MOTHER & CHILD HEALTH HANDBOOK - 2020

Abbreviations

AEFI Advance Events Following Immunization

ANC Antenatal Clinic
ARVs Antiretrovirals
AZT Zidovudine
BP Blood Pressure
CHX Chlorhexidine
CTX Cotrimoxazole
CWC Child Welfare Clinic
DBS Dry Blood spot
EDD Expected Date of Delivery
FP Family Planning
Hb Haemoglobin
HEI HIV Exposed Infant
ICF Intensified Case Finding
IPT Isoniazid Prophylaxis Therapy
IPTp Intermittent Preventive Treatment in Pregnancy
KEPI Kenya Expanded Program on Immunization
KMC Kangaroo Mother Care
KMHFL Kenya Master Health Facility Listing
LLIN Long Lasting Insecticidal Nets
LMP Last Menstrual Period
MCH Mother Child Health
MNP Micronutrients Powders
MTCT Mother To Child Transmission
NVP Nevirapine
PMTCT Prevention of Mother to Child Transmission
PNC Postnatal Care
PrEP Pre-Exposure Prophylaxis
SP Sulfadoxine/Pyrimethamine
STI Sexually Transmitted Infections
TB Tuberculosis
TD Tetanus and Diphtheria
TEO Tetracycline Eye Ointment

Attend all your Antenatal clinic visits as advised by the health care provider
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

Father’s Support for Mother & Child Health

Father, you are very important for the health of the mother and child as well as your own
health.

During pregnancy
Showing your wife /partner that you care about her can help her both physically and
emotionally
• Ensure your wife/partner has support for the house chores.
• Ensure your wife/partner eats healthy foods at least 5 out of the 10 food groups everyday
and goes for antenatal care, 8 times during the pregnancy. (See page 18)
• Accompany your wife/partner to the health facility as much as possible.
• Get tested and treated for Sexually Transmitted Infections (STIs) including HIV. If found
positive you will receive appropriate advice on how to protect your unborn baby and your
treatment.
• Ensure you and your wife/partner have a birth plan
• Be sure to play and communicate with your unborn baby during pregnancy
• Discuss family planning method of choice with your wife/partner

During childbirth
You can help your wife/partner have a safe labour and childbirth:
• Ensure availability of basic needs in the house to avoid any worries as she goes to
deliver at the health facility.
• Ensure transport to the health facility is available (Birth preparedness; money, birth
companion, emergency kit)
• Ensure other children are taken care of.
• If you stay with her during the birth, you can help by giving her both emotional and
physical support.
• Build her confidence by encouraging her by telling her she is doing well.
• Help her walk or squat during contractions or rub her back

After childbirth
• The first six weeks after birth are the most important for both mother and baby.
• Ensure the baby is given ONLY breast milk for the first 6 months for proper growth and
disease prevention.
• Take time to hold and care for your baby to establish closeness (bonding) to your new
child. This will also give your wife/partner a chance to sleep and rest. She needs a lot of
healthy foods, fluids and plenty of rest during this time.
• If the mother is HIV positive the baby should get prophylaxis (nevirapine and AZT)
during breastfeeding and a HIV test at 6 weeks of age. NB: A HIV positive couple can
get a HIV negative baby.

Attend all your Antenatal clinic visits as advised by the health care provider
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MOTHER & CHILD HEALTH HANDBOOK - 2020

• Help her rest more by doing some of house chores or getting someone else who can
help.
• Ensure the baby is exclusively breastfed (should not be given any foods, fluids and not
even water) for 6 months after childbirth.
• Be sure to play and communicate with your baby.
• Avoid sexual contact until the bleeding and the discharge that comes after childbirth
stops. (Usually 6 weeks after childbirth).
• Accompany your wife/partner to receive postnatal care.

Family Planning
• To have healthy mothers and babies it is best to space your children at least two years
between pregnancies.
• You can help your family be healthy by using family planning, the mother can start an
appropriate Family planning method immediately after childbirth.
• Visit the family planning clinic with your wife/partner and decide together which method
will work best then share the responsibility for using it.

NB: Throughout pregnancy, childbirth and there after, be alert for danger signs in the
mother and baby. If present seek medical help immediately. (See page14 and 19)

Attend all your Antenatal clinic visits as advised by the health care provider
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

SECTION 1: (ANC, CHILDBIRTH AND POSTNATAL CARE)

MATERNAL PROFILE

Name of Health Facility:

KMHFL Code: ANC No.:

PNC No.

Name of Client:

Age: Gravida: Parity: Height(cm): Weight(kg):

LMP: EDD:

Marital Status:

County: Subcounty: Ward:

Town/trading centre/village: Estate/hse no.:

Physical address:

Telephone:

Education level:

Next of Kin: Relationship:

Next of Kin’s Contacts/Phone:

MEDICAL & SURGICAL HISTORY

Surgical Operation - Specify:

Diabetes? Yes: No: Hypertension Yes: No:

Blood Transfusion: Tuberculosis:

Any Drug Allergy? Yes: No: If yes, specify:

Other allergies, specify:

Family History: Twins Tuberculosis

Attend all your Antenatal clinic visits as advised by the health care provider
Page 5 of 44
 1st

7th
6th
5th
4th
3rd
2nd
Pregnancy Order

Year

Page 6 of 44
Number of times
ANC Attended for
every pregnancy

Place of childbirth
MOTHER & CHILD HEALTH HANDBOOK - 2020

Gestation in
weeks

Duration of labour

Mode of delivery
PREVIOUS PREGNANCY

Birth weight
(grams)

Sex

Outcome

Puerperium

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 MOTHER & CHILD HEALTH HANDBOOK - 2020

PHYSICAL EXAMINATION [1st Visit]

General examination:
BP: Pulse rate
CVS: Resp.:
Breasts: Abdomen:
Examination of the external genitalia:
Discharge/genital Ulcer:

ANTENATAL PROFILE
Hb:

Blood Group:

Rhesus:
Urinalysis:

Blood RBS:

TB Screening as per the intensive case finding tool

Screening outcome:
Negative: Positive:
(If negative, and no TB signs, give Isoniazid Preventive Therapy (IPT) as per eligibility. If
positive, send for TB diagnosis)
Isoniazid Preventive Therapy (IPT): Date given: Next Visit:
Obstetric Ultrasound:
1st one done before 24 weeks (18-20 weeks) Gestation: Date:
2nd one done in 3rd trimester, Gestation: Date:
Triple testing (HIV/Syphilis/Hepatitis B): Date:
HIV: R NR Not tested Inconclusive
(If not tested refer for further counselling)
Syphilis: R NR Not tested Inconclusive
(If not tested refer for further counselling)
Hepatitis B: R NR Not tested Inconclusive
(If not tested refer for further counselling): If HIV Non-Reactive Re-testing: Date
If reactive, (see page 12) for management of the mother. If still non reactive (see page 11) for
repeat serology testing.
Note: Refer to current ART guideline for management of inconclusive results.
Couple HIV counselling and testing done Yes: No:
(If No, counsel and test. If negative, (see page 11) for retesting schedule.
Partner HIV Status
Reactive Non-Reactive Not Tested
If reactive refer partner for HIV Care.
Attend all your Antenatal clinic visits as advised by the health care provider
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MOTHER & CHILD HEALTH HANDBOOK - 2020

PRESENT PREGNANCY TABLE

Presentation
Gestation in

Foetal Heart
MUAC (cm)

Movement

Next Visit
Contacts

Fundal
Height
weeks

Foetal
Pallor
No of

Urine
Date

rate
Lie
Bp

Hb

Refer to page 10 for schedule of contacts.

WEIGHT MONITORING CHART (Plot the weight)

150
140
135
130
125
120
100
95
Mother’s Weight in kg

90
85
80
75
70
65
60
55
50
45
40
35
30

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40
Gestation In Weeks
Recommended Weight Gain: A total of at least 7kg to 12kg during pregnancy with an average of:
1st trimester 0.5kg/month, 2nd trimester 1-1.5kg/month, 3rd trimester 2- 2.2kg/month.
Attend all your Antenatal clinic visits as advised by the health care provider
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

CLINICAL NOTES
Date Clinical notes Next visit

Attend all your Antenatal clinic visits as advised by the health care provider
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MOTHER & CHILD HEALTH HANDBOOK - 2020

PREVENTIVE SERVICES
Tetanus Diphtheria Time given Date Next
(TD) injection given visit
1st injection First visit
2nd injection 4 weeks after 1st dose but 2 weeks before childbirth
3rd injection 6 months after 2nd dose
4 injection
th
1 year after 3rd inj/ subsequent pregnancy
5th injection 1 year after 4th inj/ subsequent pregnancy

MALARIA PROPHYLAXIS
Timing of Contact Dose# Date given Next visit
1: Up to 12 weeks
1a: 13 - 16 weeks IPTp - SP dose 1
2: 20 weeks IPTp - SP dose 2
3: 26 weeks IPTp - SP dose 3
4: 30 weeks IPTp - SP dose 4
5: 34 weeks IPTp - SP dose 5
6: 36 weeks No SP, if last dose received <1 Month ago
7: 38 weeks IPTp - SP dose 6 (if no dose in past month)
8: 40 weeks
NB: IPTp give SP at 4 weeks intervals from 13 weeks gestation to
term in malaria endemic areas
Long lasting Insecticide Treated Net (LLITN)

Deworming (Mebendazole 500mgs) given once in the 2nd trimester

date given

IRON AND FOLIC ACID SUPPLEMENTATION (IFAS) 270 tablets;

Dosage - 1 tablet per day; Taken with meals
Elemental Iron Contacts Gestation in weeks No. of Tablets Date Given
Upto 12weeks 60
1 12 weeks 56
(Combined Tablets 2 20 weeks 42
60mg Iron and 400μg 3 26 weeks 28
Folic acid)
4 30 weeks 28

Or any other equivalent 5 34 weeks 14

available 6 36 weeks 14
7 38 weeks 14
8 40 weeks 14
N/B The first 4 weeks are especially critical to the unborn baby in prevention of Neural Tube Defects
(birth defects of the brain, spine or spinal cord; the most common ones are spina bifida and
anencephaly). Take IFAS as per the health worker’s advise to prevent these defects.
NOTE: • IFAS should be taken from conception to delivery and thereafter if some tablets have remained.
• At every visit, give doses that will last until the next visit.
Attend all your Antenatal clinic visits as advised by the health care provider
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

Tetanus Diphtheria (TD) Vaccination:

• If a pregnant woman has not been previously vaccinated, or her immunization
status is unknown, she should receive two doses of tetanus diphtheria vaccine
one month apart with the 2nd dose given at least 2 weeks before childbirth. 2 doses
protect against tetanus infection for 1-3 years.
• A 3rd dose is recommended six months after the second dose, which should extend
protection to at least 5 years.
• Two further doses for women who are first vaccinated against tetanus during
pregnancy should be given after the 3rd dose, in the two subsequent years or
during two subsequent pregnancies.
• If a woman has had 1-4 TD injections in the past, she should receive one dose of
TD during each subsequent pregnancy to a total of 5 doses
• 5 doses protect throughout the childbearing years.
Only when the interval between the 1st and 2nd pregnancy is greater than (or equal to)
10yrs, should the schedule be re-started from T.D.-1.

(This rule does not apply to intervals greater than 10yrs between the 2nd-3rd
pregnancies or the 3rd-4th pregnancies. Meaning that a long delay between T.D.2 &
T.D. 3 is more risky than a long delay between T.D.3 & T.D4 or between T.D.4 & T.D.5)

MATERNAL SEROLOGY REPEAT TESTING

Date test done Date of Next
Serology results Comments
(dd/mm/yy) appointment
c Reactive
c Non-Reactive
c Not Tested
c Reactive
c Non-Reactive
c Not Tested
c Reactive If reactive, counsel
to start on ART
c Non-Reactive
immediately and test
c Not Tested the partner.
c Reactive
If non reactive, book
c Non-Reactive
for a repeat serology
c Not Tested test.
c Reactive
Continue testing untill
c Non-Reactive
complete cessation of
c Not Tested breastfeeding.
c Reactive
c Non-Reactive
c Not Tested
c Reactive
c Non-Reactive
c Not Tested

Note: Repeat serology test for the mother as per current national ART guideline.

Attend all your Antenatal clinic visits as advised by the health care provider
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PMTCT INTERVENTIONS FOR HIV POSITIVE MOTHERS AND THEIR EXPOSED INFANTS
MOTHER
Interventions Date started /service given and dose Comment
ART for life Visit #1 date Visit #2 date Visit #3 date: Visit #4 date Given to all regardless
of CD4 and viral load.
……………. ……………. …………....... …………… If change in regimen
Regimen: Regimen: Regimen: Regimen: indicate reason:
……………. ……………. …………….. …………… .........................
Viral load (VL) Date Viral Date Viral Date Viral Date Viral All should have a viral
sample load taken load taken load taken load taken load. Refer to current
ART guidelines for viral
................. ................. ................. ................. load monitoring.
Results Results Results Results

……………. ……………. ................. .................

NOTE: Assess all HEIs for initiation of ARV prophylaxis immediately after childbirth or at
first contact after birth.
Give the mother the ART prophylaxis to give to the baby immediately after birth and
continue until 6 weeks after complete cessation of breastfeeding. (See page 36)
CTX Prophylaxis syrup is to be issued from 6 weeks after birth (See page 20) for post-natal
assessment; and (See page 36) for ART&CTX prophylaxis)
COUNSEL MOTHER ON MANAGEMENT OF THE HEI (See page 36) for HEI prophylaxis or
ART treatment.

DENTAL HEALTH FOR YOU AND YOUR BABY

Your baby’s teeth are important for chewing, speaking and to guide the growth of the face and jaws
in readiness for permanent set of teeth later in life. Baby teeth start to develop during week 6 of
pregnancy. At birth, your baby will have small swellings in the mouth marking the areas of teeth
inside the gum. The swellings are your baby’s developing teeth, they are not ‘false” or “plastic”
teeth. The first baby teeth may come in when baby is 4-12 months old. During this time when teeth
are coming in, the gums may be itchy, and your baby may show signs of increased salivation. This
is normal and does not need the use of “teething gels” or “teething powders”. Dentists/ oral health
officer do not recommend their use as some may affect your baby.
Some babies may be born with one or more teeth in the mouth. These are called “Neonatal teeth”.
If they cause pain to the mother during breast feeding, take your baby to the dentist so that they can
be safely removed.

Cleaning your baby’s teeth

Prevent tooth decay by brushing baby teeth twice a day, (after morning feed and at night before
going to sleep), avoiding sugary foods and drinks, and not putting babies to sleep with bottles. Clean
baby teeth with a designated soft wet cloth or a soft baby-tooth brush. Start cleaning baby’s teeth
as soon as they appear. • Cavity-preventing fluoride toothpaste
starting with baby’s very first tooth is
recommended.
• Use a rice-grain-sized smear of toothpaste
for your baby or toddler age less than 2
Rice-grain-sized Smear Pea- size for age Regular for age
years, graduating to a pea-sized by age 2
for age less than 2 years 2 to 5 years more than 5 years to 5years, just like in the image on the left,
so that even when the baby swallows, the
amount is insignificant.
Attend all your Antenatal clinic visits as advised by the health care provider
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• You need to assist your baby with teeth brushing until they reach the age of 6-8 years (Until you
see they can tie their shoe-laces).
• Baby’s teeth do not cause diarrhoea, but the gums may be itchy and baby may put things like
dirty toys around them into the mouth causing stomach upsets. Ensure they have clean toys
and teething rings to soothe the gums during this time.
• Feed baby on healthy foods and snacks; avoid sweetened juices, sweets, chocolates.
• Take your baby to the dentist at the age of 1 year. The dentist will review baby’s progress and
give you more advice on the care of your baby’s teeth.

Dental care for pregnant mothers

Brush your teeth thoroughly twice a day (after breakfast and before bed) with fluoridated toothpaste.
If you feel like vomiting when you brush your teeth, try brushing about one hour after your last meal.
Visit your dentist/oral health officer to discuss other tooth-cleaning methods that may work for you, if
your gums bleed during tooth brushing or if you have any other problem with your teeth as this may
get worse when you are pregnant.

Get your teeth checked when you plan for a pregnancy to ensure you have good teeth to eat well
and keep your body healthy for the healthy development of your baby.

Dental treatment can be carried out during pregnancy without causing any harm to your baby. You
will just need to inform your dentist, so they can take the necessary care during your treatment.

During pregnancy, some mothers get the urge to eat more sugary snacks. This practice can increase
the occurrence of tooth decay and it is best to avoid.

Lost teeth due to dental problems or for any other reason can be replaced at a dental clinic.

CARE DURING PREGNANCY

• Eat one extra meal every day during pregnancy
• Eat at least 5 of the 10 food groups everyday
• Drink plenty of water at least 8 glasses per day(2 litres)
• Take iron and folic acid supplements (IFAS) everyday throughout pregnancy
• Avoid heavy work, rest more
• Sleep under an long lasting insecticidal net (LLIN)
• Go for ANC visit as soon as possible and attend 8 times during the pregnancy
• Do regular non-strenuous exercises

INFANT FEEDING

Infant feeding counseling done: Yes ☐ No: ☐

Counseling on exclusive breastfeeding and benefits of colostrum done. Yes: ☐ No: ☐

Attend all your Antenatal clinic visits as advised by the health care provider
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DANGER SIGNS DURING PREGNANCY

Severe
headache
Pale
Vaginal
Bleeding

Fever

Severe
abdominal pain

Swelling of face Reduced or

and hands no movement
of the unborn
baby
Breaking
water
Convulsions / fits

NB: Be prepared always to seek skilled care at the health facility in case of any of the above
signs.

CLINICAL NOTES
Date Clinical Notes Next visit

Attend all your Antenatal clinic visits as advised by the health care provider
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CHILDBIRTH
Duration of pregnancy _____________ in weeks
HIV tested? Yes: c No: c
If HIV test not done or Negative at ANC, counsel and test:
Reactive c NR c Not tested c
Mode of delivery __________________________ Date: ______________ Time: ____________
Place baby on mother’s abdomen immediately the baby is born: Yes c No c
Apgar score 1min ________ 5min ________ 10min _______ Resuscitation done: Yes c No c
Blood loss: ______________ Millilitres (mls)
Pre-eclampsia: c Eclampsia: c PPH: c
Obstructed labour Yes: c No: c
Condition of mother: _____________________________________________________________
Meconium stained liquor (grade)0,1,2,3,
Conducted by: Nurse: c Midwife: c Clinical Officer: c Doctor: c
Drugs administered at childbirth:
Mother: Oxytocin/Misoprostol/Heat stable carbetocin
If HIV positive c (HAART Highly Active Antiretroviral Therapy). Specify regimen _________
Other drugs specify: ________________________________________________________

Baby: CHX 7.1% c Vit K c TEO c

Cord care: Apply Chlorhexidine digluconate gel (CHX 7.1%) once daily for 7 days. Stop
application if cord drops off before 7 days. NB: DO NOT APPLY CHX ON EYES.
Baby HIV exposed: Specify ART prophylaxis given ________________________________
Other drugs specify: ____________________________________________________________
Baby’s condition _______________________________________________________________
Birth Weight gms: _________ Birth Length cm: _________ Head circumference cm: ________
Place of childbirth: Health facility: c Home: c Other (Specify): ______________________
Early initiation of breastfeeding within 1 hour after childbirth:___________________________

Note:
• Keep the baby warm, uninterrupted skin to skin for at least one hour immediately after
childbirth
• Delay bathing the baby for at least 24 hours after birth
• If preterm or low birth weight less than 2500gms, initiate kangaroo mother care at least
18 hours per day.

Take your child to the health facility, every month until he/she is 5 years old
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POSITIONING AND ATTACHMENT FOR BREASTFEEDING

Correct Good
Positioning Attachment

Is the infant correctly positioned? Positioning Is the infant able to attach? To check for
refers to when: attachment look for:
1. Baby’s head and body is straight 1. Chin touching the breast
2. Baby facing the mother with the nose 2. Mouth wide open
opposite the nipple 3. Lower lip turned outward
3. Baby’s body close to the mother’s body 4. More areola seen above than below
(Infant’s Tummy to mother’s tummy) the mouth

4. Mother supporting infant’s whole body

and not just neck and shoulders.

All the 4 signs of correct positioning All the 4 signs of good attachment
must be present to decide there is must be present for one to decide
correct positioning that there is good attachment

Is the infant correctly positioned? Is the infant well attached to the breast?
Yes c No c Yes c No c

How to attach: Signs of effective suckling:

1. Touch the baby’s upper lip with your 1. Slow deep sucks, sometimes
nipple pausing
2. Wait until the baby’s mouth is open
wide 2. Cheeks round when suckling
3. Move the baby quickly onto your 3. Baby releases breast when milk is
breast, aiming the baby’s lower lip finished or he/she is satisfied
well below the nipple 4. Mother feels relaxed

NB: During breastfeeding, show the mother correct positioning and good attachment.
• If breast milk is not enough, immediately visit a health facility.

Take your child to the health facility, every month until he/she is 5 years old
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EARLY IDENTIFICATION OF CONGENITAL ABNORMALITIES

Tick as appropriate if a sign is observed

Head size: Normal c c Abnormal Remarks

 Extra small (micro cephalic): c
 Extra big (hydrocephalic): c
 Others Specify: _____________________
Mouth and Normal c c Abnormal
Gums  Cleft lip: c
 Palate: c
 Others Specify _____________________
Ears Normal c c Abnormal
 Specify: _____________________________
Arms and legs Normal Arms c c Abnormal
Normal Legs c  Club foot: c
Normal Back c  Congenital hip dislocation: c
 Jointed fingers or toes: c
 Extra fingers and toes: c
 Others Specify: ____________________
Muscle Tone Normal c c Abnormal
 Floppiness c
 Rigidity c
 Other specify: _____________________

Joints movement Flexible c c Abnormal

 Not Flexible c
 Other specify: _____________________
Fingers & Toes Normal 5 fingers c Abnormal
and 5 toes c Specify: ______________________________________

Arms & Normal c c Abnormal

Shoulders Specify: ______________________________________
Spine/neck/ Normal c c Abnormal
back  Any Swellings c
 Protrusions c
 Sores or Marks along the spine c
 Specify: _____________________________
Body Movement Normal c c Abnormal
 Baby becomes floppy when lying
in certain position c
 Celebral palsy? c
If yes, specify: ________________________________
Abdominal wall Normal c c Abnormal
Specify: _______________________________________

Genitalia Normal c c Abnormal

Anus Perforate Imperforate (Abnormal) c

(Normal) c
List any abnormal findings (not captured previously): _________________________________________________________
NB: Assessment to be done within 48 hours after childbirth. To be repeated at 6 weeks.

Take your child to the health facility, every month until he/she is 5 years old
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HEALTHY EATING DURING PREGNANCY AND BREASTFEEDING:

WATER

NB: These are the 10

food groups and a few
examples of each.

Variety is key
• Eat at least 5 of the10 food groups each • Consume plenty of safe water throughout
day. the day.
• Eat a variety of foods within each food • Take one extra meal per day
group and of different colours across all • Take lots of nutritious fluids (Porridge,
the food groups. soup, fresh fruit juice).

CARE OF THE MOTHER AND BABY AFTER BIRTH

Eat two extra small meals Give only breast milk to Keep baby warmly
during breastfeeding period the baby for the first 6 wrapped, including cap
months of life and socks at all times

Sleep with the baby under an If childbirth occurs at home, immediately take the
insecticide treated net (LLIN) mother and the baby to the health facility
Take your child to the health facility, every month until he/she is 5 years old
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DANGER SIGNS FOR MOTHER AFTER CHILD BIRTH

Mother has:

Heavy bleeding Fever Severe Headache

Foul smelling Fits/ Convulsions

vaginal discharge

Baby:

Stops Has difficult or Feels hot or

breastfeeding well fast breathing unusually cold

Becomes less active Body becomes yellow

especially on the eyes, palms
and soles

Note: In case of any of these danger signs, immediately visit a health facility

Take your child to the health facility, every month until he/she is 5 years old
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POSTNATAL CARE
A) MOTHER
Within 48 4-6
Timing of Visit 1-2 weeks 4-6 weeks
hours months
Date/visit
Blood pressure
Temp
Pulse
Respiratory Rate
General Condition
Breast
C/S scar
Involution of uterus
Pelvic Exam
Condition of episiotomy
Lochia (smell amount and colour)
Haemoglobin (HB)
Mother’s HIV status (Test if was not tested or tested negative
during ANC, labour and delivery. If reactive, start on HAART
immediately. (See page 11)
All HIV negative mothers should receive HIV test at 6 weeks
after child birth.
Mother on HAART (Yes, No, N/A) If No, start on HAART.
HIV re-testing at 6 weeks post childbirth (Linked to CWC clinic)
and every 6 months thereafter until complete cessation of
breastfeeding. (See page 36)
Counseling on family planning: Yes/No/N/A
FP method, specify
Screen for maternal mental health

B) BABY
General condition: Well/Unwell
Temp
Breaths per minute
*Feeding method: Exclusive breastfeeding Yes /No

**Breastfeeding: Positioning: Correct/Not correct

Attachment: Good/Poor
Umbilical cord status: Clean / dry / bleeding / infected. Others specify.
Irritable, Yes/No
Any other problem?
Immunization started: Yes/No
HEI given ART prophylaxis Yes/No
(If no start on ART PROPHYLAXIS. (See page 36)

Baby cotrimoxazole prophylaxis initiated: Yes/No/N/A

*Encourage exclusive breastfeeding for all babies. If mother is HIV positive, she should adhere to ARV medicines
and the baby to be given ARV prophylaxis. **For positioning and attachment for breast feeding: (See page 16).
NB: Fill in (page 23 to 26) Child health monitoring.
Take your child to the health facility, every month until he/she is 5 years old
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

CLINICAL NOTES
Date Clinical notes Next visit

Take your child to the health facility, every month until he/she is 5 years old
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 MOTHER & CHILD HEALTH HANDBOOK - 2020

REPRODUCTIVE ORGANS CANCER SCREENING (TICK AS APPROPRIATE)

Date Exam Test Results Treatment

CERVICAL CANCER SCREENING

CERVIX HPV Negative Positive Suspicious Refered

for cancer

CERVIX VIA Negative Positive Suspicious Cryo Thermoablation LEEP Refered

cancer

CERVIX VIA/VILI Negative positive Suspicious Cryo Thermoablation LEEP Refered

cancer

CERVIX Pap Smear Normal ASCUS or Suspicious Cryo Thermoablation LEEP Refered
greater* for cancer

BREAST CANCER SCREENING

BREAST CBE Normal Benign Suspicious FNA Excision Others Refered

Lump lump (specify)

BREAST Ultrasound Normal Abnormal Diagnosis / treatment indicate Refered

(if abnormal
CBE)
ASCUS A typical squamous cells of undetermined significance LEEP Loop Electrosurgical Excision Procedure
CBE Clinical breast examination LSIL low-grade squamous intraepithelial lesion
Cryo Cryotherapy VIA Visual Inspection with Acetic Acid
FNA Fine Needle Aspiration VILI Visual Inspection with Lugol’s Iodine
HSIL High-grade squamous intraepithelial lesion
NB: Incase of any suspicious or positive result, refer for further management. The first postnatal cervical
screening should take place at 6 weeks after childbirth.
CLINICAL NOTES
Date Type of test Result Next visit

FAMILY PLANNING (COUNSEL AND INDICATE METHOD PROVIDED)

Date FP Method Weight BP Remarks

Take your child to the health facility, every month until he/she is 5 years old
Page 22 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

SECTION 2: CHILD HEALTH MONITORING

A. Particulars of the Child: Date first seen (DD/MM/YY)____/____/______
Name of Child:

Sex of child:
Date of birth – (DD/MM/YY)____/____/______
Gestation at birth (in weeks)..... Birth weight (gms)....... Birth Length (cm)...........
Other birth characteristics**
Birth order in family (e.g. 1st, 2nd, 3rd born):
Date 1st seen (DD/MM/YY)____/____/______

B. Health Record of Child:

Place of birth:
Health facility: c Home: c Other (Specify) _________________________________________________________

Birth Notification No.: ______________________________________ Date: ______________________________________

Immunization permanent register No.
Child Welfare Clinic (CWC) No.
Health facility name:
Master facility list (KMHFL) Code:

C. Civil Registration:
Birth Certificate No.:
Date of registration:
Place of registration:

**e.g. twin/triplet; caesarian birth; congenital features.

Any congenital abnormalities (cleft lip, club foot).. etc ______________________________________________________

D. Civil Registration:
Father’s name: Tel No.
Mother’s name: Tel No.
Guardian’s name (where applicable): Tel No.
Residence of child: County:
Division: Sub County:
Town/Trading centre/ Ward:
Estate & House No./Village:
Postal address:

Take your child to the health facility, every month until he/she is 5 years old
Page 23 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

E. Broad clinical review at first contact below 6 months:

Age at first contact:
Weight (gms):
Length/height (cm):
Z score (Refer to the growth charts (See pages 27 to 30))
HIV status:
Exposed: c Date:
Reactive: c Non reactive: c Date:
Unknown: c
If unknown conduct HIV test (See page 36) Refer to current ART guideline.
Haemoglobin (HB)
Physical features:
Colouration (cyanosis/jaundice/macules/hypopigmentation):
Head circumference (cm): Eyes (refer to section I):
Ears: Mouth:
Chest: Heart:
Abdomen: Umbilical cord/umbilicus:
Spine: Arms & hands:
Legs & feet:

Genitalia Normal: c Abnormal: c

(Specify: Indeterminate, undescended testes/ hypospadiasis etc) _______________________________

Anus: Perforate (Normal) c Imperforate (Abnormal) c

TB: Screen baby for TB as per the TB ICF card

F. Feeding information from parent/guardian

Breastfeeding: Well: c Poorly: c Unable to breastfeed: c
Other feeds introduced below 6 months: Yes: c No: c If yes, at what age _____________________
Counsel on exclusive breastfeeding
Complementary food from 6 months: Other foods introduced: Yes c No c
If no counsel on complementary feeding
*Retention of feeds/indigestion:
*NB: A baby who is exclusively breastfed may pass stool many times or may not pass any for
some days. This is normal unless he/she has abdominal distension or is vomiting.

G. Other problems as reported by parent/guardian

Does the baby have problems sleeping?:
Irritability: Yes c No c
Others specify:

Refer for further management as appropriate.

Take your child to the health facility, every month until he/she is 5 years old
Page 24 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020
H. Developmental Milestones
Milestones Age Normal Within Delayed
Achieved Limits time
Social smile/follows a colourful object 0-2
dangled before their eyes months
Holds the head upright / follows the
object or face with their eyes / turns the 2-4
head or responds in any other way to months
sound / smiles when you speak
Rolls over / reaches for and grasps
objects with hand / takes objects to her 4-6
mouth / babbles (makes sounds) months

Sits without support / moves object from

one hand to the other/ repeats syllables 6-9
(bababa, mamama) months

Takes steps with support / picks up small

object or string with 2 fingers / says 2-3 9 - 12
words / imitates simple gestures (claps months
hands, bye)
Where is your
nose?
Walks without support / drinks from a
cup / says 7-10 words / points to some 12-18
body parts on request months
Nice
Kicks a ball / builds tower with 3 blocks
Chicken
or small boxes / points at pictures on 18 - 24
request / speaks in short sentences months

Jumps/ undresses and dresses

themselves / says name, tells short 24
story/ interested in playing with other months
children and older

Refer for further assessment if a milestone delays beyond the normal age limit as indicat-
ed above
I. Identification of early eye problems in an infant
EYE CARE ASSESSMENT AGE IN MONTHS
(Tick on the appropriate unshaded boxes for age)
At Birth At 6 months At 9 months At 18 months

TETRACYCLINE EYE TEO (ONLY at

OINTMENT (TEO) GIVEN Birth)
PUPIL Black

White
(If white refer urgently)
SIGHT Following objects
Not following objects
(Refer to eye clinic)

SQUINT Squint
(Crossed eyes) (Refer to eye clinic)

No Squint
ANY other Yes
Problem (Refer to eye clinic)

No
NB: Some eye problems in children apart from causing visual impairment or blindness could also cause death of the
child. Early identification and treatment for the problem is critical.
Preterm infants on oxygen to have Retinopathy of Prematurity (ROP) examination.
Take your child to the health facility, every month until he/she is 5 years old
Page 25 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

J. Record of baby’s teeth development

It should be fun for your baby to know when they got their teeth. Here is a chart for you to
keep this record.
Observation Normal limits Age of baby when tooth seen Date seen
Lower Incisor 4-10 months
Upper Incisor 6-12 months
Lower Canine 12-23
Upper Canine 12-23
Lower First Molar 12-18
Upper First Molar 12-18
Lower Second Molar 24-30
Upper Second Molar 24-30

Reason for Special Care (Tick as appropriate)

• Birth weight less than 2.5kg c

• Birth less than 2 years after last birth c
• Birth order (Fifth child or more) c
• Born of a teenage mother c
• Born of a mentally ill mother c
• Child with developmental delays c
• Any of the child’s siblings been undernourished c
• Multiple births (Twins,Triplets) c
• Children with special needs c
• Orphans and vulnerable children c
• Child has disability c
• HIV Exposed Infants (HEI) c
• History/signs of child abuse/neglect c
• Cleft lip/palate c
• Any other(specify) _______________________________________________________________________

IF YOU HAVE TICKED ANY OF THE ABOVE:

COUNSEL THE CAREGIVER AND/OR REFER FOR FURTHER MANAGEMENT

Take your child to the health facility, every month until he/she is 5 years old
Page 26 of 44
 3 Refer for further investigations Weight-for-Age BOYS
2 to 3 Refer for nutritional counselling
28 28
(For feeding recommendations, See page 41) 3
27 KEY 27
Watch the direction of the line
26 showing the child’s health 26
GOOD 3-5yrs 3 main meals and 2 snacks per day
25 Means the child is 25
growing well. + 2 cups of milk
24 Continue feeding
24 2
DANGER
23 Find out why and 23
counsel
22 22
VERY DANGEROUS
21
May be ill, needs
extra care 21 1
20 20

19 19

18 18

17 17
Weight (Kg)

16 16 -1
15 15
Continue breastfeeding
14
Exclusive breastfeeding and give other foods
Birth - 6 months 6 months - 1 Year
14 -2
13 13
-3
12 12

11 11

10 10

9 9
49 50 51 52 53 54 55 56 57 58 59 60
8 8

7 7
37 38 39 40 41 42 43 44 45 46 47 48
6 6
4 - 5 years
5 5
25 26 27 28 29 30 31 32 33 34 35 36
4 4
3 - 4 years
3 3
13 14 15 16 17 18 19 20 21 22 23 24
2 2
2 - 3 years
1 1
1 2 3 4 5 6 7 8 9 10 11 12
Birth
At

1 - 2 years

Age (Completed months and years)

Birth - 1 year
NB: Plot the birth weight on the first verticle line (At Birth)
date of birth

and subsequent months, on the age specific vertical line.

Indicate

Page 27 of 44
 Length/Height-for-Age BOYS

3
120 KEY 120
2
GOOD
Means the child is 1
growing well.
110 Continue feeding 110

DANGEROUS -1
Find out why
100 and counsel 100 -2
-3
Length/Height (cm)

90 90

80 80

70 70

49 50 51 52 53 54 55 56 57 58 59 60

60 60
37 38 39 4041 42 43 44 45 46 4748
4 - 5 years

50
25 26 27 28 29 30 31 32 33 34 35 36
3 - 4 years 50

13 14 15 16 17 18 19 20 21 22 23 24 2 - 3 years
40 40
1 2 3 4 5 6 7 8 9 10 11 12
Birth

1 - 2 years
At

Birth - 1 year Age (Completed months and years)

date of birth

NB: Plot the birth length on the first verticle line (At Birth)
Indicate

and subsequent months, on the age specific vertical line.

Page 28 of 44
 Weight-for-Age GIRLS
3 Refer for further investigations
2 to 3 Refer for nutritional counselling
28 28
(For feeding recommendations, See page 41) 3
27 KEY 27
Watch the direction of the line
26 showing the child’s health 26

25
GOOD 3-5yrs 3 main meals and 2 snacks per day 25
Means the child is
growing well. + 2 cups of milk
24 Continue feeding 24 2
DANGER
23 Find out why and 23
counsel
22 22
VERY DANGEROUS
21 May be ill, needs
extra care
21 1
20 20

19 19

18 18

17 17
Weight (Kg)

16 16 -1
15 15
Continue breastfeeding
14
Exclusive breastfeeding and give other foods
Birth - 6 months 6 months - 1 Year
14 -2
13 13
-3
12 12

11 11

10 10

9 9
49 50 51 52 53 54 55 56 57 58 59 60
8 8

7 7
37 38 39 40 41 42 43 44 45 46 47 48
6 6
4 - 5 years
5 5
25 26 27 28 29 30 31 32 33 34 35 36
4 4
3 - 4 years
3 3
13 14 15 16 17 18 19 20 21 22 23 24
2 2
2 - 3 years
1 1
1 2 3 4 5 6 7 8 9 10 11 12
Birth
At

1 - 2 years

Age (Completed months and years)

Birth - 1 year
NB: Plot the birth weight on the first verticle line (At Birth)
date of birth

and subsequent months, on the age specific vertical line.

Indicate

Page 29 of 44
 If -2 to -3 intervention Length/Height-for-Age GIRLS
Below -3 Needs intervention

(For feeding recommendations, See page 41) 3

120 KEY 120
2
GOOD
Means the child is
growing well.
1
110 Continue feeding 110

DANGEROUS -1
Find out why
100 and counsel 100 -2
-3
Length/Height (cm)

90 90

80 80

70 70

49 50 51 52 53 54 55 56 57 58 59 60

60 60
37 38 39 4041 42 43 44 45 46 4748
4 - 5 years

50
25 26 27 28 29 30 31 32 33 34 35 36
3 - 4 years 50

13 14 15 16 17 18 19 20 21 22 23 24 2 - 3 years
40 40
1 2 3 4 5 6 7 8 9 10 11 12
Birth

1 - 2 years
At

Birth - 1 year Age (Completed months and years)

date of birth

NB: Plot the birth length on the first verticle line (At Birth)
Indicate

and subsequent months, on the age specific vertical line.

Page 30 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

GROWTH MONITORING RETURN DATES

DATE DATE DATE DATE

Take your child to the health facility, every month until he/she is 5 years old
Page 31 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

CLINICAL NOTES
Date Clinical Notes Next visit

Take your child to the health facility, every month until he/she is 5 years old
Page 32 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

IMMUNIZATION
PROTECT YOUR CHILD
BCG VACCINE: at birth (intra-dermal left fore Date Given Date of next visit
arm)
Dose:(0.05mls for child below 1 year)
Dose:(0.1mls for child above 1 year)
BCG-Scar Checked (Date Checked)

PRESENT
ABSENT
Repeat vaccine BCG (Date repeated)

POLIO VACCINE: (Bivalent Oral Polio Vaccine(bOPV): Date Given Date of next visit
Dose: 2 drops orally
Birth Dose at birth or within 2wks
1st Dose at 6 weeks
2nd Dose at 10 weeks
3rd Dose at 14 weeks

IPV (Inactivated Polio Vaccine)

IPV (0.5mls) Dose at 14 weeks Intramuscular into the
outer aspect of the right thigh 2.5cm (2 fingers apart) from
the site of PCV10 injection.

DIPHTHERIA/PERTUSSIS/TETANUS/HEPATITIS Date given Date of next visit

B/HAEMOPHILUS INFLUENZA Type b
Dose:(0.5mls) Intra Muscular left outer thigh
1st Dose at 6 weeks
2nd Dose at 10 weeks
3rd Dose at 14 weeks

PNEUMOCOCCAL CONJUGATE VACCINE Date given Date of next visit

Dose: (0.5mls) intramuscular into the upper outer aspect
of the right thigh
1st Dose at 6 weeks

2nd Dose at 10 weeks

3rd Dose at 14 weeks

ROTA VIRUS VACCINE Date given Date of next

1.5mls administered orally, slowly visit
1st Dose at 6 weeks

2nd Dose at 10 weeks

Take your child to the health facility, every month until he/she is 5 years old
Page 33 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

MEASLES RUBELLA VACCINE (MR) at 6 months; in the event of a mea- Date Given
sles rubella outbreak or HIV Exposed Infant (HEI)

Dose 0.5ml, deep subcutaneous injection into the right upper arm deltoid
muscle.
MEASLES RUBELLA VACCINE (MR) at 9 months Date Given
Dose 0.5ml, deep subcutaneous injection, over the deltoid muscle, upper
right arm.

MEASLES RUBELLA VACCINE (MR) at 18 Months Date Given

Dose 0.5ml, deep subcutaneous injection, over the deltoid muscle, upper
right arm.

YELLOW FEVER VACCINE at 9 months** Date Given

Dose; (0.5mls) Intra Muscular left upper deltoid

**Only in selected counties.

OTHER VACCINES
VACCINE DATE GIVEN

NB; Other vaccines refer to those not in the usual KEPI schedule and may include, Typhoid etc.
If your child develops any adverse events following immunization (AEFI) please report
immediately to the nearest health facility.

ANY ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI)

DATE: _____________________________________________ DESCRIBE: ____________________________________________

Antigen /Vaccine: _______________________________________________________________________________________________

Batch Number: __________________________________________________________________________________________________
Manufacture Date: ______________________________________________________________________________________________
Expiry Date: ______________________________________________________________________________________________________
Manufacturer’s Name: ________________________________________________________________________________________

Take your child to the health facility, every month until he/she is 5 years old
Page 34 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

VITAMIN A SUPPLEMENTATION (VAS)

VITAMIN A CAPSULE; Given orally (Start at 6 months or at first contact thereafter)

Dose Age Age given Date given Date of next visit

100,000IU 6 months
200,000 IU 12 months (1 year)
200,000 IU 18 months (1 ½ years)
200,000 IU 24 months (2 years)
200,000 IU 30 months (2 ½ years)
200,000 IU 36 months (3 years)
200,000 IU 42 months (3 1 ½ years)
200,000 IU 48 months ( 4 years)
200,000 IU 54 months (4 ½ years)
200,000 IU 59 months (5 years)
Note:
• Do not give Vitamin A Supplementation if 30 days have not elapsed since the last dose, then return
child to schedule as per age.
• For treatment of measles or Vitamin A deficiency related eye conditions, give appropriate dose on
day zero, 24 hrs later and 14 days later.
MICRONUTRIENT POWDERS (MNPs) - Dosage: 10 sachets per month
Age in months 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Number
issued
Date issued
Date of next
visit

NOTE: 1)Give 1 sachet every 3rd day; 2)Add to semi-solid food and mix; 3)Add in warm food NOT HOT;
4)Should be eaten within half an hour after mixing. 5)MNPs should not be added to liquid foods or drinks.

DEWORMING
Give once every six months to all children one year and above. Albendazole 200mg (Half a tablet) for
children 1 to 2 years and 400mg (One tablet) for children 2 years and above

Age Dosage/Tablet Age given Date given Next visit

12 months (1 year)
18 months (1 ½ years)

24 months (2 years)
30 months (2 ½ years)
36 months (3 years)
42 months (3 ½ years)
48 months ( 4 years)
54 months (4 ½ years)
59 months (5 years)

Take your child to the health facility, every month until he/she is 5 years old
Page 35 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

IDENTIFICATION OF EXPOSED CHILDREN AT FIRST CONTACT AFTER DELIVERY, OR AT

6 WEEKS OR FIRST CONTACT AFTER 6 WEEKS
Establish HIV Exposure Status of all infants at first contact:
To establish if the infant is exposed conduct a maternal antibody test. If the mother serology is
reactive the baby is Exposed (HEI).
For an infant accompanied by a guardian and with unknown maternal HIV status, conduct HIV
antibody test to establish if the infant is HIV exposed.
If the infant is exposed (HEI); Collect a DBS for DNA PCR at first contact after delivery or at 6
weeks, or first contact after 6 weeks.
All HEIs should be tested as per the table below;
Date of Sample
Type of Test Results
Collection
1 DNA PCR 1st contact after delivery or at 6 weeks, or
st

first contact after 6 weeks.

If 1st PCR test positive, collect a confirmatory DNA PCR
and baseline viral load, and start on ARV
2nd DNA PCR at 6 months
3rd DNA PCR at 12 months
Antibody test at 18 months
If breast feeding, conduct HIV antibody test at 24 months
(Repeat the HIV antibody test every 6 months until
complete cessation of breastfeeding)
Final antibody test 6 weeks after complete cessation of
breastfeeding
Key: • DNA PCR-DNA polymerase chain reaction • DBS-Dried blood spot
Note: Encourage exclusive breastfeeding for all infants including HEI.

HIV Exposed Infant

ARV Prophylaxis: Start at birth- give to mother at first contact
AZT+NVP for 6 weeks Continue NVP for minimum 12 weeks if not breastfeeding.
(Dose to be adjusted as per If breastfeeding, continue NVP until 6 weeks after complete
the infant weight/Age) cessation of breastfeeding.
Stop NVP syrup immediately if infant turns HIV positive and
start ART.
CTX Prophylaxis: Start at 6 weeks after birth or at first contact after 6 weeks.
CTX syrup 2.5 Ml OD Continue until 6 weeks after complete cessation of breastfeeding.
(Dose to be adjusted as per
the infant weight/Age)
Infant IPT syrup Given as per Infant’s eligibility.

HIV Infected Infant

ART for life. Stop NVP syrup immediately and start appropriate ART
(Dose to be adjusted as per the regimen if infant turns HIV positive. Refer to current ART
infant weight/Age) guideline for HAART regimen.
CTX syrup 2.5 Ml OD. (Dose to be Start at 6 weeks after birth or at first contact after 6
adjusted as per the infant weight/Age) weeks. Adjust dose as per weight.
IPT syrup Given as per child’s eligibility.

Take your child to the health facility, every month until he/she is 5 years old
Page 36 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

CLINICAL NOTES
Date Clinical Notes Next visit

Take your child to the health facility, every month until he/she is 5 years old
Page 37 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT)

OF HIV/SYPHILIS AND HEPATITIS B

HIV
Your baby is HIV exposed because you are HIV positive. It is important that
you exclusively breastfeed your baby. For positioning and attachment for
breastfeeding (See pages 16). Continue taking baby to the health facility
for immunization, Vitamin A /Micronutrients supplementation/ deworming,
Antiretroviral and septrin medicines as their growth is monitored every
month till they become 5 years of age.

Syphilis
What is syphilis? Syphilis is an infection that can be contracted through
unprotected sex. If a pregnant mother gets infected with Syphilis and she is
not treated adequately, she can suffer a miscarriage or give birth to a premature
or dead baby or deliver a baby with a very low birth weight or a baby already infected
with Syphilis. The baby born of a mother who has Syphilis can die within four months of life.
Syphilis can be passed on from mother to the baby during the process of childbirth.

What are the symptoms of syphilis?

Symptoms start 2 to 3 weeks after sexual contact with an infected person. It starts with a
painless sore on the penis, vagina, anus, or mouth.
These ulcers mostly heal on their own within a few weeks. Since they don’t hurt, many people
don’t get treatment for them. Then there are no symptoms until later in life where the disease will
result in damaged brain, nerves, eyes or heart.

How can I test for syphilis?

Testing is done for all pregnant mothers alongside HIV testing [Dual testing] at the Antenatal
Clinic. If your test is positive, your partner should also be tested and treated if he is found to be
positive.

Is there treatment for syphilis?

Yes, if you test positive for Syphilis, your healthcare provider will start you on appropriate
medicines to stop risk of transmitting to your baby.

How can I prevent getting infected by syphilis?

• Being faithful to your sexual partner and vice versa.
• Avoiding sex when you or your partner has any symptoms that could be caused by Syphilis
infection
• Using a condom every time you have sex

Hepatitis B
• Hepatitis B is a serious liver infection caused by the hepatitis B virus. The virus is passed
from one person to another through unprotected sex with an infected partner or sharing
needles with an infected person or from an infected mother to her baby during delivery.
• Many people do not know that they are carrying the virus, as they can have it for years
before developing symptoms. A person or mother infected with Hepatitis B, can eventually
develop liver disease which has no cure. It can also lead to early death of the child from
liver cancer, cirrhosis or liver failure.
• It is important for every pregnant woman to know their hepatitis B status in order to prevent
passing the virus to their unborn baby during delivery (See page 7).

Take your child to the health facility, every month until he/she is 5 years old
Page 38 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

HEALTH WORKER’S CONSULTATION

Date Clinical notes, diagnosis & treatment and signature) (use key words, write
legibly, 2 to 8 lines per visit)

Take your child to the health facility, every month until he/she is 5 years old
Page 39 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

HOSPITAL ADMISSIONS
Hospital Admission Date of Date of Discharge
Name Number Admission Discharge Diagnosis

SPECIAL CLINICAL ATTENDANCE

Hospital Name of Clinic Reason for Drugs from Discharge
Name attendance Clinic Diagnosis

Take your child to the health facility, every month until he/she is 5 years old
Page 40 of 44
 Counsel the caregiver on feeding recommendations FOR ALL CHILDREN during health and sickness
BREASTFEEDING 1-2 Cut food into small, Frequent breast Give your child 1 cup
years soft pieces so that feeds, feed your (250ml cup).
Newborn • Immediately after birth, put the baby on skin-to-skin contact with your child can pick, baby 5 times, (3
upto 1 week the mother for at least one hour. chew and swallow meals, 2 snacks) Add MNPs
• Initiate breastfeeding within the first hour after birth. Give comfortably.
your baby colostrum (the first yellowish, clear, whitish milk). It
protects the baby from many illnesses. 2-5 Cut food into small, May continue Give your child 11/2-
• Breastfeed on demand (day and night, as often as the baby years soft pieces so that breastfeeding 2 cups of 250 ml cup.
wants) at least 8 times in 24 hours. Frequent feeding produces your child can pick, Feed your baby 5
more milk. chew and swallow times
comfortably (3 meals, 2
• If the baby is small (low birth weight - <2500g), feed at least snacks)
every 2 to 3 hours. Wake the baby for feeding after 3 hours, if
baby does not wake self. Non-breastfed baby • If infant is <6 months, consult your health care worker
• DO NOT give other foods. Breast milk is all your baby needs. • Depending on the age, give in addition:
o 1-2 cups of milk per day
1 WEEK • Breastfeed as often as the child wants. Look for signs of
o 1-2 extra meals per day
UP TO 6 hunger, (fuss, sucking/moving lips, opening mouth, making
o 2-3 cups water per day
MONTHS sounds, sticking out the tongue, putting hands in his mouth,
making rapid eye movement before his/her eyes are open, baby o Adequate animal foods
may cry) • Use multiple micronutrient powders with complementary foods
• Breastfeed on demand (day and night, as often as the baby Feeding sick children During illness During recovery
wants) at least 8 times in 24 hours. Frequent feeding produces
• Encourage the child to drink and • Give extra breastfeeds
more milk.
to eat - with lots of patience • Feed an extra meal
• Breast milk is all your baby needs.
• Feed small amounts frequently • Give extra amount of food
• DO NOT give other foods or fluids
• Give foods that the child likes • Use extra rich foods
• Give a variety of nutrient-rich • Feed with extra patience and
COMPLEMENTARY FEEDING foods love
Age Texture Frequency Amount of food per • Continue to breastfeed – often
meal ill children breastfeed more
At 6 Start with thick Frequent breast 2 table spoon each frequently
months porridge or well feeds feed, increase to 3 Note:
mashed/ pureed Feed your child 2 table spoons in the • Introduce one type of food at a time Feed your child at least 4 of these 7 food
foods. times 3rd to 4th week. • Do not mix more than 2 types of cereals groups daily and continue breastfeeding for
(2 meals) 2 years or beyond.
Add MNPs • Give your child protein foods from 6 months
• Use a separate plate/bowl to feed your 1. Grain, grain products and other starchy foods
baby
7-8 Mashed family Frequent breast Increase amount • Observe hygiene! 2. Legumes, pulses, nuts and seeds
foods, by 8 months feeds gradually to half (½) o Wash your hands at critical times
months (after visiting the toilet, after cleaning 3. Dairy and dairy products
your baby can Feed your child 3 cup (250ml cup).
begin eating finger times baby bottoms, before eating, before
food. (3 meals) cooking, before/after handling a sick 4. Eggs
Add MNPs person). Keep cooking surfaces and
utensils clean 5. Flesh foods (beef, poultry, fish, insects)
9-11 Finely chopped Frequent breast 3/4 of a cup/bowl o Keep play items and areas clean
or mashed foods, feeds (250 ml) • Take your child to the clinic every month 6. Vitamin A rich fruits and vegetables
months until he/she is 5 years old.
introduce foods that Feed your child 4
baby can pick with times Add (MNPs) • Take your child to the Health Facility for 7. Other fruits and vegetables
their fingers. (3 meals,1 snack) Vitamin A Supplimentation at 6 months and
See page 18 for the food group examples/sample
every 6 months upto 5 years.
Page 41 of 44
Page 42 of 44
 MOTHER & CHILD HEALTH HANDBOOK - 2020

WHEN TO RETURN IMMEDIATELY

BRING ANY SICK CHILD IF:

Not able to drink Becomes sicker Develops fever

or Breastfeed

BRING CHILD WITH BRING CHILD WITH

COUGH IF: DIARRHOEA IF:
Fast breathing

Blood in stool

Drinking
poorly

Difficult
breathing

BRING YOUNG INFANT TO CLINIC IF ANY OF THE ABOVE SIGNS OR:

Palms and soles

Breast feeding poorly Feels unusually cold/hot appear yellow

Take your child to the health facility, every month until he/she is 5 years old
Page 43 of 44
MOTHER & CHILD HEALTH HANDBOOK - 2020

FLUIDS
FOR ANY SICK CHILD CHILD WITH DIARRHOEA
• Breastfeed frequently and for longer at Giving more fluids can be life saving
each feed 1) For children not on exclusive
breastfeeding:
• Increase fluid. Give soup, rice water,
Give extra fluids as much as the child will
yoghurt drinks or clean and safe water,
take:
if not on exclusive breastfeeding. • ORS solution
• Food based fluids such as
• Soup
• Rice
• Yoghurt drink
• Clean and safe water
• Breastfeed more frequently and longer
at each feeding
• Continue giving extra fluids until
diarrhoea stops
2) For babies on exclusive breastfeeding:
• Breastfeed more frequently and longer
at each breastfeed
• Give ORS solutions
3) Give zinc as advised by health worker
until it is finished.

If the child vomits, wait for 10 minutes then

give small frequent sips.

Immunisation Summary/Certificate

“Your child can receive the right

vaccines against the diseases
below, at the right time from the
nearest health facility”

Attend all your Antenatal clinic visits as advised by the health care provider
Page 44 of 44
Dear young adult
Your information is written in this MCH Handbook. When you get this Handbook from your
parents, look through from cover page to the end carefully. The cover is tired, perhaps because
your parents brought it many times to the health facility during routine health monitoring and
sickness. They also made use of the information in the Handbook and studied how to take
care of you. From the information in this Handbook you can know how you were born and grew
up till you were five years old. It can also help you know how to take care of your health, be a
healthy citizen and build a healthy nation.

Please keep this handbook safe, handle it carefully. When your child will grow up, please show
them this MCH Handbook and give them their own handbooks as presents from parents.

Parents’ sweet messages at each juncture, at:

Confirmation of pregnancy
…………………………………………………………………………………….….........….…..........
Child at age 4 months ……………………….......................………................…….….….….........
…………………………………………………………………….......................….........….…..........
Child at age 6 months ………………................………………...……............………….…............
…………………………………………………………………….......................…...........….…........
Child at age 1 year ……………………………………....….........……................……….…...........
…………………………………………………………………………………….….........….…..........
Child at age 2 years …………............................…………….......……………….....….….............
…………………………………...................……………………………………………….….........…
Child at age 3 years …………………………………………………………………….….…............
…………………………………………………………………………………….…........….…...........
Child at age 4 years ………………………………………………….......................….…............…
…………………………………………………………………………………….…......….….............
Child at age 5 years ………………………………………………………………………….….........
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