisory materials for
health workers in President’s Malaria Initiative (PMI)
countries and appraised them for adherence to the
standard WHO materials. Special attention was paid
to training in and use of diagnostics like rapid
diagnostic tests (RDTs) and assessment and
management of severe febrile diseases.
52. Methods
• Training and supervision materials voluntarily
provided by PMI countries
• Training materials from 13 countries and
supervision tools from 7 countries were reviewed
(out of the total 19 countries contacted).
53. Countries included
COUNTRY IMCI and or Malaria Tools Supervision Tools
1 ANGOLA N N
2 BENIN Y (IMCI) N
3 DRC Y (IMCI/CCM – NMCP) Y
4 ETHIOPIA Y (IMCI/CCM – NMCP) Y
5 GHANA N N
6 GUINEA N N
7 KENYA Y (IMCI) N
8 LIBERIA N Y
9 MADAGASCAR Y (IMCI) N
10 MALAWI Y (IMCI) Y
11 MALI Y (IMCI) Y
12 MOZAMBIQUE* Y (IMCI – NMCP) Y
13 NIGERIA Y (IMCI) N
14 RWANDA Y (IMCI) Y
15 SENEGAL Y (IMCI) N
16 TANZANIA (Zanzibar) N Y
17 UGANDA Y (IMCI/CCM – NMCP) N
18 ZAMBIA Y (IMCI) N
19 ZIMBABWE Y (IMCI) N
Total Received 14 8
Total Assessed 13 7
54. Methods
• Desk review
• Tools compared with most updated IMCI algorithms
• Incorporates diagnostic testing for malaria
• Particular attention to adherence to updated WHO
guidelines on diagnostic testing and management of severe
febrile illness
• Spreadsheet developed comparing specific steps in the
algorithm with what is contained in country training and
supervision materials
55. Questions not addressed by the study
• At the community level:
• How are CHWs doing?
• How often are they correctly diagnosing and treating
kids for malaria?
• What supply chain issues exist?
• How are CHWs trained?
• How do they maintain skills?
• case load, supervision, etc.
57. Classification of fever
• 12 countries defined fever correctly
• Mali: Fever defined only as measured axillary temperature >38 degrees C
A child will be considered as “having fever” if:
The child has had any fever with the current illness
The child feels hot
The child has an axillary (underarm) temperature of 37.5°C
(38°C rectal) or above
High fever is defined as a temperature of 38.5°C or above
58. Classification of fever
• 8 countries classified severe febrile illness in line with IMCI
guidelines
• Rwanda: Differentiates Severe Malaria from Very Severe Febrile Illness,
based on diagnostic test result
Severe febrile illness:
Fever plus
Any general danger sign (unable to drink or breastfeed;
vomits everything; convulsion(s); lethargic or unconscious)
And/or
Stiff neck
59. DiagnosticTesting for Malaria
Nine countries have introduced diagnostic testing for malaria in their fever algorithms
• Only four have instructions on how to perform an RDT
• Only two countries include instructions to perform an RDT when a child has
been identified as having anemia
WHO Guidelines for Parasitological/laboratory diagnosis of
malaria
Prompt parasitological confirmation by microscopy, or RDT, is
recommended in all patients suspected of malaria before
treatment is started.
Treatment solely on the basis of clinical suspicion should only be
considered when a parasitological diagnosis is not accessible or
will be delayed for more than two hours.
However, patients with suspected severe malaria, and other high
risk groups, should be treated immediately on clinical grounds.
60. Treatment of severe malaria
WHO recommendation: artesunate treatment for severe P.
falciparum malaria in children
Artesunate is preferred over quinine for the treatment of severe
P. falciparum malaria in children.
• Intravenous or intramuscular artesunate has been shown to
reduce significantly the risk of death from severe malaria
compared to intravenous quinine. Intravenous artesunate is
associated with a lower risk of hypoglycemia.
61. First-line drug for pre-referral treatment
of severe febrile disease
IMCI guidelines
Pre-referral treatments of choice: artesunate or
quinine
Benin Artesunate suppository
Democratic Republic of
Congo
Artesunate suppository
Ethiopia Artesunate suppository:
Kenya Quinine or parenteral artesunate or artemether
Madagascar Quinine
Malawi Quinine
Mali
IMCI: Quinine - NMCP: Artemether or Artesunate or
quinine
Nigeria Quinine
Rwanda Artemether
Senegal Quinine
Uganda Artesunate or Quinine or Artemether
Zambia Quinine
Zimbabwe Quinine
62. Management ofTreatment Failure
• Eleven countries addressed treatment failure
• Five have retesting with a RDT in the protocol
• Another 5 countries use a clinical diagnosis to re-classify the child
If fever persists after 2 days, or child returns within 14 days:
Do a full reassessment of the child.
If any general danger signs or stiff neck: treat for VERY SEVERE FEBRILE DISEASE – and refer to hospital.
If any cause of fever other than malaria: provide treatment for that cause.
If the fever has been present for 7 days: refer for assessment.
If there is no other apparent cause of fever:
o For children who were classified as having malaria:
◦ Do microscopy. If parasites are present and the child has finished a full course of the first line antimalarial,
give the second-line antimalarial, if available, or refer the child to a hospital.
◦ If you do not have a microscope to check for parasites, refer the child to a hospital.
DO NOT REPEAT the Rapid Diagnostic Test if it was positive on
the initial visit
o For children who had fever and were classified as having no
malaria:
◦ Repeat the malaria test. If a child has a positive malaria test, give
first-line oral antimalarial. Advise the mother to return in 3 days if
the fever persists.
63. Major findings
• In almost all countries assessed, there were one or more areas where
training materials significantly deviated from the most recentWHO
guidance
• In some countries, IMCI guidelines also deviated from national malaria
treatment guidelines
• Some of the disparities may be because national policies were last
updated before these new guidelines were issued
• Supervision tools appear to be available in only a minority of countries,
raising the question whether standardized supervision checklists are
used in some countries
• All countries should review and revise their guidelines and training
materials, as appropriate, to ensure they align with the latest WHO
guidance, and then on a regular basis thereafter
64. Questions for discussion
• What can NGOs do about “quality” as defined
earlier
• What are the biggest challenges and how can
NGOs with other partners approach them
67. KeyTake Aways
• Anemia is a prevalent and static public health problem in
women and children
• Delivering IFA and IPTp-SP to 80% of pregnant women will
improve maternal and newborn health and survival
• The dose of folic acid needs to be <5 mg to ensure the
effectiveness of SP as an anti-malaria
• iCCM needs to be integrated to malaria and maternal child
health program
• Updating guidelines, disseminating, and implementing is a stpe
by step process
68. Take Aways
• Decreasing the risk of severe negative perinatal consequences
from MIP requires initiation of IPTp-SP as early as possible in
the 2nd trimester.
• A comprehensive approach to accurate estimation of
gestational age is necessary for appropriate timing of IPTp-SP.
• Safely and effectively increasing uptake of appropriately timed
IPTp-SP will entail the engagement of a broad group of
stakeholders.
69. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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