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Table 1 Visit schedule and content

From: An effectiveness study of an integrated, community-based package for maternal, newborn, child and HIV care in South Africa: study protocol for a randomized controlled trial

Antenatal visit 1 at HOME Antenatal care action - immunisations/micronutrient supplementation
Focus on the importance of VCT (linking this with the PMTCT programme and the benefits of testing to the mother)
Emphasise the importance of antenatal care
Key messages on appropriate infant feeding
Encourage exclusive breastfeeding in HIV negative women or women of unknown HIV status.
For HIV positive women, assist with thinking about infant feeding options
Input regarding infant communication and the mother-infant relationship
Antenatal visit 2 at home Birth plans - place of birth, support during labour, care plans if returning to work
Danger signs and emergency plans - this will be done, if possible together with other family members in order to elicit their input regarding possible plans in the event of an emergency, including recognition of danger signs, emergency transport plan and emergency funds if needed
Homecoming arrangements
Follow up and re-emphasis on VCT, PMTCT, the key messages on appropriate infant feeding that were provided in antenatal visit 1; further discussion in terms of assisting with the implementation of chosen feeding option
Additional input on infant communication and the warning signs of postnatal depression
Postnatal visit 1 at home (24-48 hrs) Assessment of newborn-breathing, thermal care, colour, bleeding, neonatal eye care, checklist of danger signs
Assessment of mother - bleeding, signs for infection, mastitis
Early recognition of illness (superficial or systemic) and help seeking
Exclusive breastfeeding or appropriate infant feeding support
Hygienic cord care and what to expect regarding when the cord will drop off
Thermal care, skin to skin care and Kangaroo care if needed for preterm babies
Ensure that babies of HIV positive women have received Nevirapine
Information about warning signs for mother or baby and what to do
Support for women who have 'the blues'
Postnatal visit 2 at home (3-4 days) Assessment of the mother and the newborn, Further input on the early recognition of illness (superficial or systemic) and help seeking
Monitoring and follow up of breastfeeding or appropriate feeding and possible feeding problems
Further support for hygiene, thermal care and cord care, with Kangaroo care input if needed for preterm babies
1st week clinic visit reminder
Information about warning signs for mother or baby and what to do
Newborn Interactive Assessment - demonstration of the abilities of infants and infant communication and social responsiveness. Sleeping, crying, consolability and wider concerns
Postnatal visit 3 at home (10-14 days) Early recognition of illness (superficial or systemic) and help seeking
Ongoing monitoring of breastfeeding or other appropriate feeding
Information about warning signs for mother or baby and what to do
Promote attendance at clinic for 6 week visit for mother to have access to family planning and baby to receive immunisations and the babies of HIV+ women been given bactrim and HIV testing
Mother infant interaction modelling and communication input
Assess for signs of postnatal depression
Postnatal visit 4 at home (3-4 weeks) Early recognition of illness (superficial or systemic) and help seeking
Ongoing monitoring of breastfeeding or other appropriate feeding
Information about warning signs for mother or baby and what to do
Promote attendance at clinic for 6 week visit for mother to have access to family planning and baby to receive immunisations and the babies of HIV+ women been given bactrim and HIV testing
Mother infant interaction modelling and communication input
Assess for signs of postnatal depression
Postnatal visit 5 at home (7-8 weeks) Further input on feeding including advice regarding weaning
Infant weight from clinic card (6 week visit)
Mother infant attachment
Checklist of signs of postnatal depression
Has the child been tested for HIV at six weeks and receiving cotrimoxazole
Formula sustainability for HIV positive women using formula milk
Family planning and counselling
Input on milestones and information and specific skills about the stimulation of infants