MOTHER & CHILD HEALTH HANDBOOK - 2020 MOTHER & CHILD HEALTH HANDBOOK - 2020

PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) PHYSICAL EXAMINATION [1st Visit]

OF HIV/SYPHILIS AND HEPATITIS B
General examination:
HIV
Your baby is HIV exposed because you are HIV positive. It is important that BP: Pulse rate
you exclusively breastfeed your baby. For positioning and attachment for CVS: Resp.:
breastfeeding (See pages 16). Continue taking baby to the health facility
for immunization, Vitamin A /Micronutrients supplementation/ deworming, Breasts: Abdomen:
Antiretroviral and septrin medicines as their growth is monitored every
month till they become 5 years of age. Examination of the external genitalia:
Discharge/genital Ulcer:
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 ANTENATAL PROFILE
not treated adequately, she can suffer a miscarriage or give birth to a premature
Hb:
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. Blood Group:
Syphilis can be passed on from mother to the baby during the process of childbirth.
Rhesus:
What are the symptoms of syphilis?
Symptoms start 2 to 3 weeks after sexual contact with an infected person. It starts with a Urinalysis:
painless sore on the penis, vagina, anus, or mouth.
Blood RBS:
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 TB Screening as per the intensive case finding tool
result in damaged brain, nerves, eyes or heart.
Screening outcome:
How can I test for syphilis? Negative: Positive:
Testing is done for all pregnant mothers alongside HIV testing [Dual testing] at the Antenatal
(If negative, and no TB signs, give Isoniazid Preventive Therapy (IPT) as per eligibility. If
Clinic. If your test is positive, your partner should also be tested and treated if he is found to be
positive, send for TB diagnosis)
positive.
Isoniazid Preventive Therapy (IPT): Date given: Next Visit:
Is there treatment for syphilis? Obstetric Ultrasound:
Yes, if you test positive for Syphilis, your healthcare provider will start you on appropriate 1st one done before 24 weeks (18-20 weeks) Gestation: Date:
medicines to stop risk of transmitting to your baby. 2nd one done in 3rd trimester, Gestation: Date:
How can I prevent getting infected by syphilis? Triple testing (HIV/Syphilis/Hepatitis B): Date:
• Being faithful to your sexual partner and vice versa. HIV: R NR Not tested Inconclusive
• Avoiding sex when you or your partner has any symptoms that could be caused by Syphilis (If not tested refer for further counselling)
infection Syphilis: R NR Not tested Inconclusive
• Using a condom every time you have sex (If not tested refer for further counselling)
Hepatitis B: R NR Not tested Inconclusive
Hepatitis B (If not tested refer for further counselling): If HIV Non-Reactive Re-testing: Date
• 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 If reactive, (see page 12) for management of the mother. If still non reactive (see page 11) for
needles with an infected person or from an infected mother to her baby during delivery. repeat serology testing.
• Many people do not know that they are carrying the virus, as they can have it for years Note: Refer to current ART guideline for management of inconclusive results.
before developing symptoms. A person or mother infected with Hepatitis B, can eventually Couple HIV counselling and testing done Yes: No:
develop liver disease which has no cure. It can also lead to early death of the child from (If No, counsel and test. If negative, (see page 11) for retesting schedule.
liver cancer, cirrhosis or liver failure. Partner HIV Status
• It is important for every pregnant woman to know their hepatitis B status in order to prevent Reactive Non-Reactive Not Tested
passing the virus to their unborn baby during delivery (See page 7).
If reactive refer partner for HIV Care.
Take your child to the health facility, every month until he/she is 5 years old Attend all your Antenatal clinic visits as advised by the health care provider
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PRESENT PREGNANCY TABLE CLINICAL NOTES

Date Clinical Notes Next visit
No of Contacts

Fundal Height

mental health
Presentation
Gestation in

Foetal Heart
MUAC (cm)

Movement

Screen for

Next Visit
weeks

Foetal
Pallor
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 Take your child to the health facility, every month until he/she is 5 years old
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IDENTIFICATION OF EXPOSED CHILDREN AT FIRST CONTACT AFTER DELIVERY, OR AT CLINICAL NOTES

6 WEEKS OR FIRST CONTACT AFTER 6 WEEKS Date Clinical notes Next visit
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
1st DNA PCR 1st contact after delivery or at 6 weeks, or
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 breastfeeding, 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 Attend all your Antenatal clinic visits as advised by the health care provider
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PREVENTIVE SERVICES
VITAMIN A SUPPLEMENTATION (VAS)
Tetanus Diphtheria Time given Date Next
(TD) injection given visit VITAMIN A CAPSULE; Given orally (Start at 6 months or at first contact thereafter)

1st injection First visit Dose Age Age given Date given Date of next visit

2nd injection 4 weeks after 1st dose but 2 weeks before childbirth 100,000IU 6 months
3rd injection 6 months after 2nd dose 200,000 IU 12 months (1 year)

4th injection 1 year after 3rd inj/ subsequent pregnancy 200,000 IU 18 months (1 ½ years)
5 injection
th
1 year after 4 inj/ subsequent pregnancy
th 200,000 IU 24 months (2 years)
200,000 IU 30 months (2 ½ years)
MALARIA PROPHYLAXIS
200,000 IU 36 months (3 years)
Timing of Contact Dose# Date given Next visit
200,000 IU 42 months (3 1 ½ years)
1: Up to 12 weeks
200,000 IU 48 months ( 4 years)
1a: 13 - 16 weeks IPTp - SP dose 1
200,000 IU 54 months (4 ½ years)
2: 20 weeks IPTp - SP dose 2
200,000 IU 59 months (5 years)
3: 26 weeks IPTp - SP dose 3 Note:
4: 30 weeks IPTp - SP dose 4 • Do not give Vitamin A Supplementation if 30 days have not elapsed since the last dose, then return
child to schedule as per age.
5: 34 weeks IPTp - SP dose 5 • For treatment of measles or Vitamin A deficiency related eye conditions, give appropriate dose on
day zero, 24 hrs later and 14 days later.
6: 36 weeks No SP, if last dose received <1 Month ago
MICRONUTRIENT POWDERS (MNPs) - Dosage: 10 sachets per month
7: 38 weeks IPTp - SP dose 6 (if no dose in past month)
Age in months 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
8: 40 weeks
Number
NB: IPTp give SP at 4 weeks intervals from 13 weeks gestation to issued
term in malaria endemic areas
Date issued
Long Lasting Insecticidal Net (LLIN)
Date of next
visit
Deworming (Mebendazole 500mgs) given once in the 2nd trimester 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.
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 DEWORMING

Upto 12weeks 60 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
1 12 weeks 56
Age Dosage/Tablet Age given Date given Next visit
(Combined Tablets 2 20 weeks 42
12 months (1 year)
60mg Iron and 400μg 3 26 weeks 28
18 months (1 ½ years)
Folic acid)
4 30 weeks 28
24 months (2 years)
Or any other equivalent 5 34 weeks 14
30 months (2 ½ years)
available 6 36 weeks 14 36 months (3 years)
7 38 weeks 14 42 months (3 ½ years)
8 40 weeks 14 48 months ( 4 years)
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 54 months (4 ½ years)
anencephaly). Take IFAS as per the health worker’s advise to prevent these defects. 59 months (5 years)
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 Take your child to the health facility, every month until he/she is 5 years old
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MEASLES RUBELLA VACCINE (MR) at 6 months; in the Date Given Date of next visit Tetanus Diphtheria (TD) Vaccination:
event of a measles rubella outbreak or HIV Exposed Infant • If a pregnant woman has not been previously vaccinated, or her immunization
(HEI) status is unknown, she should receive two doses of tetanus diphtheria vaccine
Dose 0.5ml, deep subcutaneous injection into the right one month apart with the 2nd dose given at least 2 weeks before childbirth. 2 doses
upper arm deltoid muscle. protect against tetanus infection for 1-3 years.
• A 3rd dose is recommended six months after the second dose, which should extend
MEASLES RUBELLA VACCINE (MR) at 9 months Date Given Date of next visit protection to at least 5 years.
Dose 0.5ml, deep subcutaneous injection, over the deltoid • Two further doses for women who are first vaccinated against tetanus during
muscle, upper right arm. pregnancy should be given after the 3rd dose, in the two subsequent years or
during two subsequent pregnancies.
MEASLES RUBELLA VACCINE (MR) at 18 Months Date Given Date of next visit
• If a woman has had 1-4 TD injections in the past, she should receive one dose of
Dose 0.5ml, deep subcutaneous injection, over the deltoid TD during each subsequent pregnancy to a total of 5 doses
muscle, upper right arm.
• 5 doses protect throughout the childbearing years.

YELLOW FEVER VACCINE at 9 months** Date Given Date of next visit 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.
Dose; (0.5mls) Intra Muscular left upper deltoid
(This rule does not apply to intervals greater than 10yrs between the 2nd-3rd
**Only in selected counties. 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)
OTHER VACCINES
VACCINE DATE GIVEN
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
NB; Other vaccines refer to those not in the usual KEPI schedule and may include, Typhoid etc. c Non-Reactive
immediately and test
If your child develops any adverse events following immunization (AEFI) please report c Not Tested the partner.
immediately to the nearest health facility.
c Reactive
If non reactive, book
c Non-Reactive
for a repeat serology
c Not Tested test.
ANY ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI)
c Reactive
Continue testing untill
DATE: _____________________________________________ DESCRIBE: c Non-Reactive
____________________________________________ complete cessation of
c Not Tested breastfeeding.
Antigen /Vaccine: _______________________________________________________________________________________________
c Reactive
Batch Number: __________________________________________________________________________________________________ c Non-Reactive
Manufacture Date: ______________________________________________________________________________________________ c Not Tested
Expiry Date: ______________________________________________________________________________________________________ c Reactive
Manufacturer’s Name: ________________________________________________________________________________________ c Non-Reactive
c Not Tested

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

Take your child to the health facility, every month until he/she is 5 years old 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 IMMUNIZATION
MOTHER PROTECT YOUR CHILD
Interventions Date started /service given and dose Comment BCG VACCINE: at birth (intra-dermal left fore Date Given Date of next visit
ART for life Visit #1 date Visit #2 date Visit #3 date: Visit #4 date Given to all regardless arm)
of CD4 and viral load.
……………. ……………. …………....... …………… If change in regimen
Dose:(0.05mls for child below 1 year)
Regimen: Regimen: Regimen: Regimen: indicate reason: Dose:(0.1mls for child above 1 year)
……………. ……………. …………….. …………… .........................
BCG-Scar Checked (Date Checked)
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 PRESENT
ART guidelines for viral
................. ................. ................. ................. load monitoring. ABSENT
Results Results Results Results Repeat vaccine BCG (Date repeated)
……………. ……………. ................. .................
POLIO VACCINE: (Bivalent Oral Polio Vaccine(bOPV): Date Given Date of next visit
NOTE: Assess all HEIs for initiation of ARV prophylaxis immediately after childbirth or at
first contact after birth. Dose: 2 drops orally
Give the mother the ART prophylaxis to give to the baby immediately after birth and Birth Dose at birth or within 2wks
continue until 6 weeks after complete cessation of breastfeeding. (See page 36)
1st Dose at 6 weeks
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) 2nd Dose at 10 weeks
COUNSEL MOTHER ON MANAGEMENT OF THE HEI (See page 36) for HEI prophylaxis or 3rd Dose at 14 weeks
ART treatment.
IPV (Inactivated Polio Vaccine)
DENTAL HEALTH FOR YOU AND YOUR BABY IPV (0.5mls) Dose at 14 weeks Intramuscular into the
Your baby’s teeth are important for chewing, speaking and to guide the growth of the face and jaws outer aspect of the right thigh 2.5cm (2 fingers apart) from
in readiness for permanent set of teeth later in life. Baby teeth start to develop during week 6 of the site of PCV10 injection.
pregnancy. At birth, your baby will have small swellings in the mouth marking the areas of teeth
DIPHTHERIA/PERTUSSIS/TETANUS/HEPATITIS Date given Date of next visit
inside the gum. The swellings are your baby’s developing teeth, they are not ‘false” or “plastic”
B/HAEMOPHILUS INFLUENZA Type b
teeth. The first baby teeth may come in when baby is 4-12 months old. During this time when teeth Dose:(0.5mls) Intra Muscular left outer thigh
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 1st Dose at 6 weeks
officer do not recommend their use as some may affect your baby. 2nd Dose at 10 weeks
Some babies may be born with one or more teeth in the mouth. These are called “Neonatal teeth”. 3rd Dose at 14 weeks
If they cause pain to the mother during breastfeeding, take your baby to the dentist so that they can
be safely removed. PNEUMOCOCCAL CONJUGATE VACCINE Date given Date of next visit
Dose: (0.5mls) intramuscular into the upper outer aspect
Cleaning your baby’s teeth of the right thigh
Prevent tooth decay by brushing baby teeth twice a day, (after morning feed and at night before 1st Dose at 6 weeks
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 2nd Dose at 10 weeks
as soon as they appear. • Cavity-preventing fluoride toothpaste 3rd Dose at 14 weeks
starting with baby’s very first tooth is
recommended.
ROTA VIRUS VACCINE Date given Date of next visit
• Use a rice-grain-sized smear of toothpaste (0.5 mls) administered orally (5 drops)
for your baby or toddler age less than 2
1st dose at 6 weeks
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, 2nd dose at 10 weeks
so that even when the baby swallows, the
3rd dose at 14 weeks
amount is insignificant.
Attend all your Antenatal clinic visits as advised by the health care provider Take your child to the health facility, every month until he/she is 5 years old
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CLINICAL NOTES • You need to assist your baby with teeth brushing until they reach the age of 6-8 years (Until you
Date Clinical Notes Next visit 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 a 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: ☐

Take your child to the health facility, every month until he/she is 5 years old Attend all your Antenatal clinic visits as advised by the health care provider
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th/Height-for-Age GIRLS
DANGER SIGNS DURING PREGNANCY GROWTH MONITORING RETURN DATES
Severe DATE DATE DATE DATE
headache
Pale
g recommendations, See page 41) Vaginal
3
120
Bleeding
2
1
110
Fever
-1
Severe
abdominal pain
100 -2
-3
Swelling of face Reduced or 90
and hands no movement
of the unborn
baby
Breaking
water 80
Convulsions / fits

NB: Be prepared always to seek skilled care at the health facility in case of any of the above
signs.
70
CLINICAL NOTES
Date Clinical Notes Next
49 50 51 52 visit
53 54 55 56 57 58 59 60

60
37 38 39 4041 42 43 44 45 46 4748
4 - 5 years
25 26 27 28 29 30 31 32 33 34 35 36
3 - 4 years 50

24 2 - 3 years
40

e (Completed months and years)

B: Plot the birth length on the first verticle line (At Birth)
nd subsequent months, on the age specific vertical line.
Attend all your Antenatal clinic visits as advised by the health care provider Take your child to the health facility, every month until he/she is 5 years old
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