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Table 2 Proposed signal functions for PNC with essential content and components to be assessed and outline of required equipment drugs and consumables

From: Essential components of postnatal care – a systematic literature review and development of signal functions to guide monitoring and evaluation

Signal Function

Components

Essential equipment, drugs and consumablesa

1.Screening for (pre-)Eclampsia

Measure BP

BP machine and stethoscope

Test urine for proteinuria

Urine dip-stix, urine containers

2.Prevention and management of Anaemia in the mother

Measure Haemoglobin (Hb)

HemoCue® machine and cuvettes, or laboratory measurement of HB e.g. Coulter counter

Provide ferrous sulphate with folic acid

Nutritional advice

Ferrous sulphate tablets (preferably combined with folic acid)

3.Prevention and management of Malaria in mother and baby

Provide bed nets

Bed nets (preferably insecticide-treated)

Test for malaria in case of fever and provide treatment for malaria positive women and babies

Thermometer

Malaria rapid test, or, malaria microscopy done in lab

Drugs for treatment of malaria.b including; artemisinin-based combination therapy (ACT) or artesunate inj or Arthemeter inj for treatment (or as specified in national guidelines)

4.Prevention and management of HIV in mother and baby

Test for HIV

HIV rapid diagnostic test (RDT) (single or combined with syphilis RDT) and/or laboratory

Provide Prevention of Mother to Child Transmission Care (PMTC)

Provide anti-retroviral drugs (ARV) for mother and baby

Drugsb for treatment of HIV positive women and babies pregnancy and prevention of maternal to child transmission (PMTCT)

5.Prevention and management of Tuberculosis (TB) in mother and baby

Test for TB (sputum Ziehl–Neelsen stain or Gen expert point of care testing)

Sputum pots, Lab for sputum Ziehl–Neelsen staining

or Gen expert point-of-care testing

First line TB drugs (preferred)

Drugsb for treatment of tuberculosis (TB) in women and children

BCG vaccination for newborn

BCG vaccination

6.Screening and counselling for mental health and domestic violence in the mother

Screening tools

Counselling services

EPDS, WHO or other self-reporting questionnaire or other tool for mental health screening

Screening tool for domestic violence/intimate partner violence

Referral pathway for counselling and support

7.Assessment of growth and development of the baby

Assess growth—weight and length

Weighing scale, length measurement table

Care of the low-birth weight baby

Provide Kangaroo Mother Care (KMC)

Examination of the new-born baby for congenital abnormalities

Consultation area including for examination and environment facilitating respectful personalised care

8. Cord Care in the baby

Inspection and protection of cord

Chloorhexidine (4%) applied to the cord in areas of high neonatal mortality (≥ 30 per 1000)

9. Vaccination of the baby

Including e.g. Polio, Hepatitis B and BCG at birth and Polio, Rotavirus, Pentavelant at 6 weeks ( subsequent vaccinations at 8, 12 and 16 weeks including Measles Diptheria, Tetanus, Whooping cough)

Vaccins (BCG, Polio-drops, Hepatitis B)

BCG and Hepatitis B in areas of high incidence or high risk populations or as per national protocol

10. Clinical examination of the mother

Examination of fundal height and check for lochia

Check perineum and any wounds (e.g. Caesarean Section scar)

Examination of the legs to check for Deep Vein Thrombosis (DVT)

Examination area with couch b

Antibiotics

11. Counselling for and support to exclusive breastfeeding of the baby

Consultation

Examination of the breasts

Consultation area including for examination and environment facilitating respectful personalised care

12. Offer contraception/family planning

Consultation

IUD, progesterone only pill, Depo Provera, condoms

IUD insertion kit

13. Health promotion and advice for the mother

Advise on perineal care, bladder care, pelvic exercises, resumption of sexual activity

Consultation area including environment facilitating respectful personalised care

14. Debriefing following birth for the mother and counselling for danger signs in mother and baby

Consultation

Consultation area including environment facilitating respectful personalised care

  1. aAssumes availability of essential consumables such as non-sterile gloves, needles, syringes or capillary tubes, skin swabs, tourniquet and cotton wool.
  2. bAll drugs as per national protocol – can vary and needs to be specified for each country.