Table 1 Visit schedule and content
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 |
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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 |