PRIMARY LEVEL CARE OF THE

NEWBORN.
NASSIR DIIN H31/34849/2013
MWANGI K WANGARI H31/33964/2013
OBJECTIVES.
 Mother’s Health
 ANC attendance
 Delivery in a Health Facility
 Essential newborn care
 Kangaroo Mother Care
 Danger signs in the Newborn
 Major causes of the neonatal morbidity and mortality
 Role of the mother and the father.
 Role of the community midwife, the CHW and the CHEW
 Role of partners eg NGOs , FBOs and the community.
INTRODUCTION.
Primary level of care: This is the first point of contact
between individuals and the health care system. Primary level
of care ca be accessed through primary, secondary, and
tertiary health facilities.

Newborn: a child less than 28 days of age (2017)

(WHO) http://www.euro.who.int/en/health-
topics/Health-systems/primary-health-care/main-
terminology
IMPORTANCE OF THE NEONATAL PERIOD
IN CHILD MORBIDITY AND MORTALITY?
Every year nearly 41% of all under-five child deaths are
among newborn infants, babies in their first 28 days of life or
the neonatal period. (WHO)
Three quarters of all newborn deaths occur in the first week of
life
The majority - almost 3 million of these - die within one week
and almost 2 million on their first day of life.
Up to two thirds of newborn deaths can be prevented if
known, effective health measures are provided at birth and
during the first week of life
http://www.who.int/pmnch/media/press_materials/fs/fs_newbo
rndealth_illness/en/
GLOBAL CAUSES OF NEONATAL
DEATH
Please look for up to date information on this
NEONATAL MORTALITY IN
KENYA
MATERNAL HEALTH.
 This the health of a woman during pregnancy, child birth and post
partum period.
 Maternal death: death arising from pregnancy- or childbirth-related
complications (WHO)
 The maternal mortality ratio in Kenya stands at 362 deaths per 100,000
live births.(2014 Kenya Demographic and Health Survey)

 WHO: http://www.who.int/maternal-health/en/
 http://www.who.int/mediacentre/factsheets/fs348/en/
HOW DOES MATERNAL HEALTH
AFFECT NEONATAL OUTCOMES?
 In sub-Saharan Africa, an estimated 900,000 babies
die as stillbirths during the last twelve weeks of
pregnancy.
Babies who die before the onset of labour, or
antepartum stillbirths, account for two-thirds of all
stillbirths in countries where the mortality rate is
greater than 22 per 1,000 births – nearly all African
countries
Antepartum stillbirths have a number of causes,
including maternal infections – notably syphilis – and
pregnancy complications
HOW DOES MATERNAL HEALTH
AFFECT NEONATAL OUTCOMES? Contd.
Newborns are affected by problems during pregnancy
including preterm birth and restricted fetal growth, as
well as other factors affecting the baby’s development
such as congenital infections and fetal alcohol
syndrome
https://www.google.com/url?
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LEADING CAUSES OF MATERNAL
MORTALITY ()
Please look for up to date information on this
 ANC ATTENDANCE.(Focused antenatal
care model-FANC; WHO)
Antenatal care is the is the healthcare given to a pregnant woman from conception
to the onset of labor.
The aim of these ANC visit is to have a good outcome for the mother and the
unborn baby and prevent any complication that may arise during the pregnancy,
labor, delivery and postpartum period.
It is recommended that a pregnant woman should attend a minimum of 4
comprehensive personalized antenatal visits spread out during the entire
pregnancy during which specific focused activities are carried out to guide
the woman along the path of survival, , WHO as follows:
1st visit: less than 16 weeks
2nd visit: 16 - 28 weeks
3rd visit: 28-32 weeks
4th visit: 32 – 40 weeks
TRENDS IN ANC ATENDANCE
96% of women between 15 and 49 years who had live
births attended ante natal care and received services
from a skilled healthcare workers.
Only 4% of women reported not having attended ante
natal clinics

2014 Kenya Demographic and Health Survey

COMPONENTS OF GOOD ANTENATAL
CARE
WHO has 49 recommendations on good ANC care
which may be grouped into five topic areas
Nutritional interventions (14)
Maternal and Fetal assessment (13)
Preventive measures (7)
Interventions for common physiological symptoms (6)
Health systems interventions to improve the utilization
and quality of ANC (9)
DELIVERY IN A HEALTH FACILITY.
 Health-care facilities are hospitals, primary health-care centers,
isolation camps, burn patient units, feeding centers and others. In
emergency situations, health-care facilities are often faced with an
exceptionally high number of patients, some of whom may require
specific medical care (e.g. treatment of chemical poisonings). WHO
 Health delivery is important to maternal health care by ensuring safety
of the mother and the baby. In Kenya , the major challenge is
inadequate health personnel and lack of many well equipped facilities.
 Most health facilities in Kenya are understaffed with 48.6% having
fewer than 3 nurses/midwives.
 Therefore we are short of the WHO recommended one nurse/midwife
per 3 patients.
 http://www.who.int/environmental_health_emergencies/services/en/
BENEFITS OF DELIVERING IN A
HEALTHCARE FACILITY
Reduces maternal and neonatal mortality and
morbidity
Identification of danger signs, intervention and referral
for emergency care for mother and baby
Registration of the child
Improves maternal and newborn survival across al
ages
https://data.unicef.org/topic/maternal-health/delivery-
care/#
DELIVERY IN A HEALTH FACILTY.
(Cont.)
The Government of Kenya introduced a policy free delivery services in
government facilities which began June 2013.
Impact it had on facility based deliveries in Kenya : The number of deliveries
and antenatal attendance increased by 26.8% and 16.2% in county referral
hospitals and decreased by 11.9% and 5.4% respectively in low cost private
hospitals. (Kenya Health Information System)
 Six in ten live births were delivered in a health facility, 46% in the public
sector and 15% in the private sector. Still more than one-third of births
(37%) were delivered at home. (2014 KDHS)
 Delivery in a health facility increases with a woman’s education and wealth
 Health facility births are most common in urban areas (82%). More than
90% of births in Kirinyaga and Kiambu counties are delivered in a health
facility, while Wajir has the lowest rate of facility deliveries at 18% (2014
KDHS).
ESSENTIAL NEWBORN
CARE( ENC).
 This is the care that every newborn baby NEEDS regardless of where it
is born or its size and should be applied immediately after birth and
continued for the first 7 days of life. ( World Vision International)

 They are simple interventions carried out by a : skilled birth attendant

(SBA) , trained community health worker ( CHW) , or a traditional
birth attendant ( TBA)
TARGET BEHAVIOURS
 KEEP BABY WARM: caregivers and mothers make sure the newborn
baby is immediately dried after birth, placed on mothers abdomen,
covered with a clean towel/ cloth and a hat on the head. The baby is NOT
bathed for the first 24 hours.

 HELP BABY BREATHE: caregivers and mothers assist the newborn to

take its first breath by immediately rubbing its back and feet to
STIMULATE it to cry and by clearing the mouth if its having difficulty
in breathing.

 KEEP BABY CLEAN: wash hands before touching the newborn baby!
They then cut the umbilical cord with a clean blade, keep the cord area
clean and dry, apply chlorhexidine antiseptic as soon as possible and the
daily for 7 days.
TARGET BEHAVIOUR (cont).
 HELP BABY FEED: caregivers and mothers assist the newborn to
breastfeed within 1 hour of birth and make sure the baby receives the
first milk (colostrum) and exclusive breastfeeding for the first 6 months.

 HELP THE SMALL BABY SURVIVE: special care to the small baby
(preterms and LBW) by practicing ENC and Kangaroo mother care
(KMC).

 HELP PROTECT FROM HIV: newborns of a HIV positive mothers are

ensured to be brought to the facility for early infant diagnosis (EID)
testing at one month( by 4-6 weeks). To avoid needless deaths, ALL HIV-
exposed infants should be provided with ART and cotrimoxazole
immediately, until HIV status is known. Enroll life-long treatment if
positive.
TARGET BEHAVIOURS (cont.)
IF BABY IS BORN AT HOME: the mother should take the
baby to the health facility and first immunizations ( BCG, OPV )
should be administered.
KANGAROO MOTHER CARE
(KMC).
 It is defined as the early, prolonged continuous skin-to-skin contact between a
mother, or her surrogate, and her preterm baby or low birth weight infant.

 Key elements are:

POSITION: skin-to-skin on the mothers chest.

Secured with a wrap.

NUTRITION: exclusive breastfeeding whenever possible.

DISCHARGE: mother continues KMC practice at home after discharge.

SUPPORT: health care staff provide supposrt to the mother and her newborn
in the hospital. Family members offer their support during home KMC.
KANGAROO POSITION.
KANGAROO NUTRITION.
KANGAROO DISCHARGE.
KANGAROO SUPPORT.
BENEFITS OF KMC.
DANGER SIGNS OF THE
NEWBORN.
 FAST BREATHING
 SEVERE CHEST INDRAWING
 DIFFICULTY FEEDING OR SUCKING.
 FEVER (greater than 37.5 degrees Celsius)
 COLD TO TOUCH. (less than 35.5 degrees celsius)
 PROLONGED FITS OR CONVULSIONS.
 JAUNDICE
 RED SWOLEN EYELIDS AND PUS IN EYES.
 SWELLING/ REDNESS OF SKIN, PUS OR FOUL ODOUR AROUND THE
UMBILICAL CORD.
 CHILD LETHARIC OR UNCONSCIOUS
 CHILD VOMITS EVERYTHING
 DIARRHOEA
 SWOLLWN LIMB OR ABDOMEN
NEONATAL MORBIDITY AND
MORTALITY.
 Neonatal Mortality Rate (NMR) is the number of neonates dying
before reaching 28 days of age per 1000 live births in a given year.

 In 2016, the NMR in Kenya was at 22.6 deaths per 1000 live births.
(2014 Kenya Demographic and Health Survey)
CAUSES OF DEATHS AMONG UNDER-
FIVEs.
CAUSES OF NEONATAL MORTALITY
AND MORBIDITY.
 Prematurity.
 Intrapartum related complications including birth asphyxia .
 Neonatal sepsis.
 Pneumonia
 Congenital anomalies
 Neonatal tetanus.
PREVENTION AND CONTROL OF
NEONATAL MORTALITY.
 APPROPRIATE ANTENATAL CARE: explain benefits of
breastfeeding, childhood immunization, and encourage good personal
and domestic hygiene.
 TIMELY DIAGNOSIS AND TREATMENT of maternal infections and
other health problems during pregnancy.
 SCREENING of pregnant women for HIV and TORCHES as
recommended by WHO.
 IMPROVED EDUCATION AND BEHAVIOURAL CHANGES
among women, families, and health care providers.
 Delivery in a Health facility
ROLE OF THE MOTHER
 Before delivery, the mother’s role is to protect and nurture the pregnancy
through adequate nutrition, prevention of infections and injuries as well
as regular attendance of ANC with particular focus on danger signs if any
 Provide nutrition by initiating breastfeeding early, and providing
exclusive breastfeeding for six months
 Keeping the newborn warm
 Control of infection by practicing personal, environmental hygiene
besides the hygienic care of the newborn and keeping the infant from
contact with sick people. It is the role of the mother to prevent
transmission of HIV to the newborn as well
 Identifying danger signs and taking appropriate measures
 Ensuring the child receives the KEPI scheduled immunizations and
vitamin A supplement
Role of the Father
Participates in shared decision making to plan for the
birth and early life of a child
Participates in the prenatal, perinatal, and post-natal
care of the child and its mother
Recognizes the signs of danger in the mother and the
newborn
Participates in the prevention of HIV and other STIs
Participates in birth spacing and family planning
decisions
Provides for the financial needs of children and their
mothers
ROLE OF THE COMMUNITY MIDWIFE
Is a link between families with newborns and the
healthcare system
Participates in the mobilization of resources and for
transport in times of emergencies
Is a link with other stakeholders in the care of
newborns such as county administrations, and non-
governmental organizations
Identifies the most common health problems and
participates in the establishment of a solution
ROLE OF THE COMMUNITY HEALTH
WORKERS
CHWs advise, encourage, and empower families to seek ANC
services from qualified health workers.
Can identify the danger signs in pregnant women, children and
newborn and refer them to appropriate facilities for the required
interventions
Advise and promote routine immunizations among new parents
The CHW educates on breastfeeding and other post natal care
and on danger signs while making home visits.
Ensure adequate preventative measures in the case of newborns
who are exposed to HIV/AIDS
Advocate for the observance of the recommended feeding
practices among parents
ROLE OF THE CHEW
Ensure that the community and the available health
facilities can work together
Participate in the recruitment and training of CHWs
and CHCs
Monitor the community health data and use it to
influence the interventions tailored towards improving
the health of communities
ROLE OF PARTNERS; NGOS , FBOS AND
THE COMMUNITY.
Health promotion
Disease prevention
Healthcare seeking and adherence to treatment
Governance and management of health services
THANK YOU.