1. A visual guide for delivering messages on Maternal, Newborn, and Child Health & Nutrition

2. Eastern and Southern Africa Regional Office
Antenatal care
Antenatal care happens during pregnancy and before birth and refers to the series of steps that a pregnant woman and her family need to take in order to ensure that the child is born under good conditions, making use of the best resources available
A pregnant woman should have at least 4 ANC visits
First Visit: as soon as she suspects she is pregnant
Second Visit: between the fifth and the seventh month
Third Visit: at eighth month
Fourth Visit: during the last month
She should visit any time she has any concerns or health problems, especially if she has a danger sign What happens during ANC visit:
Blood pressure check
Abdominal examination to assess baby’s condition
Iron upplementation given
TT injection given (during first ANC visit and one month after receiving the first TT injection)
A woman should take single dose deworming tablet after completing 3 months of prenancy
A woman should take one iron tablet every day after completing 3 months of pregnacy and continue up to six weeks after delivery
Family should be counceled on danger signs, birth planning and HIV testing

3. Antenatal Care (ANC)

4. Eastern and Southern Africa Regional Office
Alcohol and smoking
Alcohol and smoking should be avoided during pregnancy as they harm the health of mother and baby

5. Alcohol and smoking

6. Signs of danger during pregnancy
Eastern and Southern Africa Regional Office
Signs of danger during pregnancy
The following life-threatening danger signs during pregnancy should be known:
Bleeding
Swelling of hands and face
Fever or foul-smelling discharge from vagina
Fits, convulsions or loss of consciousness

7. Signs of danger during pregnancy

8. Eastern and Southern Africa Regional Office
Birth Preparedness
During ANC visits the pregnant woman and her family should be supported in preparing for the birth by developing a ‘birth preparedness’ plan which includes the following:
Who will conduct the delivery?
Where will the delivery take place?
Who will accompany the pregnant woman when she goes for delivery?
Saving money for the delivery and any emergency that might arise.
Arrangement for transport.
Knowing your blood group.
Knowing the danger signs during pregnancy, such as bleeding; swelling of hands and face; fever or foul- smelling discharge from vagina; fits, convulsions or loss of consciousness.

9. Birth Preparedeness

10. Nutrition during pregnancy
Eastern and Southern Africa Regional Office
Nutrition during pregnancy
During pregnancy, all women need a variety of nutritious food, as available in the local context. These include foods rich in Iron, Calcium, Vitamin A, Folate and Vitamin B12, such as:
Peas and beans
Grains
Green, red, yellow & orange vegetables and fruits
Milk
Eggs
Fish
Chicken
Meat
A pregnant woman should eat one extra meal a day during pregnancy in addition to regular meals. A pregnant woman should take one extra hour of rest in a day.
A pregnant woman should take iron folate tablets during pregnancy and for at least three months after the baby’s birth to prevent neural tube defects.
Pregnant women should receive tetanus immunization to prevent neonatal tetanus.

11. Nutrition during pregnancy

12. Eastern and Southern Africa Regional Office
Time of delivery
Identify the facility where delivery services are provided by a Skilled Birth Attendant (Doctor, Staff Nurse or ANM) The newborn cared for by the same Skilled Birth Attendant who conducts delivery
Delivery conducted by a Skilled Birth Attendant (Doctor, Staff Nurse or ANM)
Life threatening danger signs during delivery period:
Excessive bleeding before or after deliver
Swelling of hands and face
Continuous labor lasting more than 12 hours
Fever or foul-smelling discharge from vagina
Fits, convulsions or loss of consciousness
In addition to the life threatening danger signs above, the following are additional danger signs:
Hand or foot coming out first
Cord coming out first
Baby not delivered within 12 hours of rupture of membrane
Placenta not delivered within 30 minutes after delivery

13. Time of delivery

14. Postnatal Care (PNC) for mother and newborn
Eastern and Southern Africa Regional Office
Postnatal Care (PNC) for mother and newborn
The woman and her newborn closely monitored for any danger signs and not left alone during the first 24 hours after delivery
The following essential care should be taken to prevent newborn from infection and complications:
The newborn dried with a clean, soft and dry cloth
The newborn wrapped from head to toe with another dry cloth and kept warm along with the mother
Breastfeeding (colostrum) initiated within 1 hour of birth
Cut the cord with a clean blade and tie it with clean material
Cord kept dry and nothing applied to the cord
Bathing of newborn avoided for the first 24 hours
Health worker contacted for the first PNC visit within 3 days (preferably within 24 hours).
Newborn should get Polio and BCG immunization

15. Postnatal Care (PNC) for mother and newborn

16. Exclusive breast feeding for six months
Eastern and Southern Africa Regional Office
Exclusive breast feeding for six months
A mother should initiate breastfeeding within one hour after delivery The infant should only be fed breastmilk for the first 6 months
A caregiver should refuse all other liquids and foods, including water, for the infant during the first 6 months
A breastfeeding mother should breastfeed on demand, both day and night (8 to 12 times) to build up breastmilk supply
If the mother is to be away from home, she can continue to breastfeed her child by hand expressing breastmilk in a cup. Breastmilk should be stored in a clearn, covered cup at room temperature for up the eight hours. The expressed breastmilk can be fed to the infant by another caregiver.
A breastfeeding mother cleans her breasts with water daily and wears a clean blouse/shirt
Newborn should be breastfed at regular times to prevent breasts from developing sores or being engorged (painful swelling), if there is too much milk production, some milk should be expressed
What to know about breastfeeding for healthy newborn development:
Exclusive breastfeeding for six months. No other fluids/feeds including water to be given during this period.
Newborn breastfed day and night, 8 or more times in 24 hours. Use alternate breast during alternate feeds
Duration of breastfeeding: at least 15 minutes to one breast or as long as the newborn wants
Advantages of Breastfeeding:
Breastfeeding is the first immunization for the newborn. The colostrum provides life-protecting immunity for the newborn
Breast milk protects the newborn against infections and allergies
Breast milk contains complete nutrients for healthy growth and development of the newborn
Breastfeeding helps the uterus return to its previous size and preventbleeding after birth
Breastfeeding reduces the mother’s risk of ovarian cancer and breast cancer
Breastfeeding promotes mother-newborn bonding

17. Exclusive breast feeding for six months

18. Nutrition during lactation
Eastern and Southern Africa Regional Office
Nutrition during lactation
A breastfeeding mother needs to eat a greater amount of food every day compared to when she was pregnant
A breastfeeding mother should have a diversified diet rich in proteins, vitamins and minerals
A breastfeeding mother should have iodized (packet) salt in her meals
A breastfeeding mother should have iron, vitamin A, and folic acid supplements.
The additional nutrients that support breastfeeding are needed throughout the first two years of breastfeeding.
The nutritional status of the breastfeeding mother will determine the quality of the breastmilk produced.

19. Nutrition during lactation

20. Life-threatening danger signs in newborns
Eastern and Southern Africa Regional Office
Life-threatening danger signs in newborns
The following are the life-threatening dangers signs in newborns:
Unable to suck or breast feed
Lethargic or unconscious
Weak cry or absent cry
Cold hands and feet
Fast breathing or difficulty in breathing or severe chest indrawing
Umbilical discharge with redness extending to the surrounding skin
One abscess or more than 10 skin pustules on the newborn’s body
Fever

21. Life-threatening danger signs in newborns

22. Complementary Feeding
Eastern and Southern Africa Regional Office
Complementary Feeding
After the age of 6 months, infants require food in addition to breastmilk to promote healthy growth
Complementary feeding should begin with soft, thick staple foods such as porridge, mashed potatoes, or mashed bananas
Infants aged 6-8 moths needs to each 2-3 times a day Beginning 9 months, infants need to eat 3-4 times a day
Infants should be provided with snacks in addition to regular meals. Nutritious snacks include fruit, beans, or breads with nut paste
Caregivers should practice active and responsive feeding by patiently feeding the infant and actively encouraging the infant to eat

23. Complementary Feeding

24. Postnatal hygiene Personal hygiene:
Eastern and Southern Africa Regional Office
Postnatal hygiene
Personal hygiene:
A woman should have clean room and clean clothes
Use clean sanitary pad or clean cloth until discharge stops
Wash hands with soap before taking food, before handling the newborn, before breastfeeding and after toilet.
Wash perineum (The place where baby comes out) daily and after toilet
Wash body daily

25. Postnatal hygiene

26. Eastern and Southern Africa Regional Office
A woman and newborn should have 4 Postnatal Care (PNC) visits with a health worker
First PNC visit: within within 24 hours of delivery
Second PNC visit: within 3 days of delivery
Third PNC visit: between 7 to 14 days after delivery
Fourth PNC visit: at 6 weeks after delivery
What happens during PNC visits for mother and newborn:
Check for bleeding
Support breastfeeding
Manage complications (including referral to a facility as necessary)
Obtain counseling on danger signs and home care
Manage anemia
Promote nutrition
Promote use of ITNs
Obtain family planning counseling

27. A woman and newborn should have
four Postnatal Care (PNC) visits
with a health worker

28. Family planning What to know about family planning:
Eastern and Southern Africa Regional Office
Family planning
What to know about family planning:
There is a chance of pregnancy after six weeks of delivery, so a couple should seek Family Planning counseling and ser- vices at six week PNC visit
Family Planning options for males include vasectomy and condom
Family Planning options for females after delivery includes Minilap, depo injection, copper T and norplant

29. Family planning

30. Eastern and Southern Africa Regional Office
Immunizations
Immunization is urgent and important. Immunization protects your child from many killer diseases including Polio and Measles. Early protection is critical against dangerous and killer diseases
A child who is not immunized is more likely to become sick, permanently disabled or malnourished, and could possibly die
The immunizations in the first year and into the second year are especially important
Every child should complete the recommended series of immunizations at the right time
Parents/Caregivers should ensure that the child gets all immunizations on the national immunization schedule
Vaccine-preventable diseases:
Tuberculosis: BCG vaccine.
Diphtheria, tetanus, and pertussis: pentavalent 1 to 3 DTP vaccine.
Polio: IPV (inactivated polio vaccine) and OPV (oral polio vaccine).
Pneumococcal pneumonia: PCV (pneumococcal conjugate vaccine).
Rotavirus: Rotarix or Rota Teq vaccines.
Haemophilus influenzae type B: Hib vaccines.
Cervical cancer: HPV (human papilloma virus) vaccine.
Measles and Rubella: MR vaccine.
Rubella: rubella containing vaccines.
Hepatitis B: hepatitis B vaccine.
Meningitis: Meningitis A.
Yellow fever: Yellow fever.

31. Immunizations

32. Eastern and Southern Africa Regional Office
Learn your HIV status
It is important for a pregnant woman to know her HIV status
A pregnant woman should go for voluntary counselling and testing for HIV to protect her health, the health of her baby and the health of her family
The only way for a pregnant woman to know if she has HIV is to be tested for it. If she is HIV negative she must learn how to protect herself and her baby from getting HIV
If a pregnant woman tests positive for HIV she needs to immediately begin antiretroviral therapy to reduce the chances of infection to her baby, and access other care and treatment to ensure better health for herself and her baby
Mothers who are HIV positive should take anti-retroviral drugs (ARVs) and exclusively breastfeed their babies for 6 months. Giving ARVs to an HIV positive mother can significantly reduce the risk of transmission through breastfeeding and also improve her health. This enables infants of HIV positive mothers to be breastfed with a low risk of transmission
All children should be tested for HIV infection. If tested and treated for HIV early, children born with HIV can survive and stay healthy
Anti-retroviral therapy is a lifelong treatment
After 6 months, breastfeeding should be discontinued only when a safe and nutritiously complete diet is available

33. Learn your HIV status

34. Insecticide-treated bed nets
Eastern and Southern Africa Regional Office
Insecticide-treated bed nets
A bed net should be used to prevent mosquito bites in malaria endemic areas
Pregnant women, mothers, and newborns should sleep under insecticide-treated bed nets to prevent malaria

35. Insesticide-treated bed nets

36. Eastern and Southern Africa Regional Office
Food safety
Following food safety practices can prevent the transmission of fecal-oral disease
Cooked food should be separated from uncooked food
Food should be cooked and reheated to safe temperatures
Clean utensils should be used to eat and prepare food
Hands should be washed with water and soap prior to eating and preparing food
Food that will not be consumed immediately should be covered and stored in a cool place

37. Food safety

38. Eastern and Southern Africa Regional Office
Diarrhea
Diarrhea can be prevented through hand washing, using a clean water supply, and proper sanitation
Human excreta should be disposed of in a latrine, buried, or burned
Drinking water should be treated prior to consumption
Hands should be washed with soap and water, or with ash, after dealing with human waste, before eating, feeding or preparing food
Diarrhea can be prevented through exclusively breastfeeding in the first 6 months, vitamin A supplementation, zinc supplementation, and the rotavirus vaccine
Children who experience diarrhea should be given extra fluids and foods to replenish the body
Caregivers should seek help from a trained health worker if:
Diarrheal episodes last for more than three to four days
The child has blood in the stool
The child experiences several watery stools within an hour
The child vomits frequently or has a fever
The child refuses to drink and/or eat

39. Diarrhea