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Newborn Health in Humanitarian Settings - Field Guide PDF

192 Pages·2017·16.37 MB·English
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Newborn Health in Humanitarian Settings FIELD GUIDE Baby Ismil* is comforted by his mother Azida* and grandmother Fatima*. Four week-old Ismil* was born in a makeshift settlement for displaced Rohingya people in Cox’s Bazar, Bangladesh. Cover Photographer’s Credit: © Hanna Adcock/Save the Children Date: 23 November 17 *Names have been changed to protect identities. Newborn Health in Humanitarian Settings FIELD GUIDE UNICEF - Programme Division 3 United Nations Plaza New York, NY 10017 USA www.unicef.org © United Nations Children’s Fund (UNICEF), and Save the Children All rights reserved, revised January 2018. This compendium is based on country-level documentation and data. While carefully reviewed, it is not edited or fact checked to offcial UN publication standards. Statements in the case studies do not imply or constitute offcial opinions or policy positions of either The United Nations, UNICEF or Save the Children Table of Contents ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 1.1 W hat is the Purpose of this Field Guide? . . . . . . . . . . . . . . . . . . . 13 1.2. W ho is the Field Guide Intended For? . . . . . . . . . . . . . . . . . . . . . 14 1.3. H ow is the Field Guide Organized? . . . . . . . . . . . . . . . . . . . . . . . . 16 2. BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.1. H umanitarian Settings Across the Globe . . . . . . . . . . . . . . . . . 19 2.1.a. C hallenges to newborn health service delivery . . . . . . . . . . . . . . . . 22 2.2. N ewborn Health: Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.2.a. G lobal burden of newborn mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.2.b. P rincipal causes of neonatal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3. NEWBORN HEALTH SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 3.1. G eneral Principles and Considerations . . . . . . . . . . . . . . . . . . . . . 39 3.1.a. T he continuum of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 3.1.b. L evels of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 3.2 E ssential Newborn Care (ENC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.2.a. E NC at the household level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3.2.b. E NC in primary care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.c. Essential newborn care in hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 2 .3.3 erP utam ir w oL/yt iB ht r eW i thg )W BL( . . . . . . . . . . . . . . . . . . . . . . 15 3.3.a. M anaging prematurity at the household level . . . . . . . . . . . . . . . . . 65 3.3.b. Managing prematurity in primary care facilities . . . . . . . . . . . . . . . 75 3.3.c. M anaging prematurity in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 .4.3 eN n robw efnI itc sno . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.4.a. M anaging infections at the household level . . . . . . . . . . . . . . . . . . . 56 3.4.b. M anaging infections in primary care facilities . . . . . . . . . . . . . . . . . 86 3.4.c. M anaging infections in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07 .5.3 utrapa rtnI m lpmoC iitac sno . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.5.a. M anaging intrapartum complications at the household level . . . . 37 3.5.b. M anaging intrapartum-related complications in primary care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 3.5.c. M anaging intrapartum-related complications in hospital . . . . . . . 57 .4 GET ART S CI SNOIT AREDISNOC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.4 iaM ertsn ima gn eN n robw eH la ht i n uH inam irat na droC iitan no . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.4 dnoC uitc gn a iS ut ita no lanA isy s . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.2.a. E xamine national policies and protocols . . . . . . . . . . . . . . . . . . . . . . 48 4.2.b. E xamine existing clinical guidelines, key messages/ BCC materials, tools and training materials . . . . . . . . . . . . . . . . . . . 58 4.2.c. I ncorporate questions about newborn health services within a rapid health assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.2.d. A ssess resource availability: facilities, supplies and staff . . . . . . 68 Newborn Health in Humanitarian Settings: Field Guide 3 Newborn Strategic Program Implementation 1 Introduction 2 Background 3 Health Services 4 Considerations 5 Considerations 6 Annexes 4.3 Developing a Response Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 4.3.a. P rioritizing newborn interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 4.3.b. A ddress staff competency gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 4.3.c. P rocure essential medicines and supplies . . . . . . . . . . . . . . . . . . . . 93 4.3.d. U pdate and distribute clinical guidelines, protocols and other essential materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 4.3.e. D istribute supply kits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 4.3.f. E stablish partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 4.3.g. P romote quality improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 4.3.h. D evelop proposals to secure additional funding . . . . . . . . . . . . . . 95 4.4 Developing and Implementing a Monitoring and Evaluation (M&E) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 5. PROGRAM IMPLEMENTATION CONSIDERATIONS . . . . .100 5.1 D eveloping and Disseminating Key Messages/BCC Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 5.2 Developing a Referral System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102 5.2.a. W hen referral is not possible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 5.3 H ome Visits for Mothers and Babies . . . . . . . . . . . . . . . . . . . . . .106 5.4. P rocuring Newborn Care Supply Kits . . . . . . . . . . . . . . . . . . . . . .108 5.5. N ewborn Deaths in Crisis Settings . . . . . . . . . . . . . . . . . . . . . . . .109 5.3.a. S upport for neonatal loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 4 .6 SEXENA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 1 enA x :1 Newborn Health Services Summary Tables, by Level of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 1 A1 Essential Newborn Care (ENC) Services for all Newborns . . .31 1 B1 Services to Prevent and Manage Prematurity/LBW . . . . . . . . 121 C1 Services to Prevent and Manage Newborn Infections and Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .621 enA x :2 Doses of Common Drugs for Neonates . . . . . . . . . . . . . . . . . .50 1 enA x :3 Advanced Care for Very Sick Newborns . . . . . . . . . . . . . . . . . 041 A3 Requirements for Advanced Newborn Care . . . . . . . . . . . . . . . . 141 B3 S urveillance and Monitoring Form for Inpatient Newborns . . . 241 C3 Resources for Advanced Newborn Care . . . . . . . . . . . . . . . . . . . . 341 enA x :4 Tools to Support Neonatal Referrals . . . . . . . . . . . . . . . . . . . . 41 A4 Job Aid: When to Refer a Newborn to the Hospital . . . . . . . . . 541 B4 Job Aid: Transferring the Sick Newborn . . . . . . . . . . . . . . . . . . . . 051 C4 Sample Referral Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 ennA x :5 Newborn Care Supply Kits for Humanitarian Settings . . . . 251 A5 C ommunity Newborn Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 B5 Clinic or Primary Health Facility Newborn Kit . . . . . . . . . . . . . . 651 C5 Hospital Newborn Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 enA x :6 Indicators and Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . 861 A6 List of Indicators Collected Through Routine Systems . . . . . . 961 B6 List of Indicators and Questions to Measure Facility Capacity to Provide Newborn Health Services . . . . . . . . . . . . . .87 1 Newborn Health in Humanitarian Settings: Field Guide 5 Newborn Strategic Program Implementation 1 Introduction 2 Background 3 Health Services 4 Considerations 5 Considerations 6 Annexes ACKNOWLEDGEMENTS Save the Children and the United Nations Children’s Fund (UNICEF) led the development of the Newborn Health in Humanitarian Settings: Field Guide with many thanks to Heather Papowitz and Ribka Amsalu, in collaboration with representatives from Columbia University, The ELMA Relief Foundation, International Medical Corps (IMC), International Rescue Committee (IRC), Jhpiego, Johns Hopkins University (JHU), London School of Hygiene and Tropical Medicine (LSHTM), Offce of U.S. Foreign Disaster Assistance (OFDA), SickKids Centre for Global Health, Stanford University, United Nations High Commissioner for Refugees (UNHCR), United Nations Population Fund (UNFPA), University of Alberta, U.S. Agency for International Development (USAID), U.S. Centers for Disease Control and Prevention (CDC), Women’s Refugee Commission (WRC), World Health Organization (WHO) and World Vision International. 6 TOC ehT deev lempo tn fo eht ietn ir m 5 1 02 Field Guide sa w led yb eH ehta r iw opa P zt dna iR akb lasmA u dna irw et t n y b uJ di ht droCcM-bo R dna eah ca R l .sk caS ehT 8 1 02 ev isr no fo eht Field Guide sa w er iv es d yb haraS ewony hC .ht eT inh c lac eR iv eew sr i( n la ebahp it lac dro e :)r imaS ar uobA ekab r ,)O HW( iR akb lasmA u evaS( eht ihC lder ,)n eN el ma drahB ja w FNU( ,)A P uaL ar erC inom in evaS( eht ihC lder ,)n iS nahbo lw orC e y AMLE( ihP liporhtna e ,)s eB danr eet t eaD l snam ,)O HW( eso J hp de G t far - nosnho J evaS( eht ihC lder ,)n Wil am eoD de sn FNU( ,)A P iM eh c lle Gef fa y iS( iKk c d s eC ertn ro f Gllabo eH la ,)ht eM nag Gla lehga r evaS( eht ihC lder ,)n dnE gna dnaH ez l ,)CDC( eJ es entraH s evaS( eht ihC lder ,)neT debab iaH leeg irb el FECINU( ,) iM eh c lle enyH s ,)CDC( erP e aht eyI ragn evaS( eht ihC lder ,)n eD arb nosk ca J FECINU( ,) etaK eK ebr r inU( ev isr t y fo lA eb tr ,)a uoL luo ebo K iis ,)O HW( dnaS ar uarK es ,)C RW( imS t a uK ram ,)DIA SU( enrO ll a iL ecn ot t ,)O HW( ena J t eM ey sr ,)CMI( eh ca R l eroM ks y loC( uibm ,)a iD ena foroM ,)CDC( itaK e iroM s evaS( eht ihC lder ,)n haraS no x oM ,)MT HS L( lo J een oakaN FO( ,)A D eH ehta r iw opa P .zt ( U N I C EF), Luew i eP ar s o n (U N I C EF), Nicola s eP yr aud (MSF), auP l obRins o n (I M C ) , Seev rin Ritet r on V X ylande r (OW )H , Sa mira Sa mi (J H U ) , Ma rian hiSc lpero rd, Elaine Scudde r e(vS a the Children), Ha n n a ap piT s (J H U ) , Lisa hoT m a s (WO H) , asBia om c z y k T ( C D C ) , Ma ria Ts olka e(vS a the Children), Stephen alW l e(vS a the Children), auP l Wise (St a on frd), Bina alV s a n g k a r e(vS a the Children), osJep ar g a s V (U N H C R ) , Na bila Za k a (U N I C EF) , a nd Will Zek c ( U N I C EF). Fudn i gn ro f iht s Field Guide sa w iv orp ded yb ehT AMLE eR lie f Fuo dn ita ,no iv aS gn eN nrobw iL ev evaS/s eht ihC lder ,n evaS eht ihC lder n ita v onI no Fudn )AEDI( dna FECINU . eh T iv e s w dna ip o in s n o eerp x es s d i n ih t s ep a p r er a eso h t f o eh t ua s r o h tdn a d o t o n en ec ir a s s l y er e� t c eh t iv e s w dna ip o in s n o f o eh t i r er eps it c ev in a g r o it a z . s n o Newborn Health in Humanitarian Settings: Field Guide 7 ABOUT This Field Guide is a companion to the Inter-agency Field Manual on Sexual and Reproductive Health in Humanitarian Settings (2018), providing information related specifcally to newborn care during the neonatal period (days 0-28). The interim Field Guide was originally published in 2015. After feld-testing in two humanitarian crises (South Sudan and Somalia) and soliciting extensive feedback from practitioners, it was revised in 2017 and published in January 2018. The Field Guide has been designed as an enhancement to national strategies and programs aimed at improving the lives of newborns and their mothers, and to strategies such as the Every Newborn Action 8

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