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What is FANC?
Is health care given to a pregnant woman from conception to
the onset of labour.
It is personalised care provided to a pregnant woman which
emphasises on the woman’s overall health, her preparation for
childbirth and readiness for complications (emergency
preparedness).
It is timely, friendly, simple and safe service to a pregnant
woman.
©MOH-DRH/DOMC/NLTP/JHPIEGO
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AIM OF FANC
©MOH-DRH/DOMC/NLTP/JHPIEGO
The approach:
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The risk approach to ANC has not resulted in significant
improvement in maternal survival. Life threatening
Complications of pregnancy are difficult to predict with
any degree of certainty. Health care providers must,
therefore, consider the possibility of complications in
every pregnancy and prepare clients accordingly.
©MOH-DRH/DOMC/NLTP/JHPIEGO
Four comprehensive,
personalized antenatal visits:
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1 S T V I S I T: < 1 6 W E E K S
2 N D V I S I T: 1 6 - 2 8 W E E K S
3 R D V I S I T: 2 8 - 3 2 W E E K S
4 T H V I S I T: 3 2 - 4 0 W E E K S
NB: DEPENDING ON INDIVIDUAL NEED, SOME WOMEN WILL
REQUIRE ADDITIONAL VISITS.
Objectives of Focused Antenatal Care
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©MOH-DRH/DOMC/NLTP/JHPIEGO
Objective one: Early detection and treatment of Problems
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Why disease detection and not risk assessment?
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Objective two: Prevention of complications
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Objective three: Birth preparedness and complications
readiness
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Service providers should discuss components of birth plan which
include:
Is the EDD known?
Has a facility been identified?
Has a SBA/professional been identified?
Has a means of Transport been identified?
Are emergency Funds identified?
Who is the custodian of the emergency funds?
Has a Birth companion been identified?
Are Items for clean safe©MOH-DRH/DOMC/NLTP/JHPIEGO
birth and for the newborn been
identified?
Objective three cont…Complication Readiness
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Individual birth plan ensures that the client:
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Danger signs in labour:
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Danger signs in postpartum period (Mother):
Excessive bleeding 17
Fever
Foul smelling discharge
Abdominal cramps or pains
Painful breasts or cracked nipples
Mental disturbances
Extreme fatigue
Facial or hand swelling
Headaches
Convulsions
Painful calf muscles ©MOH-DRH/DOMC/NLTP/JHPIEGO
Danger signs in postpartum period
Fast breathing(more than 6018breaths/minute)
Slow breathing less than 30 breaths/minute
Severe chest in-drawing
Grunting
Umbilicus draining pus/redness extending to skin
Floppy or stiff
Fever (temp 38 degrees celsius and above
Convulsions
More than 10 skin pustules
Bleeding from stump/cut
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Objective four: Health promotion using health messages and
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counseling
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To come to postpartum clinic :Immediately,48hours, 2
weeks, at 6 weeks,6months and one year.
To visit well baby clinic (MCH/FP Clinic) for
immunizations
Follow up for exposed babies to TB and HIV.
To chose a postpartum family planning method:
- LAM (exclusive breastfeeding)
- Progesterone only pills
- Condoms
- Post partum IUCD
- feeding options
©MOH-DRH/DOMC/NLTP/JHPIEGO
Teach mothers about the importance of
immunizations: 23
©MOH-DRH/DOMC/NLTP/JHPIEGO
National guidelines for IPT
IPT is an effective approach to preventing malaria in
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pregnant women by giving anti malarial drugs in treatment
doses at defined intervals after quickening to clear a
presumed burden of parasites
The MOH Guidelines on Malaria directs us to give SP to
pregnant women in endemic malaria areas, at least twice
during each pregnancy, even if she has no physical signs
and her hemoglobin is within normal range.
Administer IPT with each scheduled visit after quickening
(16 wks) to ensure women receive at least 2 doses at an
interval of at least 4 weeks.
IPT should be given under Directly Observed Therapy
(DOT) in the ANC and ©MOH-DRH/DOMC/NLTP/JHPIEGO
can be given on an empty stomach.
National guidelines for Tetanus toxoid
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Objective 5: Provision of Skilled Care at Birth
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Currently only 41% of pregnant women receive skilled care at
birth
By 2015, it is expected that three quarters of pregnant women
should receive skilled care at birth
A skilled attendant offers services either at the health facility
or within the community (domiciliary practice)
FANC provides an opportunity to increase skilled care
Brainstorm strategies in your catchment area in support of
increased skilled care
©MOH-DRH/DOMC/NLTP/JHPIEGO
During FANC visits, ensure that the following have
been accomplished
History taking: 27Provide:
Iron, folate , IPT*(SP is the currently
Current complaints/identify danger recommended) tetanus toxoid and
signs Nevirapine if recommended
Dietary history Counselling on:
Tetanus vaccination status Danger signs
Reproductive history Individual birth plan (IBP)
Complication readiness
History of medical illness e.g. TB
Nutrition, breastfeeding, family
Physical exam: planning, safer sex, hygiene, etc.
Physical assessment of general health PMTCT
Swollen glands Return date
Genital inspection, including sexually ANC Profile
transmitted infections Most of the lab work should be done
Check for blood pressure, edema and during the first visit
proteinuria to rule out pre-eclampsia Sputum for AFB
Check for anaemia Urinalysis
Hb, grouping and Rh factor
Check baby’s growth
VDRL/RPR
Sickle cell, Stool and Hepatitis B
(if indicated)
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The role of fathers in antenatal care
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Adolescents and pregnancy
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In Kenya, 17-18% of all births are to women under the age
of 20 years*
Pregnant youth are entitled to the same quality of care that
older women are
Research has shown that adolescents tend to delay seeking
care due to social and cultural practices and as such more
attention should be directed to them
Services should be provided in an acceptable, non-
judgmental manner, convenient and offer confidentiality to
the adolescents.
Note: This will encourage the young women to return for
continued antenatal services.
*KDHS 1998/2003 ©MOH-DRH/DOMC/NLTP/JHPIEGO
Reinforce counseling to the
31 adolescents /youth on..
Peer influence
Early ANC attendance
Safer sex (ABCD)
Drug abuse
STI, HIV/AIDS/TB
Family Planning
Dangers of abortion
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Before the woman leaves your clinic, STOP and ask her if she:
FANC TB
STIs PMTCT
LAB CCC
MALARIA
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What is Tuberculosis (TB)? 34
Tuberculosis is a chronic infectious disease caused by an organism
called mycobacterium tuberculosis, an acid fast rod shaped bacilli.
– Over 90% of new TB cases and deaths occur in developing countries
TB is one of the leading infections causing of deaths among women
of reproductive age
TB has increased by 10 fold over the last 15 years in Kenya
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Factors leading to the increase in TB
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HIV epidemic
Poverty
Overcrowding
Poor nutrition
Limited access to health services
Chronic diseases e.g. Diabetes,
carcinoma etc
Immune suppressing therapy
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Risk of TB infection
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The risk of one being infected with the TB bacillus depends on:
Exposure to bacilli
Intensity of exposure
Duration of exposure
Presence of undetected smear positive TB
Presence of poorly treated previous TB
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Types of Tuberculosis
Pulmonary Tuberculosis (PTB) 37 is the most common and
infectious type of TB.
– It affects the lungs and causes 81% of all TB cases in Kenya
• Extra Pulmonary Tuberculosis (outside of the lungs) any organ of the body
such as the kidney, bladder, ovaries, testes, eyes, bones or joints, intestines, skin
or glands, and the meninges i.e. TB meningitis
– The most common extra pulmonary TB is TB of the glands also called TB
lymphadenitis
– The most severe extra pulmonary TB is pleural effusion and meningitis.
©MOH-DRH/DOMC/NLTP/JHPIEGO
Signs and Symptoms of Pulmonary
38 Tuberculosis (PTB)
Persistent cough lasting for two or more weeks with or
without blood stained sputum
Loss of body weight
Intermittent fever
Excessive night sweats
Shortness of breath
Loss of appetite
Chest pain
Excessive tiredness and generally feeling unwell
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Signs and symptoms of TB of the
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glands (TB lymphadenitis*)
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When does TB pass from the40mother to the baby?
Pregnant women who are infected with TB can pass TB to the
baby:
During pregnancy through the placenta barrier
causing fetal death or infection (congenital TB is
rare)
At birth when the baby inhales or ingests infected
amniotic fluid or secretions
After delivery when the baby inhales droplet
secretions if the mother is coughing-commonest
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TB affects the health of a pregnant
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woman and her baby
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Screening for TB
Ask every mother at every ANC/PNC visit the following
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questions:
symptom YE NO
S
1. Have you had a persistent cough with or
without sputum for more than two weeks?
2. Have you experienced excessive sweating or
fever at night?
3. Have you lost any weight?
4. Do you have any chest pain?
5. Have you been in contact with any one who has
TB?
6. Do you have any swollen glands?
(Confirm during physical examination)
©MOH-DRH/DOMC/NLTP/JHPIEGO
Investigations
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©MOH-DRH/DOMC/NLTP/JHPIEGO
Why integration…TB/FANC
Since the onset of the HIV epidemic in the early
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eighties in Kenya, the prevalence of TB has risen
sharply
HIV increases the likelihood of developing tuberculosis
Pregnancy also increases the risk of developing TB
TB is the major opportunistic infection in HIV and the
leading killer of PLWHA
More than 50% of TB clients in Kenya are also HIV
positive
At least one out of eight of HIV+ pregnant women
could also have TB*
*USAID Bureau for Africa, 2000
©MOH-DRH/DOMC/NLTP/JHPIEGO
Integration of HIV, TB and malaria interventions into MCH
services:
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Integration addresses structural , managerial and
operational issues at all levels of the health system
in order to:
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Intensified TB case finding
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in FANC
All pregnant women should be screened for TB
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C (Coughing)
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Symptoms of TB ?
W (Weight loss)
F (Fever)
N (Night sweats)
G (enlarged Glands)
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Refer to Lab:
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Collection of sputum specimen: laboratory
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PTB confirmation is based on 3 sputum specimens
collected within a 24-hour period
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Explain that TB can be treated over a 6-8 month period and the
drugs are safe to use during pregnancy and breastfeeding
If the sputum is positive
– Send the woman to the TB clinic directly
– Document the positive results in the register
If the sputum is negative, but the woman is symptomatic, send
her to the TB clinic anyway
– Note: Negative smear test for TB does NOT exclude TB
– Explain that after delivery, barrier methods of family planning are necessary
as some TB drugs interfere with the absorption of hormonal contraceptives.
©MOH-DRH/DOMC/NLTP/JHPIEGO
TB treatment
If a pregnant woman is confirmed to have TB the treatment
will last 6-8 months : 53
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What can be done to support TB control
Adhere to the national TB control program guidelines for
case detection, definition and management.
Provide health education for the community.
Encourage symptomatic women to come for TB testing and
treatment.
Provide counseling support so that they will complete their
treatment.
Develop a system for supervising community health workers
assisting health care providers to track and monitor treatment
compliance.
Keep accurate records. ©MOH-DRH/DOMC/NLTP/JHPIEGO
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Follow-up visits:
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Referral 2
Laboratory TB Clinic
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Drug Interactions
Interacting TB Drug Effect of interaction Management
drug recommendation
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Caution
If a client is on Anti-TB drugs, anti-convulsants and/or
antiretrovirals, the interactions between these drugs and
hormonal contraceptives may lower the effectiveness of the
latter. Barrier methods are preferred
©MOH-DRH/DOMC/NLTP/JHPIEGO
Treatment:
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THANK YOU!
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