Download Resource - Healthy Newborn Network

Theme 1 - Antenatal Care to Prevent
Problems in Newborn (LBW and
Neonatal Infections)
Newborn care starts before birth in pregnancy as a mother
needs to be given adequate nourishment, kept free from
infections, monitored for emergence of complications.
For these, preventive measures are advised or prompt
treatment is given. Effective care in pregnancy is the first
step towards newborn care. For example, the following
actions are taken to prevent newborn problems.
Antenatal Care
Actions
Maternal immunization
with tetanus toxoid
Screening and management
of under nutrition
Screening and treatment
for anemia
Micronutrient
supplementation
Screening and treatment
of STIs
Malaria prevention
Newborn Problem It
May Prevent
Neonatal tetanus
LBW
LBW
LBW
Gonococcal or Chlamydia
eye infections, sepsis,
abortion, still birth,
congenital syphilis
LBW, prematurity, abortion
Discussions were held with mothers in FGD’s and IDI’s
and with decision makers and key informants about certain
measures in pregnancy that has effect on LBW and neonatal
infections, including neonatal tetanus. These include:
• Pattern of seeking antenatal care
• Reasons for seeking or not seeking antenatal care
• Dietary changes during pregnancy
• Changes in workload
• Maternal immunization for tetanus toxoid (discussed in
section 3)
1.1 Pattern of Seeking Antenatal Care (ANC)
Jhelum (in Punjab) and Charsadda and Haripur
(in NWFP) are the 3 district where majority
of mothers mentioned that they usually go to
doctors or LHVs for ANC, however, the frequency
of visits depends on two considerations: (a) availability of
money, and (b) illness. For some it was once every month
and for majority it was at least 3-4 times during pregnancy.
“Even if we do not have money, we borrow from others
to go for check up during pregnancy. It is a must to go”
( Mo-Golpur, Jhelum)
“Mothers do not go to any dai for check up but go to
doctors” (FGD-Utman Zai, Charsadda)
Hospitals, doctors, private clinics and LHVs were mentioned
for seeking ANC.
Seeking ANC follows the affordability by individuals and
most cannot afford it, therefore, do not seek it unless there
is illness or problem in pregnancy. Hence, it becomes clear
that women do not give much value to the advice, iron
tablet and TT immunization given by LHWs. For them, ANC
is check up by doctor and getting ultrasound done.
In the other 6 out of 9 districts, women are
mostly not seeking ANC, and those who are
seeking, belong to the urban areas.
“In the past people did not have much knowledge
about check ups during pregnancy, but now LHW
goes to every one’s house and they have gained a lot
of knowledge from her. She advises to go for regular
check-ups during pregnancy” (FGD- Faizabad, an
urban area in Khuzdar).
The main reasons for the contrast in rural and urban areas
regarding seeking ANC appears to be lack of facilities and
relative poverty in rural areas.
A number of participants could not think
of visiting a health care provider (HCP) if
everything was proceeding normally.
“We do not care about minor illnesses and we only go
to hospital when it becomes intolerable like fever does
not stop for 4 -5 days” (FGD-Johi, Dadu).
“If there is some problem like, pain in ribs, high or low
blood pressure, blood deficiency, only then we go for
check ups.” (FGD-Darvesh, Haripur).
The problems during pregnancy for which ANC is sought
were reported to be the following
• Giddiness
• Loss of appetite, indigestion, vomiting
• Turning pale or yellow
• Weight gain or swelling of body
• High blood pressure
• Bleeding
10 l Formative Research on Neonatal Sepsis, Low Birth Weight AND Birth Asphyxia