CORE Spring Meeting, April 2013Baltimore, MD

About 40% of deaths in children younger than 5 years occurred in the neonatal period, most often because of preterm birth complications (14%), intrapartum related complications (9%), and neonatal sepsis or meningitis (5%).

Average Density of Health Worker in countries with highest U5MR = 5.2 per 10,000 pop

22% of WHO recommendation

iCCM Plus is a priority

Formative Research

• Literature review

• Key Informant Interviews

• Focal Groups Discussions

Training method and tool development

• 5-days initial training plus weekly supportive supervision for 3-months

• iCCM Plus package

Supportive Supervision

• Completion of data captured

• Medicine administration

• Medicine and equipment storage

• Assessment and follow-up of a sample of sick child

• Testing of one component of algorithm

Newborn Care

Look/Ask

Is the baby newly born?Is the baby crying?

What To Do?

• Dry the baby with a clean cloth and check to see if his mouth and nose are clear.

• Place baby on the mother’s abdomen and cover with a dry cloth, including the head.

• Dab the umbilical cord, including the base of the cord, with 4% chlorhexidine

• Initiate breastfeeding

• Eye care- apply tetracycline eye ointment within 1 hour

If the baby is not crying or breathing well after drying, you will need to help the baby to breathe within the first minute.Go to “Helping a Newborn Breathe”

If YES to these signs

Information and images on this and following pages adapted from Helping Babies Breathe, American Academy of Pediatrics, 2010.

Helping a Newborn Breathe

Look/Ask

• Is the baby newly born?• Is the baby NOT crying?

• This baby needs help to breathe.

What To Do?

Within one minute,• Keep the baby warm• Position the head

• Aspirate (clean) the mouth and nose

• Stimulate breathing by rubbing the back

If baby is still not breathing well:• Ventilate with bag mask • Give 40 breaths per minute• Observe once per minute for

crying or breathing

Continue until newborn is breathing well or declare as stillbirth if the there is no breathing within 10 minutes. All newborns needing help to breathe need urgent referral to a hospital or health center after they are breathing normally.

If YES to ANY Sign

Preliminary assumption: based on these results CCM-related content of the iCCM Plus tool seems to be appropriate in the

training of illiterate community-based staff with no health background

WK1 WK2 WK3 WK4 WK50

5

10

15

20

25

30

35

40

45

#formsForm/AssReferral

Wk1 WK2 WK3 WK4 WK5 total

# forms 8 19 11 28 42 108GDS 2 3 0 7 2 14Spneu 5 6 3 11 18 43Nspneu 1 0 1 1 1 4Sdehy 0 2 0 5 4 11Nsdehy 1 0 0 1 0 2Diarrhe 0 5 3 4 4 16Smalar 0 3 4 12 12 31NBGDS 0 1 0 0 0 1NBD 0 1 0 0 0 1Referral 3 10 10 28 36 87Forms w/assist

8 18 4 12 29 71

Preliminary conclusions • Supervision approach seems to

be working– 100% referral forms @PHCU– In creased referral of ARI– HHP’s controlling stocks of drugs and

equipment– Progressively fewer need on form

assistance– Weekly Skype discussion vital

• Challenges• Transportation• Due to distance weekly supervision

non-feasible• Administrative issues• Referral forms need to be simplified• Language barriers