Lady Health Workers Guide

© 2007 MKFC Stockholm College

Lady Health Workers Guide

Lady
Health Workers
Guide



contents
3 our Pakistan – 8 How to avoid – what should we know

our community takes action 8 20 days cord care is needed

3 current situation

3 Health Care System in Pakistan 9 vaccination / immunization
3 Lady Health Workers 9 immunization

3 Improving family and community practices 9 Why, When, Where

3 National Program for Family Planning and Primary Health Care 9 Immunization is urgent

3 Childhood mortality is high in Pakistan 9 Age Immunizations to be given

3 Hiv/Aids 10 sterile needles

3 Women’s Health 10 secure the child’s life: vaccinate

3 Our Goals 10 Immunization protects against several dangerous diseases

10 Measles cause deaths

4 maternal care 10 Polio disables

and children’s health 10 Breastmilk protects too

4 the major Problems causing neonatal death 10 Vitamin A – No blindness

4 mother and child health services needed

4 Guidelines for postnatal care (WHO 1998) 11 hygiene
4 Our Community makes the difference 11 hygiene Practice

11 Co-operation upon good.

5 better nutrition – for health and develoPment 11 clean Water

5 Challenges 11 Families and communities

5 Why breastfeeding 11 can protect their water supply

5 Breastfeeding benefits 11 Families can keep water clean in the home

6 good Practice With breastfeeding 11 Washing hands

6 Signs that the baby is in a good position for breastfeeding

6 Signs that the baby is feeding well 13 diarrhoea
6 Almost every mother can produce enough milk 13 Why diarrhoea is dangerous

6 Substitutes with clean water 13 Recommended drinks for a child with diarrhoea

7 the umbilical cord – hoW to Protect 14 no blindness – Wash the face

7 cutting the cord sterile

7 tie tightly before

7 Length of the cord stump: 2–3 cm

7 How to tie the cord

7 cord care – traditional Practices

7 Unclean substances dangerous

8 Traditional cord practices causes infections and death

8 signs of infection in cord

8 Clean hands are important!

8 neonatal deaths

2



our Pakistan – our community takes action

current situation implementation of different primary health
Pakistan is a rapidly developing country. Rec
c care activities.
cently, big economic reforms have resulted in
a stronger economic outlook and given growth Major challenges remain and childhood mortalc c
especially in the manufacturing and financial ity and morbidity rates are unacceptably high
services sectors. in Pakistan.

Health Care System in Pakistan Hiv/Aids
Health care in Pakistan is provided by both HIV is not a dominant epidemic in the adult
public and private systems. population of Pakistan. Nevertheless, coupled
with an extremely low awareness of HIV/AIDS
Lady Health Workers in Pakistan, as well as a growing number of
An example of a promising recent initiative is cases, the AIDS epidemic is poised to take a
the lady health worker (LHW) communitycbased hold in Pakistan. The government estimates the
program, which is bringing health information number of HIV/AIDS cases between 70,000 and
to the communities. Presently, 3,000 women 80,000.
are serving as LHWs in their home villages.
Women’s Health
The lady workers shall get training in checking The Government has signed CEDAW (Convenc c
weight for age, management of the diarrhoea, tion on the Elimination of All Forms of Disc
c
counseling on breast feeding and nutrition. crimination Against Women) on 29 February,
1996, and CRC (Child Registration Certificate)
Improving family and community practices and Health and Education issues have become
Families have major responsibilities for caring important.
their children. Improving family and commuc c
nity practices is very important in the health Our Goals
work: to reinforce practices that are important Our Pakistan is committed to the goal of
for child survival. making population in Pakistan healthier, as
evidenced by the continuing strong support
National Program for for the Social Action Program (SAP) in the
Family Planning and Primary Health Care government’s National Health Policy Guidec c
The Implementation of the National Proc c lines up to 2010.
gramme for Family Planning and Primary
Health Care with a communitycbased approach
is sound.

Childhood mortality is high in Pakistan
In the past progress has been made to reduce
childhood mortality and morbidity through

3



maternal care and children’s health

The postnatal period (especially the first 24 • Sexually Transmitted Diseases
hours) is the most critical time: twocthirds of (STD prevention)
newborn deaths and also of all maternal deaths
occur in this period. Maternal health problems For Children:
are also widespread, complicated in part by frec c • Immunisation/vaccination.
quent births. The fertility remains high, at 5.3 • Primary health care.
births per woman, and population growth rates • Nutrition programme.
are much higher than elsewhere in South Asia. • Providing free milk, monthly check up of
weight, general conditions of children.
• Of every 38 women who give birth, one dies.
• The infant mortality rate is 101 per 1,000 and Guidelines for postnatal care (WHO 1998)
• The mortality rate for children under age For the baby
five is 140 per 1,000 births. Acute respiratory • immediate and exclusive breastfeeding
infections and diarrhoeal diseases are the • warming of the infant
leading causes of mortality. • hygienic care of the umbilical cord
• Annually 500,000 children die from pneumoc c • identification of danger signs
nia or diarrhoeal diseases.
For the mother
the major Problems • monitoring and referral for complications
causing neonatal death such as excessive bleeding, pain, and infecc c
Other than diseases, malnutrition causes many tion
deaths. Malnutrition is not not eating enough. • counseling on breastfeeding
You can be malnourished if you eat the wrong • advice on nutrition, newborn care practices
foods – for example too much sugar or not and family planning
enough vitamins. • Maternal and newborn postnatal care during
the the first few days after delivery to imc
c
In 1987 Ministry of Health in Pakistan reported prove survival of both.
51.5% children under 5 years were chronically • A contact with health services
malnourished. • Healthy household practices

mother and child Our Community makes the difference
health services needed: The underlying problems that affect
For Mothers: health are poverty, illiteracy, women’s
• Family planning and emphasis on small famc
c low status, inadequate water supplies and
ily norm. sanitation persist.
• Antenatal care.
• Postnatal care. The goal in our community is to take acc
c
• Safe mother hood. tion for better lives for all of us.
• Promotion of breast feeding.

4



better nutrition – for health and develoPment

Better nutrition is a prime entry point to endc
c Breastfeeding benefits
ing poverty and a milestone to achieving better 1. Breastmilk alone is the only food and drink
quality of life. Better nutrition means: an infant needs for the first six months. No
other food or drink, not even water, is usuc
c
• stronger immune systems, ally needed during this period.
• less illness and
• better health. 2. There is a risk that a woman infected with
HIV can pass the disease on to her infant
Healthy children learn better. Healthy people through breastfeeding. Women who are inc c
are stronger, are more able to create opportunicc fected or suspect that they may be infected
ties to break the cycles of poverty and hunger. should consult a trained health worker for
testing.
Challenges
• Poor nutrition contributes to 1 out of 2 3. Newborn babies should be kept close to
deaths their mothers and begin breastfeeding
• 1 out of 4 preschool children suffers from within one hour of birth.
undercnutrition, which can severely affect
a child’s mental and physical developc c 4. Frequent breastfeeding causes more milk
ment to be produced. Almost every mother can
• Undercnutrition among pregnant women breastfeed successfully.
leads to 1 out of 6 infants born with low
birth weight. 5. Breastfeeding helps protect babies and
• Inappropriate feeding of infants and young children against dangerous illnesses.
young children are responsible for onec
third of the cases of malnutrition. 6. A woman employed away from her home
can continue to breastfeed her child as ofc
c
ten as possible when she is with the infant.
Why breastfeeding
Babies who are breastfed have fewer illnesses 7. Exclusive breastfeeding can give a woman
and are better nourished than those who are more than 98 per cent protection against
fed other drinks and foods. pregnancy for six months after giving birth
– if her menstrual periods have not rec
c
Almost every mother can breastfeed successc c sumed.
fully. Those who might lack the confidence to
breastfeed need practical support of the baby’s
father and their family, friends and relatives.

5



good Practice With breastfeeding Almost every mother can
A newborn baby needs to remain in skinctocskin produce enough milk when:
contact with the mother as much as possible. It • she breastfeeds exclusively
is best for the mother and baby to stay together • the baby is in a good position and has the
in the same room or bed. breast well in the mouth
• the baby feeds as often and for as long
Having the baby start to breastfeed soon after as he or she wants, including during the
birth stimulates the production of the mother’s night.
breastmilk.

Many new mothers need encouragement and Breastmilk is the baby’s ‘first immunization’. It
help to begin breastfeeding. Another woman helps to protect against diarrhoea, ear and
who has successfully breastfed or a family chest infections and other health problems.
member, friend or member of a women’s The protection is greatest when breastmilk
breastfeeding support group can help a mother alone is given for the first six months and
overcome uncertainties and prevent difficulc
c breastfeeding continues well into the second
ties. year and beyond. No other drinks or foods can
provide this protection.
How the mother holds her baby and how the
baby takes the breast in the mouth are very Substitutes with clean water
important. Using breastmilk substitutes, such as infant
formula or animal’s milk, can be a threat to
Signs that the baby is in infants’ health. This is particularly the case
a good position for breastfeeding are: if parents cannot afford sufficient substicc
• the baby’s whole body is turned towards tutes, which are quite expensive, or do not
the mother always have clean water with which to mix
• the baby is close to the mother them.
• the baby is relaxed and happy.

Signs that the baby is feeding well:
• the baby’s mouth is wide open
• the baby’s chin is touching the mother’s
breast
• more of the dark skin around the mothc c
er’s nipple can be seen above the baby’s
mouth than below it
• the baby takes long, deep sucks
• the mother does not feel any pain in the
nipple.

6



the umbilical cord – hoW to Protect

The umbilical cord is a unique tissue in a huc
c connected to the infant’s blood stream (Figure
man body. It consists of two arteries and one 1); it therefore needs to be sterile to avoid infecc
c
vein. During pregnancy, the placenta supplies tion.
all material for fetal growth and removes
waste products. Blood flowing through the tie tightly before
cord brings nutrients and oxygen to the fetus A sterile and sharp instrument, such as a new
and carries away carbon dioxide and metabolic razor blade or scissors, is usually recommended
wastes. for cutting the cord. Experience with a blunter
instrument resulted in more vessel spasm and
thus less blood loss. Using a blunt instrument
could possibly result in an increased incidence
of infection due to more trauma to the tissues.
The cord must always be clamped or tied tightc c
ly before cutting.

Length of the cord stump: 2–3 cm
The recommended length of the stump after
cutting is usually 2 or 3 cm. The importance
of keeping the cord clean and dry and of not
letting it come in contact with urine and faeces
should be explained to the family.

How to tie the cord
The cord must be always be tied or clamped at
the baby’s side before the cutting, since leaving
Figure 1: A transection of the abdominal wall: a cord it untied can cause excessive bleeding.
stump with one vein (a) and two arteries (b) entering the
abdominal wall cord care – traditional Practices
A wide variety of traditional practices and
When the cord stops pulsating, the umbilical beliefs are associated with care of the umbilical
vessels are constricted but are not yet obliterc
c cord. These traditional beliefs must be taken
ated. Therefore the cord has to be tied/clamped into account when introducing clean cord care
tightly in order to keep the umbilical vessels occ programmes in a community since these bec
c c
cluded and prevent bleeding. liefs may conflict with programme recommenc c
dations.
cutting the cord sterile
To separate the newborn from the placenta, Unclean substances dangerous
the cord must be cut. The instrument used cuts Some traditional practices such as applying
through living tissue and vessels that are still unclean substances to the cord are dangerous

7



and should be discouraged or replaced with must be treated as for severe bacterial infecc
c
safer alternatives. Practices will not change uncc tion and antibiotics should preferably be given
less people are convinced that the new practice intravenously. The diagnosis of cord infection
is indeed better. Some traditional practices are is uncertain: the cord may appear unusually
beneficial and should be promoted, while othc c moist or smelly, with or without discharge, but
ers may be ignored. there are no other signs. Sometimes there are
no obvious outward signs of infection.
Traditional cord practices
causes infections and death Clean hands are important!
• In some areas, no tie is used or the cord is The newborn baby has no protective flora
tied only if bleeding occurs. This practice inc
c at birth. Normal skin flora begin to be
creases the risk of bleeding from the stump. acquired within 24 hours. The umbilicus is
colonized by bacteria from environmental
• A variety of tools are used to cut the cord. sources such as the mother and the hands
They are usually items that are available of caregivers.
in the house, or that relate to the father’s
trade, such as scissors, knives, broken glass or
stones. These are rarely cleaned or boiled bec c neonatal deaths
fore use and are dangerous sources of infecc c Many infections that leads to death are due to
tion. cord infections.

In most cultures, some kind of substance is apc c How to avoid – what should we know
plied to the cord stump. Ash, oil, butter, spice • Current medical practices regarding
pastes, herbs and mud are substances that are when and how to cut the cord,
commonly used. These substances are often • the length of the remaining stump,
contaminated with bacteria and spores and • the choice of cord ties and the applicac
c
thus increase the risk of infection. One of the tion of antimicrobials on the stump are
most dangerous practices is the application of identified.
cow, chicken or rat dung to the stump; this is
associated with a high risk of neonatal tetanus. 20 days cord care is needed
The cord normally falls off between 5 and
In many cultures it is common to bind the newcc 15 days after birth. After the cord separates,
born’s abdomen with cloth or bandages. This the umbilicus continues to elaborate small
practice keeps the stump moist, thus delaying amounts of mucoid material until complete
healing and increasing the risk of infection, healing takes place, usually a few days after
especially if the material used is unclean. separation. During this time the umbilicus is
still susceptible to infections, although less so
signs of infection in cord than in the first 2–3 days. Infection may delay
When the newborn has systemic signs of infecc c healing, causing the umbilicus to stay moist for
tion such as fever, lethargy or poor feeding, it longer periods.

8



vaccination / immunization

Children who are immunized are protected • It is safe to immunize a child who has a
from these dangerous diseases. All children minor illness, a disability or who is malnourc
c
have the right to this protection. ished.

immunization • All pregnant women need to be protected
Every girl and boy needs to be immunized. And against tetanus. Even if the woman was imc
c
pregnant women need to be immunized to proc c munized earlier, she may need additional
tect themselves and their infants. tetanus toxoid vaccinations.

Why, When, Where • Disease can spread quickly when people
It is essential that all parents know why, when, are crowded together. All children living in
where and how many times the child should be congested conditions, particularly in refugee
immunized. Parents also need to know that it or disaster situations, should be immunized
is safe to immunize the child even if the child immediately, especially against measles.
has an illness or a disability or is suffering from
malnutrition. Age Immunizations to be given

Immunization is urgent! At birth
Every child needs a series of immunizations BCG**, polio and, in some countries, hepatic
c
during the first year of life. It is essential tis B
that infants complete the full number of
immunizations – otherwise the vaccines 6 weeks
may not work. DPT**, polio and, in some countries, hepatic
c
tis B and Hib

• Immunization protects against several danc c 10 weeks
gerous diseases. A child who is not immuc c DPT, polio and, in some countries, hepatitis
nized is more likely to suffer illness, become B and Hib
permanently disabled or become undernourc c 14 weeks
ished and die. DPT, polio and, in some countries, hepatitis
B and Hib
• All children, including those who are disac
c
bled, need to be vaccinated. The vaccines 9 months
work by building up the child’s defences Measles (12c15 months in industrialized
against disease. Immunization only works if countries) and, in some countries, yellow
given before the disease strikes. fever, mumps and rubella.

9



*National immunization schedules may difc c Polio disables
fer slightly from country to country. All children, everywhere, need to be immuc c
**BCG offers partial protection against some nized against polio. The signs of polio are a
forms of tuberculosis and leprosy; DPT proc c floppy limb or the inability to move. For every
tects against diphtheria, pertussis (whoopc
c 200 children who are infected, one will be disacc
ing cough) and tetanus. bled for life.

sterile needles Breastmilk protects too
A new or sterile needle and syringe must be Breastmilk and colostrum, the thick yellow
used for every person being immunized. People milk produced during the first few days after
should insist on this. birth, provide protection against pneumonia,
diarrhoea and other diseases. Protection lasts
secure the child’s life: vaccinate for as long as the child is breastfed.
Immunization protects against
several dangerous diseases Vitamin A – No blindness
A child who is not immunized is more likely to Vitamin A helps children fight infections and
suffer illness, become permanently disabled or prevents blindness. Vitamin A is found in
become undernourished and die. breastmilk, liver, fish, dairy products, some
orange and yellow fruits and vegetables, and
Immunization protects children against some some green leafy vegetables. In areas of vitacc
of the most dangerous diseases of childhood. min A deficiency, children aged six months
All children, including those who are disabled, and older should be given vitamin A capsules
need to be vaccinated. A child is immunized by or liquid when they are immunized or during
vaccines, which are injected or given by mouth. National Immunization Days. Vitamin A is also
The vaccines work by building up the child’s an important part of measles treatment.
defences against disease. Immunization only
works if given before the disease strikes. More than half of all illnesses and deaths
among young children are caused by germs
Measles cause deaths that get into their mouths through food or wac
c
All children need to be immunized against ter or dirty hands. Many of these germs come
measles, which is a major cause of malnutricc from human and animal faeces.
tion, poor mental development, and hearing
and visual impairments. The signs that a child
has measles are a fever and rash that have
lasted for three days or more, together with a
cough, a runny nose or red eyes. Measles can
cause death.

10



hygiene

hygiene Practice • Only use water that is from a safe source or
Many illnesses, especially diarrhoea, can be is purified. Water containers need to be kept
prevented by good hygiene practices: covered to keep the water clean.
• putting all faeces in a toilet or latrine;
• washing hands with soap and water or ash clean Water
and water after defecating or handling chilcc Only use water that is from a safe source or is
dren’s faeces, and before feeding children or purified. Water containers need to be kept covc c
touching food; and ered to keep the water clean.
• ensuring that animal faeces are kept away
from the house, paths, wells and children’s Families and communities
play areas. can protect their water supply by:
• keeping wells covered and installing a handc c
Co-operation upon good. pump
Everyone in the community needs to work • disposing of faeces and waste water (especialc c
together to build and use toilets and lac c ly from latrines and household cleaning) well
trines, protect water sources, and safely away from any water source used for cookc c
dispose of waste water and garbage. It is ing, drinking or washing
important for governments to support • building latrines at least 15 metres away and
communities by providing information on downhill from a water source
lowccost latrines and toilet facilities that all
families can afford. In urban areas, governc c Families can keep water clean in the home by:
ment support is needed for lowccost sanitac c • storing drinking water in a clean, covered
tion and drainage systems, improved drinkc c container
ing water supply, and garbage collection. • avoid touching clean water with unclean
hands
• taking water out of the container with a
• All family members, including children, need clean ladle or cup
to wash their hands thoroughly with soap
and water or ash and water after contact Washing hands
with faeces, before touching food, and before
feeding children. All family members, including children,
need to wash their hands thoroughly with
• Washing the face with soap and water every soap and water or ash and water after concc
day helps to prevent eye infections. In some tact with faeces, before touching food, and
parts of the world, eye infections can lead to before feeding children.
trachoma, which can cause blindness.

11



Soap and water or ash and water should be
placed conveniently near the latrine or toilet.
• It is especially important to wash the hands
after defecating and after cleaning the botcc
tom of a baby or child who has just defecatc c
ed. It is also important to wash hands after
handling animals and raw foods.
• Hands should always be washed before prec c
paring, serving or eating food, and before
feeding children. Children should be taught
to wash both hands after defecating and bec c
fore eating to help protect themfrom illness.

Children often put their hands into their
mouths, so it is important to wash a child’s
hands often, especially after they have been
playing in dirt or with animals.

Children are easily infected with worms, which
deplete the body’s nutrients. Children should
not play near the latrine or toilet. Shoes should
be worn near latrines to prevent worms from
entering the body through the skin of the feet.

Children living in areas where worms are
common should be treated two to three
times per year with a recommended anticc
helmenthic medication.

12



diarrhoea

Diarrhoea is caused by germs that are swalc
c Some people think that drinking liquids makes
lowed, especially germs from faeces. diarrhoea worse. This is not true.

• Diarrhoea kills children by draining liquid
from the body, thus dehydrating the child. Recommended drinks
As soon as diarrhoea starts, it is essential that for a child with diarrhoea:
the child be given extra fluids as well as reguc
c • breastmilk more often than usual
lar foods and fluids. • soups
• rice water
• A child’s life is in danger if there are several wac
c • fresh fruit juices
tery stools within an hour or if there is blood • weak tea with a little sugar
in the faeces. Immediate help from a trained • clean water from a safe source. If there
health worker is needed. is a possibility the water is not clean, it
should be purified by boiling or filtering.
• Breastfeeding can reduce the severity and • oral rehydration salts (ORS) mixed with
frequency of diarrhoea. the proper amount of clean water.

• A child with diarrhoea needs to continue
eating regularly. While recovering from diarc c Drinks should be given from a clean cup. A
rhoea, the child needs at least an extra meal feeding bottle should never be used.
every day for at least two weeks
The child should be given extra liquids uncc
• If the child is dehydrated with severe or perc
c til the diarrhoea has stopped.
sistent diarrhoea, only oral rehydration soluc c After 1 week revisit to health worker revisit.
tion or medicines recommended by a trained
health worker should be used. Diarrhoea usually stops after three or four
days. If it lasts longer, caregivers should seek
Why diarrhoea is dangerous help from a trained health worker.
Diarrhoea kills children by draining liquid
from the body, thus dehydrating the child. As
soon as diarrhoea starts, it is essential that the
child be given extra fluids as well as regular
foods and fluids.

A child has diarrhoea when he or she passes
three or more watery stools a day. The more
numerous the watery stools, the more dangercc
ous the diarrhoea.

13



no blindness – Wash the face

Washing the face with soap and water every
day helps to prevent eye infections. In some
parts of the world, eye infections can lead
to trachoma, which can cause blindness.

A dirty face attracts flies, spreading the germs
they carry from person to person. The eyes may
become sore or infected and vision may be imc c
paired or lost if the eyes are not kept clean and
healthy.

14

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