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Training Manual for Preventive Malaria - Ministry of Health

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Table 1. Components <strong>of</strong> Antenatal Care Visits<br />

ACTIVITY FIRST VISIT (16 weeks*) SECOND VISIT (24–28 weeks) THIRD VISIT (32 weeks) FOURTH VISIT (36 weeks)<br />

ASSESSMENT<br />

CARE<br />

PROVISION<br />

RECORD<br />

Conduct a thorough assessment:<br />

• Ask about problems/danger signs<br />

• History: menstrual and<br />

contraceptive history, present<br />

pregnancy, obstetric history,<br />

medical and surgical history,<br />

family history, STI history, Drug<br />

history, lactation history<br />

• Physical examination: general<br />

well-being; blood pressure;<br />

breasts, pelvis, abdomen, genitals<br />

• Testing: haemoglobin levels Hb,<br />

sickling, electrophoresis, VDRL,<br />

Blood group and RH, Stool and<br />

Urine R/E<br />

To:<br />

• Detect s/s <strong>of</strong> complications or<br />

diseases<br />

• Calculate EDD/gestational age<br />

• Determine if normal progress<br />

• Appropriate care/referral <strong>for</strong><br />

problems identified<br />

• Voluntary counselling and testing<br />

<strong>for</strong> HIV<br />

• Development <strong>of</strong> birth plan<br />

(including review <strong>of</strong> danger signs<br />

and complication readiness)<br />

• Initiation <strong>of</strong> preventive measures:<br />

• If after 16 weeks, first dose <strong>of</strong> IPT<br />

• TT and iron/folate if appropriate<br />

• <strong>Health</strong> messages/counselling on<br />

issues such as malaria prevention<br />

through IPT and ITNs, nutrition,<br />

common discom<strong>for</strong>ts<br />

Conduct a targeted assessment:<br />

• Ask about problems/danger signs<br />

• History: problems/changes since<br />

last visit<br />

• Physical examination: general<br />

well-being, blood pressure,<br />

abdomen (including FHR), other<br />

elements as indicated<br />

• Testing: as indicated to:<br />

• Detect s/s <strong>of</strong> malaria and other<br />

complications or diseases<br />

• Confirm EDD and normal<br />

progress<br />

• Continuation or revision (if<br />

appropriate) <strong>of</strong> plan <strong>of</strong> care<br />

• Appropriate care/referral <strong>for</strong><br />

problems identified<br />

• Further development/review <strong>of</strong><br />

birth plan<br />

• Continuation <strong>of</strong> preventive<br />

measures:<br />

• Dose <strong>of</strong> IPT if appropriate<br />

• TT and iron/folate if appropriate<br />

• <strong>Health</strong> messages/counselling<br />

continued on issues such as<br />

malaria prevention through IPT<br />

and ITNs, STI prevention<br />

Conduct a targeted assessment:<br />

• Ask about problems/danger<br />

signs<br />

• History: problems/changes since<br />

last visit<br />

• Physical examination: general<br />

well-being, blood pressure,<br />

abdomen (including FHR), other<br />

elements as indicated<br />

• Testing: as indicated to:<br />

• Detect s/s <strong>of</strong> malaria and other<br />

complications or diseases<br />

• Confirm EDD and normal<br />

progress<br />

• Continuation or revision (if<br />

appropriate) <strong>of</strong> plan <strong>of</strong> care<br />

• Appropriate care/referral <strong>for</strong><br />

problems identified<br />

• Further development/review <strong>of</strong><br />

birth plan<br />

• Continuation <strong>of</strong> preventive<br />

measures:<br />

• Dose <strong>of</strong> IPT if appropriate<br />

• TT and iron/folate if appropriate<br />

• <strong>Health</strong> messages/counselling<br />

continued on issues such as<br />

malaria prevention through IPT<br />

and ITNs, hygiene<br />

Conduct a targeted assessment:<br />

• Ask about problems/danger signs<br />

• History: problems/changes since<br />

last visit<br />

• Physical examination: general<br />

well-being, blood pressure,<br />

abdomen (including FHR and<br />

foetal presentation), other<br />

elements as indicated<br />

• Testing: as indicated to:<br />

• Detect s/s <strong>of</strong> malaria and other<br />

complications or diseases<br />

• Confirm EDD and normal<br />

progress<br />

• Identify mal-presentation<br />

• Continuation or revision (if<br />

appropriate) <strong>of</strong> plan <strong>of</strong> care<br />

• Appropriate care/referral <strong>for</strong><br />

problems identified<br />

• Finalization <strong>of</strong> birth plan<br />

• Continuation <strong>of</strong> preventive<br />

measures:<br />

• Dose <strong>of</strong> IPT if appropriate<br />

• TT and iron/folate if appropriate<br />

• <strong>Health</strong> messages/counselling<br />

continued on issues such as<br />

malaria prevention through IPT<br />

and ITNs, family planning,<br />

newborn care, signs <strong>of</strong> labour<br />

Be<strong>for</strong>e each visit, review records from the last ANC visit if available. During the visit, record findings, care provided, and date <strong>of</strong> next ANC visit.<br />

*Or when the woman first thinks she is pregnant<br />

20

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