Table 1 Essential reproductive, maternal, newborn and child health interventions
From: Essential interventions: implementation strategies and proposed packages of care
Priority interventions | Level of care | Health care cadre | Key commodities |
|---|---|---|---|
Preconception/periconceptual interventions | |||
Community Primary Referral | All | • Barrier methods (male and female • Condoms, diaphragm, gels, foams) • Oral contraceptives (progestin only and combined) • Emergency contraceptives and hormonal injections | |
|  | Primary Referral | Professional health workers | • All of the above plus implants • Long acting reversiblecontraceptives (implants) • Intrauterine devices • Surgical contraception |
Prevention and management of sexually transmitted infections (STIs), including HIV for prevention of mother to child transmission (PMTCT) of HIV and syphilis [89, 90] | Community Primary Referral | All | • Materials for counselling • Condoms (male and female) • Antibiotics in line with essential medicine guidelines |
|  | Primary Referral | Professional health workers | • Materials for counselling • Condoms (male and female) • Antibiotics in line with essential medicine guidelines • Laboratory test kits for STI/HIV • Anti-retroviral medicines (refer to the essential list of medicines) |
Folic acid fortification and/or supplementation to prevent neural tube defects [17–19] | Community Primary Referral | All | • Folic acid fortification of staple food e.g. flour • Folic acid tablets |
Essential package | Primary Referral | Professional health workers | • Fetal stethoscope • Scale • Sphygmomanometer • Haemoglobinometer |
Iron and folic acid supplementation during pregnancy [20, 21, 94] | Primary Referral Community | All | • Iron and folic acid |
Tetanus immunization in pregnancy for preventing neonatal tetanus [13, 14] | Primary Referral Community | All | • Vaccine (TT vaccine) |
Prevention and management of malaria in pregnancy a) Prophylactic antimalarial for preventing malaria in pregnancy [8, 9] b) Provision and promotion of use of insecticide treated nets for preventing malaria in pregnancy [11, 95–97] | Primary Referral Community | All | a) Antimalarial drugs according to the situation/context b) Insecticide treated nets |
Interventions for smoking cessation during pregnancy for improving birth outcomes [36, 37] | Community Primary Referral | All | • Materials for individual and group counselling and behavioural change interventions on smoking cessation |
Primary Referral | Professional Health Workers | • Onsite tests and laboratory equipment • Penicillin • Counselling material | |
Prevention and management of HIV and prevention of mother to child transmission in pregnancy [3–6] | Community Primary Referral | All | • HIV test kits • Antiretroviral drugs • Cotrimoxazole |
Prevention and management of hypertension in pregnancy a) Calcium supplementation in pregnancy [22–24] b) Low-dose Aspirin for the prevention of pre-eclampsia in high risk women [24, 57, 58] c) Use of antihypertensive drugs for treating severe hypertension in pregnancy [59, 60] | a) Community Primary Referral b) Primary Referral c) Primary Referral d) Primary Referral | a) All b) Professional health workers c) Professional health workers d) Professional health workers | a) Calcium b) Low dose aspirin c) Methyldopa, hydralazine, nifedipine d) Magnesium sulphate (Injection) |
Reduce malpresentation at term using external cephalic version (>36 weeks) [72–77] | Referral | Professional health workers | • Stethoscope |
Management of prelabour rupture of membranes and preterm labour: A) Induction of labour for management of prelabour rupture of membranes at term [51] | Referral | Professional health workers | • Uterotonic (oxytocin and/or misoprostol) • Partograph • Stethoscope |
B) Antibiotics for management of preterm rupture of membranes [99, 100] | Primary Referral | Professional health workers | • Antibiotic (erythromycin) |
C) Corticosteroids for prevention of neonatal respiratory distress syndrome [65–67]. | Primary Referral | Professional health workers | • Corticosteroids (betamethasone, dexamethasone) |
Management of unintended pregnancy:[68] a) Availability and provision of safe abortion when indicated and legally permitted b) Provision of post abortion care | Primary Referral | Professional Health Workers | • Materials for counselling, health education and health promotion • Medications for induced abortion (mifepristone, misoprostol) • Vacuum aspiration equipment • Uterotonics (misoprostol, oxytocin) • Antibiotics in line with essential medicine guidelines • Surgical procedures when required |
Childbirth | |||
Social support during childbirth [29] | Community Primary Referral | All | Â |
Prophylactic antibiotic for caesarean-section [71] | Referral | Professional health workers | • Antibiotics (ampicillin or cefazolin) |
Prevention of postpartum haemorrhage A) Prophylactic uterotonic to prevent postpartum haemorrhage [34, 101] | Community Primary Referral | All | • Uterotonics (oxytocin, misoprostol) |
B) Active management of third stage of labour to prevent postpartum haemorrhage [30–33]. | Primary Referral | Professional health workers | • Uterotonics (oxytocin, ergometrine) |
Referral | Professional health workers | • Uterotonics (oxytocin, misoprostol) | |
Caesarean section for absolute maternal indication (e.g. obstructed labour and central placenta previa) | Referral | Professional health workers | • Surgical environment |
Management of post-partum haemorrhage e.g.: a) Uterine massage [102] c) Manual removal of placenta (only by professional health workers) | Community Primary Referral | Community health workers (a+b) and referral. | • Uterotonics (oxytocin, ergometrine, misoprostol) • IV fluids • Blood transfusion • Surgical facilities |
Postnatal – mothers | |||
Advice and provision of family planning [104] | Community Primary Referral | All | • Barrier methods (male and female condoms, diaphragm, gels, foams) • Oral contraceptives (progestin only and combined) • Long acting reversible contraceptives (implants and injectable contraceptives) • Intrauterine devices • Surgical contraception • Emergency contraception |
Prevent, measure and treat maternal anaemia [105] | Referral | Professional health workers | • Ferrous salt (liquid or tablet) • Ferrous salt + folic acid (tablet) • Folic acid (tablet) • Nutritional supplements • Hydroxycobalamine (injection) • Lab tests • Blood products |
Detection and management of postpartum sepsis [106] | Referral | Professional health workers | • Antibiotics (ampilcillin, gentamicin, metronidazole) |
Screening and initiation or continuation of antiretroviral therapy for HIV [53] | Primary Referral | Professional | • Antiretroviral medicines |
Birth and postnatal – newborn | |||
Immediate essential newborn care (at the time of birth) | |||
Promotion and provision of thermal care for all newborns to prevent hypothermia (immediate drying, warming, skin to skin, delayed bathing) [38] | Community Primary Referral | All | • Materials for counselling, health education and health promotion |
Promotion and support for early initiation and exclusive breastfeeding (within the first hour) [1, 42–44, 107, 108]. | Community Primary Referral | All | • Materials for counselling, health education and health promotion |
Promotion and provision of hygienic cord and skin care [16, 109, 110] | Community Primary Referral | All | • Cord clamp and scissors • Clean birth kit for health facilities |
Neonatal resuscitation with bag and mask for babies who do not breath at birth [39–41]. | Community Primary Referral | Professional health workers | • Training aids and devices to maintain competencies • Newborn resuscitation device (Ambu Bag, bag-mask and suction device) |
Newborn immunization | Primary Referral | Professional health workers | • Vaccines, syringes, safety boxes, cold chain equipment |
Neonatal infection management | Â | Â | Â |
Presumptive antibiotic therapy for the newborns at risk of bacterial infection [111] | Referral | Professional health workers | • Antibiotics (ampicillin and gentamycin or penicillin) |
Case management of neonatal sepsis, meningitis and pneumonia [112–115] | Community Primary Referral | All (Community refer) | • Materials for counselling, health education and health promotion • Thermometer / digital thermometer • Timer • Blood sugar sticks (disposable) • Nasogastric tube • Antibiotics (oral and injectable) |
Kangaroo mother care for preterm and for < 2000g babies [69, 70] | Primary Referral | Professional health workers | • Materials for counselling, health education and health promotion • Support Binder for KMC (KMC wrap) • Hat • Nasogastric tube |
Extra support for feeding the small and preterm baby [116] | Primary Referral | Professional Health Workers | • Nasogastric tubes • Feeding cups • Breast pump • Syringe drivers • Blood sugar testing sticks • Materials for counselling |
Prophylactic and therapeutic use of surfactant to prevent respiratory distress syndrome in pre-term babies [83–85] | Referral | Professional health workers | • Surfactant (await generics) • Oxygen supply/concentrator • Pulse oximeter |
Continuous positive airway pressure (CPAP) to manage pre-term babies with respiratory distress syndrome [80–82] | Referral | Professional health workers | • Standard CPAP or bubble CPAP • Oxygen supply/concentrator • Pulse oximeter |
Primary Referral | Professional health workers | • Bilirubinometer • Phototherapy lamp • eye shade • IV fluids • Exchange transfusion kit | |
Infancy and childhood | Â | Â | Â |
Promotion and support for exclusive breastfeeding for 6 months [119–121] | Referral Primary Community | All | • Materials for counselling, health education and health promotion, including individual and group counselling |
Promotion and support of continued breastfeeding and complementary feeding a) Continued breastfeeding up to 2 years and beyond [122] b) Appropriate complementary feeding starting at 6 months [45, 123–125] | Referral Primary Community | All | • Materials for counselling, health education and health promotion |
Prevention and management of childhood malaria a) Provision and promotion of use of insecticide treated bed nets for children [11] | Community Primary Referral | All | • Materials for counselling, health education and health promotion • Insecticide treated nets • Rapid diagnostic tests • Antimalarial drugs according to guidelines |
Comprehensive care of children infected or exposed to HIV infection [52–55] | Referral Primary | Professional health workers | • Antiretroviral drugs • HIV test kits • Cotrimoxazole • Psychosocial support • Nutritional support |
Promote and provide routine immunization plus H.influenzae, meningococcal, pneumococcal, and rotavirus vaccines [12, 128–130] | Community Primary Referral | All | • Materials for counseling, health education and health promotion • Vaccines, syringes, safety boxes, cold chain equipment |
Vitamin A supplementation from 6 months of age in Vitamin A deficient populations [131–133] | Community Primary Referral | All | • Vitamin A capsules • Material for counselling on Vitamin A rich foods |
Management of severe acute malnutrition:[28, 134] a) Without complications (All levels) b) With complications (Referral) | Community Primary Referral | All | Community level • Appropriate ready-to-use therapeutic foods • Micronutrient supplements • Vitamin A capsules Health facility level • Antibiotics • Therapeutic food formulations (F75/100) |
Case management of childhood pneumonia[15, 135–137] a) Vitamin A as part of treatment for measles-associated pneumonia for children above 6 months [25, 26] b) Vitamin A as part of treatment for non-measles-associated pneumonia for children above 6 months [138–140] | Community Primary Referral | All | Community level • Respiratory rate timers • Vitamin A capsules Health facility level • Antibiotics Referral level • Oxygen for severe pneumonia • Pulse oximeter |
Case management of diarrhoea: | Community Primary Referral | All | • Materials for counselling, health education and health promotion • Zinc (tablets / solution) • ORS • Appropriate antibiotics for dysentery according to guidelines |
Case management of meningitis | Referral | Professional health workers | • Appropriate antibiotics • Supportive treatment |
Cross-cutting community strategies | Â | Â | Â |
Home visits across the continuum of care women’s groups [1, 86, 87, 150, 151] | Community | All | • Material for counselling, health education and health promotion |