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Saving Mothers
and Babies
A learning programme
for professionals




Developed by the
Perinatal Education Programme
Saving
Mothers
and Babies
A learning programme
for professionals
Developed by the
Perinatal Education Programme




www.ebwhealthcare.com
VERY IMPORTANT
We have taken every care to ensure that drug
dosages and related medical advice in this book
are accurate. However, drug dosages can change
and are updated often, so always double-check
dosages and procedures against a reliable,
up-to-date formulary and the given drug‘s
documentation before administering it.




Saving Mothers and Babies:
A learning programme for professionals
Version 1.0.0
First published by Electric Book Works in 2008
Text © Perinatal Education Programme 2008
Getup © Electric Book Works 2008
ISBN (paperback): 978-1-920218-29-4
ISBN (PDF ebook): 978-1-920218-60-7
All text in this book excluding the tests and
answers is published under the Creative Commons
Attribution Non-Commercial No Derivatives
License. You can read up about this license at http://
creativecommons.org/licenses/by-nc-nd/3.0/.
The multiple-choice tests and answers in this
publication may not be reproduced, stored in a
retrieval system, or transmitted in any form or by
any means without the prior permission of Electric
Book Works, 87 Station Road, Observatory, Cape
Town, 7925.
Visit our websites at www.electricbookworks.com
and www.ebwhealthcare.com
Contents



Acknowledgements                             5      Neonatal mortality                           43
                                                    The ratio of stillbirths to early neonatal
Introduction                                 7        deaths                                     46
                                                    Perinatal care index                         47
   About the EBW Healthcare series           7      Case study 1                                 47
   Why decentralised learning?               7      Case study 2                                 48
   Books in the EBW Healthcare series        7      Case study 3                                 49
   Format of the courses                     9      Case study 4                                 50
   Contributors                             10
   Updating the course material             11   4 Maternal and perinatal mortality
   Contact information                      11     audits                                        51

1 Introduction to maternal and perinatal            Audit                                        51
  mortality                              12         Perinatal mortality meetings                 53
                                                    Perinatal mortality reports                  56
   Mortality                                12      Perinatal problem identification
   Audit                                    15        programme (PPIP)                           57
   Birth register                           17      Case study 1                                 59
   Low birth weight                         19      Case study 2                                 60
   Case study 1                             20      Case study 3                                 61
   Case study 2                             20      Case study 4                                 61
   Case study 3                             21      PPIP classifications of perinatal deaths     62
   Case study 4                             22
                                                 5 Finding solutions to maternal and
2 Maternal mortality                        23     perinatal mortality                           64
   Mortality ratio                          23      Finding solutions                            64
   Causes of maternal death                 25      Avoidable factors associated with
   Confidential enquiry                     27        maternal deaths                            66
   Avoidable factors                        28      Preventing maternal deaths                   67
   Case study 1                             32      Avoidable factors associated with
   Case study 2                             32        perinatal deaths                           68
   Case study 3                             33      Preventing perinatal mortality               70
   Case study 4                             34      Case study 1                                 73
   PPIP classification of maternal deaths   35      Case study 2                                 73
3 Perinatal mortality                       36      Case study 3                                 74

   Perinatal mortality                      36
   Stillbirths                              40
Acknowledgements
We acknowledge all the participants of Saving     Editor-in-Chief of the Perinatal Education
Mothers and Babies courses who have made          Programme: Prof D. L. Woods
suggestions and offered constructive criticism.
                                                  Editors of Saving Mothers and Babies: Prof D L
It is only through constant feedback from
                                                  Woods, Prof R C Pattinson, Dr D H Greenfield
colleagues and participants that the content of
Perinatal Education Programme courses can         Contributors: Prof G Theron, Prof H de Groot,
be improved.                                      Ms H Louw. .
Funding towards this publication was
generously provided by Eduhealthcare.
Introduction

ABOUT THE EBW                                        families and places of work, and the content
                                                     frequently fails to address the real healthcare
HEALTHCARE SERIES                                    requirements of the poor, rural communities
                                                     who face the biggest healthcare challenges.
EBW Healthcare publishes an innovative
                                                     To help solve these many problems, a self-
series of distance-learning books for
                                                     help decentralised learning method has been
healthcare professionals, developed by the
                                                     developed which addresses the needs of
Perinatal Education Trust, Eduhealthcare,
                                                     professional healthcare workers, especially
the Desmond Tutu HIV Foundation and the
                                                     those in poor, rural communities.
Desmond Tutu TB Centre, with contributions
from numerous experts.
Our aim is to provide appropriate, affordable        BOOKS IN THE EBW
and up-to-date learning material for
healthcare workers in under-resourced areas,         HEALTHCARE SERIES
so that they can manage their own continuing
education courses which will enable them to          Maternal Care addresses all the common
learn, practise and deliver skillful, efficient      and important problems that occur
patient care.                                        during pregnancy, labour, delivery and the
The EBW Healthcare series is built on                puerperium. It covers the antenatal and
the experience of the Perinatal Education            postnatal care of healthy women with normal
Programme (PEP), which has provided                  pregnancies, monitoring and managing
learning opportunities to over 60 000 nurses         the progress of labour, specific medical
and doctors in South Africa since 1992. Many         problems during pregnancy, labour and the
of the educational methods developed by PEP          puerperium, family planning and regionalised
are now being adopted by the World Health            perinatal care. Skills workshops teach clinical
Organisation (WHO).                                  examination in pregnancy and labour, routine
                                                     screening tests, the use of an antenatal card
                                                     and partogram, measuring blood pressure,
WHY DECENTRALISED                                    detecting proteinuria and performing and
                                                     repairing an episiotomy.
LEARNING?
                                                     Maternal Care is aimed at healthcare workers
                                                     in level 1 hospitals or clinics.
Continuing education for healthcare workers
traditionally consists of courses and workshops
                                                     Primary Maternal Care addresses the
run by formal trainers at large central hospitals.
                                                     needs of healthcare workers who provide
These teaching courses are expensive to attend,
                                                     antenatal and postnatal care, but do not
often far away from the healthcare workers’
8     SAVING MOTHERS AND BABIES



conduct deliveries. It is adapted from theory       for women during pregnancy, labour and
chapters and skills workshops from Maternal         delivery. It also presents improved methods
Care. This book is ideal for midwives and           of providing infant care with an emphasis
doctors providing primary maternal care             on kangaroo mother care and exclusive
in level 1 district hospitals and clinics,          breastfeeding.
and complements the national protocol of
antenatal care in South Africa.                     Saving Mothers and Babies was developed in
                                                    response to the high maternal and perinatal
Intrapartum Care was developed for doctors          mortality rates found in most developing
and advanced midwives who care for women            countries. Learning material used in this book
who deliver in district hospitals. It contains      is based on the results of the annual confidential
theory chapters and skills workshops adapted        enquiries into maternal deaths and the Saving
from the labour chapters of Maternal Care.          Mothers and Saving Babies reports published in
Particular attention is given to the care           South Africa. It addresses the basic principles
of the mother, the management of labour             of mortality audit, maternal mortality,
and monitoring the wellbeing of the fetus.          perinatal mortality, managing mortality
Intrapartum Care was written to support             meetings and ways of reducing maternal and
and complement the national protocol of             perinatal mortality rates. This book should
intrapartum care in South Africa.                   be used together with the Perinatal Problem
                                                    Identification Programme (PPIP).
Newborn Care was written for healthcare
workers providing special care for newborn          Birth Defects was written for healthcare
infants in regional hospitals. It covers            workers who look after individuals with birth
resuscitation at birth, assessing infant size and   defects, their families, and women who are at
gestational age, routine care and feeding of both   increased risk of giving birth to an infant with a
normal and high-risk infants, the prevention,       birth defect. Special attention is given to modes
diagnosis and management of hypothermia,            of inheritance, medical genetic counselling,
hypoglycaemia, jaundice, respiratory distress,      and birth defects due to chromosomal
infection, trauma, bleeding and congenital          abnormalities, single gene defects, teratogens
abnormalities, as well as communication with        and multifactorial inheritance. This book
parents. Skills workshops address resuscitation,    is being used in the Genetics Education
size measurement, history, examination and          Programme which trains healthcare workers in
clinical notes, nasogastric feeds, intravenous      genetic counselling in South Africa.
infusions, use of incubators, measuring blood
glucose concentration, insertion of an umbilical    Perinatal HIV enables midwives, nurses
vein catheter, phototherapy, apnoea monitors        and doctors to care for pregnant women and
and oxygen therapy.                                 their infants in communities where HIV
                                                    infection is common. Special emphasis has
Primary Newborn Care was written                    been placed on the prevention of mother-to-
specifically for nurses and doctors who             infant transmission of HIV. It covers the basics
provide primary care for newborn infants in         of HIV infection and screening, antenatal
level 1 clinics and hospitals. Primary Newborn      and intrapartum care of women with HIV
Care addresses the care of infants at birth, care   infection, care of HIV-exposed newborn
of normal infants, care of low-birth-weight         infants, and parent counselling.
infants, neonatal emergencies, and common
minor problems in newborn infants.                  Childhood HIV enables nurses and doctors
                                                    to care for children with HIV infection. It
Mother and Baby Friendly Care describes             addresses an introduction to HIV in children,
gentler, kinder, evidence-based ways of caring      the clinical and immunological diagnosis
INTRODUCTION            9


of HIV infection, management of children            2. Pre- and post-tests
with and without antiretroviral treatment,
                                                    There is a multiple-choice test of 20 questions
antiretroviral drugs, opportunistic infections
                                                    for each chapter at the end of the book.
and end-of-life care.
                                                    Participants are encouraged to take a pre-test
                                                    before starting each chapter, to benchmark
Childhood TB was written to enable
                                                    their current knowledge, and a post-test after
healthcare workers to learn about the primary
                                                    each chapter, to assess what they have learned.
care of children with tuberculosis. The book
covers an introduction to TB infection,             Self-assessment allows participants to monitor
and the clinical presentation, diagnosis,           their own progress through the course.
management and prevention of tuberculosis
in children and HIV/TB co-infection.                3. Question-and-answer format
Childhood TB was developed by paediatricians
with wide experience in the care of children        Theoretical knowledge is presented in a
with tuberculosis, under the auspices of the        question-and-answer format, which encourages
Desmond Tutu Tuberculosis Centre at the             the learner to actively participate in the
University of Stellenbosch.                         learning process. In this way, the participant
                                                    is led step by step through the definitions,
Child Healthcare addresses all the common           causes, diagnosis, prevention, dangers and
and important clinical problems in children,        management of a particular problem.
including immunisation, history and                 Participants should cover the answer for a few
examination, growth and nutrition, acute and        minutes with a piece of paper while thinking
chronic infections, parasites, skin conditions,     about the correct reply to each question. This
and difficulties in the home and society. Child     method helps learning.
Healthcare was developed for use in primary
care settings.                                      Simplified flow diagrams are also used, where
                                                    necessary, to indicate the correct approach to
Adult HIV covers an introduction to HIV             diagnosing or managing a particular problem.
infection, management of HIV-infected adults
at primary-care clinics, preparing patients for     Each question is written in bold, like this,
antiretroviral (ARV) treatment, ARV drugs,          and is identified with the number of the
starting and maintaining patients on ARV            chapter, followed by the number of the
treatment and an approach to opportunistic          question, e.g. 5-23.
infections. Adult HIV was developed by
doctors and nurses with wide experience in          4. Important lessons
the care of adults with HIV, under the auspices
of the Desmond Tutu HIV Foundation at the
University of Cape Town.                             Important practical lessons are emphasised by
                                                     placing them in a box like this.

FORMAT OF THE COURSES                               5. Notes
                                                      NOTE Additional, non-essential information is
                                                      provided for interest and given in notes like this.
1. Objectives                                         These facts are not used in the case studies or
The learning objectives are clearly stated at the     included in the multiple-choice questions.
start of each chapter. They help the participant
to identify and understand the important
lessons to be learned.
10   SAVING MOTHERS AND BABIES



6. Case studies                                   CONTRIBUTORS
Each chapter closes with a few case
studies which encourage the participant           The developers of our learning materials are a
to consolidate and apply what was learned         multi-disciplinary team of nurses, midwives,
earlier in the chapter. These studies give the    obstetricians, neonatologists, and general
participant an opportunity to see the problem     paediatricians. The development and review of
as it usually presents itself in the clinic or    all course material is overseen by the Editor-
hospital. The participant should attempt to       in-Chief, emeritus Professor Dave Woods,
answer each question in the case study before     a previous head of neonatal medicine at the
reading the correct answer.                       University of Cape Town who now consults to
                                                  UNICEF and the WHO.
7. Practical training
                                                  Perinatal Education Trust
Certain chapters contain skills workshops,
which need to be practised by the participants    Books developed by the Perinatal Education
(preferably in groups). The skills workshops,     Programme are provided as cheaply as possible.
which are often illustrated with line drawings,   Writing and updating the programme is both
list essential equipment and present step-by-     funded and managed on a non-profit basis by
step instructions on how to perform each          the Perinatal Education Trust.
task. If participants aren’t familiar with a
practical skill, they are encouraged to ask an    Eduhealthcare
appropriate medical or nursing colleague to
demonstrate the clinical skill to them. In this   Eduhealthcare is a non-profit organisation
way, senior personnel are encouraged to share     based in South Africa. It aims to improve health
their skills with their colleagues.               and wellbeing, especially in poor communities,
                                                  through affordable education for healthcare
                                                  workers. To this end it provides financial
8. Final examination
                                                  support for the development and publishing of
On completion of each course, participants        the EBW Healthcare series.
can take a 75-question multiple-choice
examination on the EBW Healthcare website,        The Desmond Tutu HIV Foundation
when they are ready to.
                                                  The Desmond Tutu HIV Foundation at the
All the exam questions will be taken from         University of Cape Town, South Africa,
the multiple-choice tests from the book. The      is a centre of excellence in HIV medicine,
content of the skills workshops will not be       building capacity through training and
included in the examination.                      enhancing knowledge through research.
Participants need to achieve at least 80%
in the examination in order to successfully       The Desmond Tutu Tuberculosis Centre
complete the course. Successful candidates        The Desmond Tutu Tuberculosis Centre at
will be emailed a certificate which states        Stellenbosch University, South Africa, strives
that they have successfully completed             to improve the health of vulnerable groups
that course. EBW Healthcare courses are           through the education of healthcare workers
not yet accredited for nurses, but South          and community members, and by influencing
African doctors can earn CPD points on the        policy based on research into the epidemiology
successful completion of an examination.          of childhood tuberculosis, multi-drug-
Please contact info@ebwhealthcare.com or          resistant tuberculosis, HIV/TB co-infection
+27 021 44 88 336 when you are ready to take      and preventing the spread of TB and HIV in
the exam.                                         southern Africa.
INTRODUCTION   11


UPDATING THE COURSE                              CONTACT INFORMATION
MATERIAL
                                                 EBW Healthcare
EBW Healthcare learning materials
are regularly updated to keep up with            Website: www.ebwhealthcare.com
developments and changes in healthcare           Email: info@ebwhealthcare.com
protocols. Course participants can make
important contributions to the continual         Telephone: +27 021 44 88 336
improvement of EBW Healthcare books              Fax: +27 088 021 44 88 336
by reporting factual or language errors,
                                                 Post: 87 Station Road, Observatory, 7925,
by identifying sections that are difficult to
                                                 Cape Town, South Africa
understand, and by suggesting additions or
improvements to the contents. Details of
alternative or better forms of management        Editor-in-Chief: Professor Dave Woods
would be particularly appreciated. Please send   Website: www.pepcourse.co.za
any comments or suggestions to the Editor-in-
Chief, Professor Dave Woods.                     Email: pepcourse@mweb.co.za
                                                 Telephone: +27 021 786 5369
                                                 Fax: +27 021 671 8030
                                                 Post: Perinatal Education Programme,
                                                 PO Box 34502, Groote Schuur, Observatory,
                                                 7937, South Africa

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Saving Mothers and Babies: Introduction

  • 1. Saving Mothers and Babies A learning programme for professionals Developed by the Perinatal Education Programme
  • 2. Saving Mothers and Babies A learning programme for professionals Developed by the Perinatal Education Programme www.ebwhealthcare.com
  • 3. VERY IMPORTANT We have taken every care to ensure that drug dosages and related medical advice in this book are accurate. However, drug dosages can change and are updated often, so always double-check dosages and procedures against a reliable, up-to-date formulary and the given drug‘s documentation before administering it. Saving Mothers and Babies: A learning programme for professionals Version 1.0.0 First published by Electric Book Works in 2008 Text © Perinatal Education Programme 2008 Getup © Electric Book Works 2008 ISBN (paperback): 978-1-920218-29-4 ISBN (PDF ebook): 978-1-920218-60-7 All text in this book excluding the tests and answers is published under the Creative Commons Attribution Non-Commercial No Derivatives License. You can read up about this license at http:// creativecommons.org/licenses/by-nc-nd/3.0/. The multiple-choice tests and answers in this publication may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior permission of Electric Book Works, 87 Station Road, Observatory, Cape Town, 7925. Visit our websites at www.electricbookworks.com and www.ebwhealthcare.com
  • 4. Contents Acknowledgements 5 Neonatal mortality 43 The ratio of stillbirths to early neonatal Introduction 7 deaths 46 Perinatal care index 47 About the EBW Healthcare series 7 Case study 1 47 Why decentralised learning? 7 Case study 2 48 Books in the EBW Healthcare series 7 Case study 3 49 Format of the courses 9 Case study 4 50 Contributors 10 Updating the course material 11 4 Maternal and perinatal mortality Contact information 11 audits 51 1 Introduction to maternal and perinatal Audit 51 mortality 12 Perinatal mortality meetings 53 Perinatal mortality reports 56 Mortality 12 Perinatal problem identification Audit 15 programme (PPIP) 57 Birth register 17 Case study 1 59 Low birth weight 19 Case study 2 60 Case study 1 20 Case study 3 61 Case study 2 20 Case study 4 61 Case study 3 21 PPIP classifications of perinatal deaths 62 Case study 4 22 5 Finding solutions to maternal and 2 Maternal mortality 23 perinatal mortality 64 Mortality ratio 23 Finding solutions 64 Causes of maternal death 25 Avoidable factors associated with Confidential enquiry 27 maternal deaths 66 Avoidable factors 28 Preventing maternal deaths 67 Case study 1 32 Avoidable factors associated with Case study 2 32 perinatal deaths 68 Case study 3 33 Preventing perinatal mortality 70 Case study 4 34 Case study 1 73 PPIP classification of maternal deaths 35 Case study 2 73 3 Perinatal mortality 36 Case study 3 74 Perinatal mortality 36 Stillbirths 40
  • 5. Acknowledgements We acknowledge all the participants of Saving Editor-in-Chief of the Perinatal Education Mothers and Babies courses who have made Programme: Prof D. L. Woods suggestions and offered constructive criticism. Editors of Saving Mothers and Babies: Prof D L It is only through constant feedback from Woods, Prof R C Pattinson, Dr D H Greenfield colleagues and participants that the content of Perinatal Education Programme courses can Contributors: Prof G Theron, Prof H de Groot, be improved. Ms H Louw. . Funding towards this publication was generously provided by Eduhealthcare.
  • 6. Introduction ABOUT THE EBW families and places of work, and the content frequently fails to address the real healthcare HEALTHCARE SERIES requirements of the poor, rural communities who face the biggest healthcare challenges. EBW Healthcare publishes an innovative To help solve these many problems, a self- series of distance-learning books for help decentralised learning method has been healthcare professionals, developed by the developed which addresses the needs of Perinatal Education Trust, Eduhealthcare, professional healthcare workers, especially the Desmond Tutu HIV Foundation and the those in poor, rural communities. Desmond Tutu TB Centre, with contributions from numerous experts. Our aim is to provide appropriate, affordable BOOKS IN THE EBW and up-to-date learning material for healthcare workers in under-resourced areas, HEALTHCARE SERIES so that they can manage their own continuing education courses which will enable them to Maternal Care addresses all the common learn, practise and deliver skillful, efficient and important problems that occur patient care. during pregnancy, labour, delivery and the The EBW Healthcare series is built on puerperium. It covers the antenatal and the experience of the Perinatal Education postnatal care of healthy women with normal Programme (PEP), which has provided pregnancies, monitoring and managing learning opportunities to over 60 000 nurses the progress of labour, specific medical and doctors in South Africa since 1992. Many problems during pregnancy, labour and the of the educational methods developed by PEP puerperium, family planning and regionalised are now being adopted by the World Health perinatal care. Skills workshops teach clinical Organisation (WHO). examination in pregnancy and labour, routine screening tests, the use of an antenatal card and partogram, measuring blood pressure, WHY DECENTRALISED detecting proteinuria and performing and repairing an episiotomy. LEARNING? Maternal Care is aimed at healthcare workers in level 1 hospitals or clinics. Continuing education for healthcare workers traditionally consists of courses and workshops Primary Maternal Care addresses the run by formal trainers at large central hospitals. needs of healthcare workers who provide These teaching courses are expensive to attend, antenatal and postnatal care, but do not often far away from the healthcare workers’
  • 7. 8 SAVING MOTHERS AND BABIES conduct deliveries. It is adapted from theory for women during pregnancy, labour and chapters and skills workshops from Maternal delivery. It also presents improved methods Care. This book is ideal for midwives and of providing infant care with an emphasis doctors providing primary maternal care on kangaroo mother care and exclusive in level 1 district hospitals and clinics, breastfeeding. and complements the national protocol of antenatal care in South Africa. Saving Mothers and Babies was developed in response to the high maternal and perinatal Intrapartum Care was developed for doctors mortality rates found in most developing and advanced midwives who care for women countries. Learning material used in this book who deliver in district hospitals. It contains is based on the results of the annual confidential theory chapters and skills workshops adapted enquiries into maternal deaths and the Saving from the labour chapters of Maternal Care. Mothers and Saving Babies reports published in Particular attention is given to the care South Africa. It addresses the basic principles of the mother, the management of labour of mortality audit, maternal mortality, and monitoring the wellbeing of the fetus. perinatal mortality, managing mortality Intrapartum Care was written to support meetings and ways of reducing maternal and and complement the national protocol of perinatal mortality rates. This book should intrapartum care in South Africa. be used together with the Perinatal Problem Identification Programme (PPIP). Newborn Care was written for healthcare workers providing special care for newborn Birth Defects was written for healthcare infants in regional hospitals. It covers workers who look after individuals with birth resuscitation at birth, assessing infant size and defects, their families, and women who are at gestational age, routine care and feeding of both increased risk of giving birth to an infant with a normal and high-risk infants, the prevention, birth defect. Special attention is given to modes diagnosis and management of hypothermia, of inheritance, medical genetic counselling, hypoglycaemia, jaundice, respiratory distress, and birth defects due to chromosomal infection, trauma, bleeding and congenital abnormalities, single gene defects, teratogens abnormalities, as well as communication with and multifactorial inheritance. This book parents. Skills workshops address resuscitation, is being used in the Genetics Education size measurement, history, examination and Programme which trains healthcare workers in clinical notes, nasogastric feeds, intravenous genetic counselling in South Africa. infusions, use of incubators, measuring blood glucose concentration, insertion of an umbilical Perinatal HIV enables midwives, nurses vein catheter, phototherapy, apnoea monitors and doctors to care for pregnant women and and oxygen therapy. their infants in communities where HIV infection is common. Special emphasis has Primary Newborn Care was written been placed on the prevention of mother-to- specifically for nurses and doctors who infant transmission of HIV. It covers the basics provide primary care for newborn infants in of HIV infection and screening, antenatal level 1 clinics and hospitals. Primary Newborn and intrapartum care of women with HIV Care addresses the care of infants at birth, care infection, care of HIV-exposed newborn of normal infants, care of low-birth-weight infants, and parent counselling. infants, neonatal emergencies, and common minor problems in newborn infants. Childhood HIV enables nurses and doctors to care for children with HIV infection. It Mother and Baby Friendly Care describes addresses an introduction to HIV in children, gentler, kinder, evidence-based ways of caring the clinical and immunological diagnosis
  • 8. INTRODUCTION 9 of HIV infection, management of children 2. Pre- and post-tests with and without antiretroviral treatment, There is a multiple-choice test of 20 questions antiretroviral drugs, opportunistic infections for each chapter at the end of the book. and end-of-life care. Participants are encouraged to take a pre-test before starting each chapter, to benchmark Childhood TB was written to enable their current knowledge, and a post-test after healthcare workers to learn about the primary each chapter, to assess what they have learned. care of children with tuberculosis. The book covers an introduction to TB infection, Self-assessment allows participants to monitor and the clinical presentation, diagnosis, their own progress through the course. management and prevention of tuberculosis in children and HIV/TB co-infection. 3. Question-and-answer format Childhood TB was developed by paediatricians with wide experience in the care of children Theoretical knowledge is presented in a with tuberculosis, under the auspices of the question-and-answer format, which encourages Desmond Tutu Tuberculosis Centre at the the learner to actively participate in the University of Stellenbosch. learning process. In this way, the participant is led step by step through the definitions, Child Healthcare addresses all the common causes, diagnosis, prevention, dangers and and important clinical problems in children, management of a particular problem. including immunisation, history and Participants should cover the answer for a few examination, growth and nutrition, acute and minutes with a piece of paper while thinking chronic infections, parasites, skin conditions, about the correct reply to each question. This and difficulties in the home and society. Child method helps learning. Healthcare was developed for use in primary care settings. Simplified flow diagrams are also used, where necessary, to indicate the correct approach to Adult HIV covers an introduction to HIV diagnosing or managing a particular problem. infection, management of HIV-infected adults at primary-care clinics, preparing patients for Each question is written in bold, like this, antiretroviral (ARV) treatment, ARV drugs, and is identified with the number of the starting and maintaining patients on ARV chapter, followed by the number of the treatment and an approach to opportunistic question, e.g. 5-23. infections. Adult HIV was developed by doctors and nurses with wide experience in 4. Important lessons the care of adults with HIV, under the auspices of the Desmond Tutu HIV Foundation at the University of Cape Town. Important practical lessons are emphasised by placing them in a box like this. FORMAT OF THE COURSES 5. Notes NOTE Additional, non-essential information is provided for interest and given in notes like this. 1. Objectives These facts are not used in the case studies or The learning objectives are clearly stated at the included in the multiple-choice questions. start of each chapter. They help the participant to identify and understand the important lessons to be learned.
  • 9. 10 SAVING MOTHERS AND BABIES 6. Case studies CONTRIBUTORS Each chapter closes with a few case studies which encourage the participant The developers of our learning materials are a to consolidate and apply what was learned multi-disciplinary team of nurses, midwives, earlier in the chapter. These studies give the obstetricians, neonatologists, and general participant an opportunity to see the problem paediatricians. The development and review of as it usually presents itself in the clinic or all course material is overseen by the Editor- hospital. The participant should attempt to in-Chief, emeritus Professor Dave Woods, answer each question in the case study before a previous head of neonatal medicine at the reading the correct answer. University of Cape Town who now consults to UNICEF and the WHO. 7. Practical training Perinatal Education Trust Certain chapters contain skills workshops, which need to be practised by the participants Books developed by the Perinatal Education (preferably in groups). The skills workshops, Programme are provided as cheaply as possible. which are often illustrated with line drawings, Writing and updating the programme is both list essential equipment and present step-by- funded and managed on a non-profit basis by step instructions on how to perform each the Perinatal Education Trust. task. If participants aren’t familiar with a practical skill, they are encouraged to ask an Eduhealthcare appropriate medical or nursing colleague to demonstrate the clinical skill to them. In this Eduhealthcare is a non-profit organisation way, senior personnel are encouraged to share based in South Africa. It aims to improve health their skills with their colleagues. and wellbeing, especially in poor communities, through affordable education for healthcare workers. To this end it provides financial 8. Final examination support for the development and publishing of On completion of each course, participants the EBW Healthcare series. can take a 75-question multiple-choice examination on the EBW Healthcare website, The Desmond Tutu HIV Foundation when they are ready to. The Desmond Tutu HIV Foundation at the All the exam questions will be taken from University of Cape Town, South Africa, the multiple-choice tests from the book. The is a centre of excellence in HIV medicine, content of the skills workshops will not be building capacity through training and included in the examination. enhancing knowledge through research. Participants need to achieve at least 80% in the examination in order to successfully The Desmond Tutu Tuberculosis Centre complete the course. Successful candidates The Desmond Tutu Tuberculosis Centre at will be emailed a certificate which states Stellenbosch University, South Africa, strives that they have successfully completed to improve the health of vulnerable groups that course. EBW Healthcare courses are through the education of healthcare workers not yet accredited for nurses, but South and community members, and by influencing African doctors can earn CPD points on the policy based on research into the epidemiology successful completion of an examination. of childhood tuberculosis, multi-drug- Please contact info@ebwhealthcare.com or resistant tuberculosis, HIV/TB co-infection +27 021 44 88 336 when you are ready to take and preventing the spread of TB and HIV in the exam. southern Africa.
  • 10. INTRODUCTION 11 UPDATING THE COURSE CONTACT INFORMATION MATERIAL EBW Healthcare EBW Healthcare learning materials are regularly updated to keep up with Website: www.ebwhealthcare.com developments and changes in healthcare Email: info@ebwhealthcare.com protocols. Course participants can make important contributions to the continual Telephone: +27 021 44 88 336 improvement of EBW Healthcare books Fax: +27 088 021 44 88 336 by reporting factual or language errors, Post: 87 Station Road, Observatory, 7925, by identifying sections that are difficult to Cape Town, South Africa understand, and by suggesting additions or improvements to the contents. Details of alternative or better forms of management Editor-in-Chief: Professor Dave Woods would be particularly appreciated. Please send Website: www.pepcourse.co.za any comments or suggestions to the Editor-in- Chief, Professor Dave Woods. Email: pepcourse@mweb.co.za Telephone: +27 021 786 5369 Fax: +27 021 671 8030 Post: Perinatal Education Programme, PO Box 34502, Groote Schuur, Observatory, 7937, South Africa