1. CORE Spring Meeting, April 2013
Baltimore, MD

2. About 40% of deaths in children younger than 5 years occurred in the
neonatal period, most often because of preterm birth complications
(14%), intrapartum related complications (9%), and neonatal sepsis or
meningitis (5%).
Average Density of Health Worker in
countries with highest U5MR = 5.2 per
10,000 pop
22% of WHO
recommendation
iCCM
Plus is a
priority

3. Formative
Research
• Literature
review
• Key
Informant
Interviews
• Focal
Groups
Discussions
Training method
and tool
development
• 5-days initial
training plus
weekly
supportive
supervision
for 3-
months
• iCCM Plus
package
Supportive
Supervision
• Completion of
data captured
• Medicine
administration
• Medicine and
equipment
storage
• Assessment
and follow-up
of a sample of
sick child
• Testing of one
component of
algorithm

5. Newborn Care
Look/Ask
Is the baby newly born?
Is the baby crying?
What To Do?
• Dry the baby with a clean
cloth and check to see if his
mouth and nose are clear.
• Place baby on the mother’s
abdomen and cover with a
dry cloth, including the
head.
• Dab the umbilical
cord, including the base of
the cord, with 4%
chlorhexidine
• Initiate breastfeeding
• Eye care- apply tetracycline
eye ointment within 1 hour
If the baby is not crying or breathing
well after drying, you will need to help
the baby to breathe within the first
minute.
Go to “Helping a Newborn Breathe”
If YES
to
these
signs
Information and images on this and following pages adapted from Helping Babies Breathe, American Academy of Pediatrics, 2010.

6. Helping a Newborn Breathe
Look/Ask
• Is the baby newly born?
• Is the baby NOT crying?
• This baby needs help to breathe.
What To Do?
Within one minute,
• Keep the baby warm
• Position the head
• Aspirate (clean) the mouth and
nose
• Stimulate breathing by rubbing
the back
If baby is still not breathing well:
• Ventilate with bag mask
• Give 40 breaths per minute
• Observe once per minute for
crying or breathing
Continue until newborn is breathing well or declare as stillbirth if
the there is no breathing within 10 minutes. All newborns
needing help to breathe need urgent referral to a hospital or
health center after they are breathing normally.
If
YES
to
ANY
Sign

8. Preliminary assumption: based on these results CCM-related
content of the iCCM Plus tool seems to be appropriate in the
training of illiterate community-based staff with no health
background

9. 0
5
10
15
20
25
30
35
40
45
WK1 WK2 WK3 WK4 WK5
#forms
Form/Ass
Referral

10. Wk1 WK2 WK3 WK4 WK5 total
# forms 8 19 11 28 42 108
GDS 2 3 0 7 2 14
Spneu 5 6 3 11 18 43
Nspneu 1 0 1 1 1 4
Sdehy 0 2 0 5 4 11
Nsdehy 1 0 0 1 0 2
Diarrhe 0 5 3 4 4 16
Smalar 0 3 4 12 12 31
NBGDS 0 1 0 0 0 1
NBD 0 1 0 0 0 1
Referral 3 10 10 28 36 87
Forms
w/assist
8 18 4 12 29 71

11. Preliminary conclusions
• Supervision approach seems to
be working
– 100% referral forms @PHCU
– In creased referral of ARI
– HHP’s controlling stocks of drugs and
equipment
– Progressively fewer need on form
assistance
– Weekly Skype discussion vital
• Challenges
• Transportation
• Due to distance weekly supervision
non-feasible
• Administrative issues
• Referral forms need to be simplified
• Language barriers