Table 3 Grading of interventions according to the level of health care delivery
From: Essential interventions for maternal, newborn and child health: background and methodology
Intervention | Referral level | 1st level / outreach | Community |
|---|---|---|---|
Adolescents & pre-pregnancy | |||
Family planning | A | A | A |
Prevent& manage sexually transmitted illness including HIV for prevention and mother to child transmission for HIV and syphilis | A | A | A |
Folic acid fortification and/or supplementation for preventing neural tube defects | A | A | A |
Pregnancy | |||
Management of unintended pregnancy a) Availability and provision of safe abortion care when indicated and legally permitted b) Provision of post abortion care | A | B | - |
Appropriate antenatal care package: Screening for maternal illness Screening for hypertensive disorders of pregnancy Screening for anemia Screening for fetal growth problems (IUGR) Iron and folic acid to prevent maternal anemia Tetanus immunization Counseling on family planning, birth and emergency preparedness Prevention and management of HIV, including with antireterovirals Prevent and manage malaria with insecticide treated nets and antimalarial Smoking cessation | A | A | C |
Reduce malpresentation at term with external cephalic version | A | - | - |
Management of pre-eclampsia • Calcium to prevent hypertension • Low dose aspirin to prevent hypertension | A | B | - |
Magnesium sulphate for eclampsia | A | C | - |
Induction of labor to manage premature rupture of membranes at term | A | - | - |
Antibiotics for preterm rupture of membranes | A | B | - |
Corticosteroids to prevent respiratory distress syndrome in newborns | A | - | - |
Childbirth | |||
Prophylactic antibiotics for caesarean section | A | - | - |
Management of postpartum hemorrhage (e.g. uterotonics, uterine massage) | A | B | C |
Active management of third stage of labor to prevent postpartum hemorrhage | A | A | - |
Cesarean section for absolute maternal indication | A | - | - |
Induction of labor for prolonged pregnancy | A | - | - |
Prophylactic uterotonics to prevent postpartum hemorrhage Management of postpartum hemorrhage (e.g. uterotonics, manual removal of placenta, uterine massage) | A | B | C |
Post natal (Mother) | |||
Family planning | A | A | A |
Prevent and treat maternal anemia | A | B | - |
Detect and manage postpartum sepsis | A | B | - |
Screen and initiate or continue antiretroviral therapy for HIV | A | A | - |
Post natal (newborn) | |||
Immediate thermal care | A | B | B |
Initiation of exclusive breastfeeding (within first hour) | A | A | A |
Hygienic cord and skin care | A | B | B |
Neonatal resuscitation with bag and mask (professional health worker) | A | B | - |
Case management of neonatal sepsis, meningitis and pneumonia | A | B | - |
Kangaroo mother care for preterm and for less than 2000g babies | A | B | - |
Management of newborns with jaundice | A | B | - |
Surfactant to prevent respiratory distress syndrome in preterm babies | A | - | - |
Continuous positive airway pressure (CPAP) to manage babieswith respiratory distress syndrome | A | - | - |
Extra support for feeding small and preterm babies | A | B | - |
Presumptive antibiotic therapy for newborns at risk of bacterial infections | A | - | - |
Infancy and childhood | |||
Exclusive breastfeeding for 6 months | A | A | A |
Continued breastfeeding and complementary feeding from 6 months | A | A | A |
Prevention and case management of childhood malaria | A | A | A |
Vitamin A supplementation from 6 months of age | A | A | A |
Comprehensive care of children infected with or exposed to HIV infection | A | A | - |
Routine Immunization and H. influenzae, meningococcal, pneumococcal and Rota virus vaccines | A | A | B |
Management of severe acute malnutrition | A | A | - |
Case management of childhood pneumonia | A | A | A |
Case management of diarrhea | A | A | A |
Cross cutting community strategies | |||
Home visits for women and children across the continuum of care | - | - | A |