Table 1 Proposed actions during home visits by community health workers

Focus of pregnancy visit 1 (as early as possible or in second trimester)

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Counsel on and refer for ANC including TT, IPT and ITNs

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Counsel on birth preparedness and use of clean delivery practices

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Assess and counsel on danger signs of pregnancy

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Counsel on and refer for HIV testing for PMTCT

Focus of pregnancy visit 2 (in third trimester)

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Counsel on birth preparedness

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Assess for maternal danger signs and refer if present

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Counsel on clean delivery practices

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Counsel on immediate maternal newborn and newborn care practices

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Counsel on newborn danger signs

Three visits after pregnancy (PNC)

Postnatal visit 1: birthday to day 2

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Screen for and counsel on maternal and newborn danger signs and refer if present

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Take newborn’s temperature, weight and respiratory rate

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Support temperature management (skin-to-skin for all babies, delayed bathing, and wrapping)

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Support immediate and exclusive breastfeeding

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Encourage cleanliness especially cord care

Postnatal visit 2: day 3 after birth

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Assess for maternal and newborn danger signs and refer if necessary

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Refer for immunization

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Counsel mother on breastfeeding and birth spacing

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Reinforce need to seek care/call CHW for signs of local infection or danger signs

Postnatal visit 3: day 5 to 7 after birth

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Assess for maternal and newborn danger signs and refer if necessary

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Refer for immunization

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Counsel mother on breastfeeding and birth spacing

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Reinforce need to seek care/call CHW for signs of local infection or danger signs

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Promote access to under five clinics and family planning at six weeks

If very low birth weight suspected ¹

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Refer if also danger sign present or two extra visits to support home care (breastfeeding, warmth, early danger sign recognition) if no danger sign or referral not possible

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Promote temperature management (skin-to-skin, wrapping and delayed bathing)

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Assist with feeding if needed

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Attention to hygiene

Additional home visits: when called by caretakers

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Check for signs of local infection and danger signs

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Give early treatment (tentatively cotrimoxazole) and arrange facilitated referral