Caring for the newborn at home: a training course for community health workers
This World Health Organization (WHO) and United Nations Children's Fund (UNICEF) publication provides training materials and guidelines for community health workers to help improve the provision of postnatal care services, increase support for pregnant and lactating mothers and their newborns and encourage women and their families to also seek antenatal and intrapartum care from a skilled healthcare professional. The key objectives of the training course include: helping community health workers develop their communication skills, particularly in regard to building good relationships with families; to improve competence in counselling families about the importance of attending antenatal care, planning for birth in a health facility, home care for pregnant women and appropriate newborn care practices immediately after birth; to increase skills in assessing breastfeeding, the ability to recognise danger signs and awareness of the newborn's weight, deciding whether to refer or provide care at home, and advising families on how to best care for the newborn at home; to improve competence in helping families to provide extra care for a small baby. The training comprises 30 sessions divided into two units: home visits during pregnancy and home visits after birth. Also provided, in addition to the comprehensive training course manual, are: a community health worker register, detailed counselling cards providing guidelines regarding what the community health worker should say and do at each visit, a mother and baby record card, and a referral note. Comprehensive facilitator guides are also provided to help facilitators to both prepare and deliver the course successfully and to supervise field practice. The training course is based on experiences of training community health workers in caring for newborns at home from several studies, particularly the SEARCH research study in India and the NEW HINTS study in Ghana.
Building a future for women and children: the 2012 report
This ‘countdown to 2015’ report highlights both the progress of and barriers to individual countries achieving Millennium Development Goals (MDGs) 4 and 5. Countdown 2015 is a global initiative, involving international agencies, professional organisations, donors, nongovernmental organisations, academics and governments, that aims to support, encourage and track progress towards achieving the MDGs—in particular, goals 4 and 5 relating to child mortality and maternal health. Countdown 2015 specifically focuses on highlighting evidence-based solutions and obtaining comprehensive data that can be analysed and used to ensure that stakeholders are held accountable for progress. The report provides comprehensive country-level information listing progress in adopting and implementing relevant policies, information about health systems and financing, levels of equity in coverage and levels of intervention coverage, information about nutrition, water, sanitation, cause of death, infant and maternal mortality ratios and key population characteristics which it is hoped will be used as tools for action. Annex D lists essential interventions for reproductive, maternal, newborn and child health. Key headlines include: maternal mortality has dramatically declined but faster progress is required (only nine [12%] out of the 75 countries included in this report are considered to be on track to achieve MDG Goal 5 and 25 [33%] countries have made insufficient or no progress towards this goal); child mortality has also declined but again more needs to be done; improvements have been made in newborn survival but urgent action is needed with regard to stillbirths, in particular intrapartum stillbirth and preterm birth; many countries included in the report face severe nutrition crises. Haemorrhage and hypertension together account for more than half of all the maternal deaths—defined as deaths of women while pregnant or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management. The remaining causes include sepsis (8%) and unsafe termination of pregnancy (9%).
Making health services adolescent friendly: developing national quality standards for adolescent-friendly health services
This guidebook, produced by the Department of Maternal, Newborn, Child and Adolescent Health at the WHO, outlines the public health rationale for ensuring that adolescents have easy access to the health services that they require, in particular to sexual and reproductive health services. Aimed at national public health programme managers, it provides a step-by-step guide on how to develop quality standards for health service provision to adolescents and also provides help in identifying how to practically assess whether these standards have been achieved. The guidebook is divided into three chapters: chapter one focuses upon discussing the theoretical basis for improving the availability of health services specifically designed for adolescents; chapter two outlines a step-by-step process for developing national quality standards for the provision of health services to adolescents, the importance of each step and how this process can be undertaken; and chapter three provides resources and materials that can be used to prepare and run a workshop to develop national standards (Powerpoint presentation slides are also available from www.who.int/entity/maternal_child_adolescent/documents/adolescent_friendly_health_services_2012.ppt). Annex 1 lists the five dimensions of quality health services for adolescents (equitable; accessible; acceptable; appropriate; effective) and annex 2 lists the key actions that are required at national, district and local levels to improve the quality of health service provided to adolescents. This guidebook is intended as a companion volume to the 2009 guidebook produced by the WHO entitled Quality assessment guidebook: A guide to assessing health services for adolescent clients.
Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy: a demonstration project in six African countries
This report, published by the WHO, presents the results of a demonstration project regarding the prevention of cervical cancer by screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy, which began in September 2005 and was completed in May 2009. The project took place over seven sites in six African countries (Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania and Zambia) and targeted women between the ages of 30 and 50 years. The report states that over 250 000 women die from cervical cancer every year and that in sub-Saharan Africa the majority of cancers (over 80%) are diagnosed at a late stage–mainly as a result of a lack of public information provision about cervical cancer and prevention services. The screening programme involves the application of acetic acid to the cervix and macroscopic inspection for aceto-white lesions on the ectocervix and treating such lesions with nitrous oxide cryotherapy on a ‘screen and treat’ basis. This strategy is proposed in a low resource setting instead of the screening with cervical cytology and treating with loop excision usually employed in most developed countries. Women with clinical evidence of cervical carcinoma, aceto-white lesions occupying more than 75% of the cervix or extending more than 2 mm beyond the outer limit of the standard cryotherapy probe, or a lesion extending onto the vaginal wall or more than 2 mm into the cervical canal, were referred to a higher level of health care for further evaluation and treatment. No cervical biopsy was taken before treatment with cryotherapy to confirm the presence of cervical intraepithelial neoplasia (CIN) or to exclude microinvasive cervical carcinoma. Between September 2005 and May 2009, a total of 19 579 women were screened. Overall, 10.1% with VIA results were positive, and 1.7% of these women had lesions suspicious of cancer on inspection. A total of 87.7% of all VIA-positive cases were eligible for cryotherapy. The majority of women (63.4%) received cryotherapy within 1 week of initial screening. The single-visit approach enabled 39.1% of women to be screened and treated on the same day. However, over 39.1% of all women eligible for cryotherapy did not receive treatment, for various reasons, including equipment not being in working order at the time of screening, and women requiring consent from their spouses to receive cryotherapy. Based on the experience of integrating VIA and cryotherapy into reproductive health services during the demonstration project, both service providers and the women who were screened and treated are reported as being satisfied with the service. Women who had cryotherapy were followed-up after 12 months with a repeat VIA assessment. Those women with aceto-white lesions still present at this evaluation were then referred to further assessment at a higher healthcare facility. There was no reporting on the data on outcome of this repeat VIA assessment. At the close of the study country teams proposed plans regarding how to sustain and scale-up cervical cancer prevention services and highlighted barriers such as funding and human resources issues. The report lists a number of recommendations and identifies that provider training, sustainable supervision and reliable supply and maintenance of equipment and consumables will be required to ensure successful scale-up of VIA and cryotherapy services within the six countries.