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Postnatal Care Blended Learning Module for the Health Extension Programme Federal Democratic Republic of Ethiopia Ministry of Health Postnatal Care Blended Learning Module for the Health Extension Programme HEAT Health Education and Training HEAT in Africa Federal Democratic Republic of Ethiopia Ministry of Health The Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs) have developed this innovative Blended Learning Programme in partnership with the HEAT Team from The Open University UK and a range of medical experts and health science specialists within Ethiopia. Together, we are producing 13 Modules to upgrade the theoretical knowledge of the country’s 33,000 rural Health Extension Workers to that of Health Extension Practitioners and to train new entrants to the service. Every student learning from these Modules is supported by a Tutor and a series of Practical Training Mentors who deliver the parallel Practical Skills Training Programme. This blended approach to work-place learning ensures that students achieve all the required theoretical and practical competencies while they continue to provide health services for their communities. These Blended Learning Modules cover the full range of health promotion, disease prevention, basic management and essential treatment protocols to improve and protect the health of rural communities in Ethiopia. A strong focus is on enabling Ethiopia to meet the Millennium Development Goals to reduce maternal mortality by three-quarters and under-5 child mortality by two-thirds by the year 2015. The Modules cover antenatal care, labour and delivery, postnatal care, the integrated management of newborn and childhood illness, communicable diseases (including HIV/AIDS, malaria, TB, leprosy and other common infectious diseases), family planning, adolescent and youth reproductive health, nutrition and food safety, hygiene and environmental health, non-communicable diseases, health education and community mobilisation, and health planning and professional ethics. In time, all the Modules will be accessible from the Ethiopian Federal Ministry of Health website at www.moh.gov.et; online versions will also be available to download from the HEAT (Health Education and Training) website at www.open.ac.uk/africa/heat as open educational resources, free to other countries across Africa and anywhere in the world to download and adapt for their own training programmes. Dr Kesetebirhan Admasu State Minister of Health Ethiopian Federal Ministry of Health !" &UHDWLYH&RPPRQV &UHDWLYH&RPPRQV/LFHQVH'HHG $WWULEXWLRQ1RQ&RPPHUFLDO6KDUH$OLNH8QSRUWHG &&%<1&6$ 7KLVLVDKXPDQUHDGDEOHVXPPDU\RIWKH/HJDO&RGH WKHIXOOOLFHQVH 'LVFODLPHU <RXDUHIUHH WR6KDUH²WRFRS\GLVWULEXWHDQGWUDQVPLWWKHZRUN WR5HPL[²WRDGDSWWKHZRUN 8QGHUWKHIROORZLQJFRQGLWLRQV $WWULEXWLRQ²<RXPXVWDWWULEXWHWKHZRUNLQWKHPDQQHUVSHFLILHGE\WKH DXWKRURUOLFHQVRU EXWQRWLQDQ\ZD\WKDWVXJJHVWVWKDWWKH\HQGRUVH\RX RU\RXUXVHRIWKHZRUN 1RQFRPPHUFLDO²<RXPD\QRWXVHWKLVZRUNIRUFRPPHUFLDOSXUSRVHV 6KDUH$OLNH²,I\RXDOWHUWUDQVIRUPRUEXLOGXSRQWKLVZRUN\RXPD\ GLVWULEXWHWKHUHVXOWLQJZRUNRQO\XQGHUWKHVDPHRUVLPLODUOLFHQVHWRWKLV RQH :LWKWKHXQGHUVWDQGLQJWKDW :DLYHU²$Q\RIWKHDERYHFRQGLWLRQVFDQEHZDLYHGLI\RXJHW SHUPLVVLRQIURPWKHFRS\ULJKWKROGHU 3XEOLF'RPDLQ²:KHUHWKHZRUNRUDQ\RILWVHOHPHQWVLVLQWKHSXEOLF GRPDLQXQGHUDSSOLFDEOHODZWKDWVWDWXVLVLQQRZD\DIIHFWHGE\WKH OLFHQVH 2WKHU5LJKWV²,QQRZD\DUHDQ\RIWKHIROORZLQJULJKWVDIIHFWHGE\WKH OLFHQVH <RXUIDLUGHDOLQJRUIDLUXVHULJKWVRURWKHUDSSOLFDEOHFRS\ULJKW H[FHSWLRQVDQGOLPLWDWLRQV 7KHDXWKRU VPRUDOULJKWV 5LJKWVRWKHUSHUVRQVPD\KDYHHLWKHULQWKHZRUNLWVHOIRULQKRZ WKHZRUNLVXVHGVXFKDVSXEOLFLW\RUSULYDF\ULJKWV WKHZRUNLVXVHGVXFKDVSXEOLFLW\RUSULYDF\ULJKWV 1RWLFH²)RUDQ\UHXVHRUGLVWULEXWLRQ\RXPXVWPDNHFOHDUWRRWKHUVWKHOLFHQVHWHUPVRIWKLV ZRUN7KHEHVWZD\WRGRWKLVLVZLWKDOLQNWRWKLVZHESDJH #$%&'()*+,*-*&./ Postnatal Care is one of 13 Blended Learning Modules for the Ethiopian Health Extension Programme. Together with the practical skills training sessions that accompany each of the supported self-study texts, this programme will upgrade the Health Extension Workers who complete the curriculum to Health Extension Practitioners at Level-IV of the Ethiopian Occupational Standards. The upgrading programme is sponsored by the Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs). The FMOH gratefully DFNQRZOHGJHVWKHUHFHLSWRIIXQGLQJIRUWKLVSURJUDPPHIURPWKH(WKLRSLDQ2I¿FHRI81,&() WKH8QLWHG1DWLRQV&KLOGUHQ¶V(PHUJHQF\)XQG 7KH2SHQ8QLYHUVLW\8.WKH$ODQDQG1HVWD Ferguson Foundation Trust UK, and AMREF (the African Medical and Research Foundation). :HDUHDOVRWKDQNIXOIRUWKHVXSSRUWRIWKH(WKLRSLDQ2I¿FHVRI81,&()DQGWKH:RUOG+HDOWK Organisation (WHO) for freely enabling their experts to participate in the development of this Module. This Postnatal Care Module was produced by a team of Ethiopian experts, who were trained and supported by experts in blended learning pedagogy from the HEAT (Health Education and Training) Team for Africa at The Open University UK. The contributors of original material are: 'U<LIUX%HUKDQ+DZDVVD8QLYHUVLW\&ROOHJHRI0HGLFLQHDQG+HDOWK6FLHQFHV Dr Basiro Davey, HEAT Team, The Open University UK 'U1HEUHHG)HVVHKD:+2(WKLRSLD Dr Mulualem Gessese, Yekatit 12 Hospital, Addis Ababa 'U$VVD\H.DVVLH81,&()(WKLRSLD The Academic Editors of Postnatal Care are Dr Basiro Davey, Deputy Director (Ethiopia), HEAT Team, and Peggotty Graham, both at The Open University UK. The illustrations in colour were drawn by Dr Radmilla Mileusnic at The Open University. The other members of the HEAT Team are: Lesley-Anne Long, HEAT Programme Director $OLVRQ5RELQVRQ+($73URJUDPPH&RRUGLQDWRU Dawn Partner, HEAT Senior Production Assistant Jessica Aumann, HEAT Programme Assistant Ali Wyllie, HEAT Lead eLearning Advisor :HDFNQRZOHGJHWKHYLWDOFRQWULEXWLRQVRIWKH3URJUDPPH&RRUGLQDWRUVZLWKLQ(WKLRSLD $WR0RKDPPHG+XVVHLQ$EHVHNR81,&()(WKLRSLDDQGWKH)HGHUDO0LQLVWU\RI+HDOWK Ato Tedla Mulatu, AMREF Ethiopia The cover design for Postnatal CareLVE\&KULV+RXJK/HDUQLQJDQG7HDFKLQJ6ROXWLRQV The Open University UK. The cover photographs are reproduced with the permission of $05()DQG6YHQ7RUI¿Q ODUJHFLUFOH ZKRSKRWRJUDSKHG$OPD]D+HDOWK([WHQVLRQ:RUNHU PRQLWRULQJDWKUHHGD\ROGEDE\LQ'RLVRYLOODJH0DOOHZRUHGD6RXWK2PR]RQH61135 (WKLRSLDDQG,QGULDV*HWDFKHZIURP81,&()(WKLRSLD VPDOOFLUFOH ZKRSKRWRJUDSKHGWKH community health worker counselling the mother at home. !"" We particularly wish to acknowledge our use in this Module of adapted extracts and illustrations from Safe and Clean Birth and Newborn Care: A Reference for Health Extension Workers in Ethiopia (2008), which was based on A Book for Midwives: Care for Pregnancy, Birth and Women’s Health by Susan Klein, Suellen Miller and Fiona Thompson (2004), published by the +HVSHULDQ)RXQGDWLRQ%HUNHOH\&DOLIRUQLD86$The Book for Midwives was created with the collaboration of hundreds of advisors, reviewers, writers, artists and others, whose expertise is gratefully acknowledged. It is through the generous permission and encouragement of the Hesperian Foundation for others to copy, reproduce, or adapt the original book, including its illustrations, to meet local needs — provided that reproductions are provided free or at cost and QRWIRUSUR¿W²WKDWWKHSURGXFWLRQRISDUWVRIWKLVPostnatal Care Module was made possible. Safe and Clean Birth and Newborn Care was adapted from the original book by the Ethiopian Federal Ministry of Health (FMOH) Safe Motherhood Technical Working Group, with 3$QQLH&ODUN03+&100LGZLIHU\$GYLVRU$&&(663URJUDP$PHULFDQ&ROOHJHRI1XUVH Midwives, with the generous support of the US Agency for International Development under the WHUPVRIWKH$&&(66&RRSHUDWLYH$JUHHPHQW*+6$ 7KHRSLQLRQVH[SUHVVHGLQWKLV0RGXOHDUHWKRVHRIWKHDXWKRUVDQGGRQRWQHFHVVDULO\UHÀHFW the views of any of the donor organisations whose generous support made the production of Postnatal Care possible. !""" 1'&.*&./ Study Session 1 Postnatal Care at the Health Post and in the Community 2 The Normal Puerperium 3 The Abnormal Puerperium 4 Preparation for Postnatal Care 5 Routine Postnatal Care for the Mother 6 Routine Screening of Newborns for Life-Threatening Conditions 7 Breastfeeding, the Warm Chain Principle, and Counselling HIV-Positive Mothers 8 Special Care for Preterm and Low Birth Weight Babies 9 Making a Referral for Postnatal Care Notes on the Self-Assessment Questions (SAQs) for Postnatal Care !"0 2&.3'+4$."'&!.'!.5*!!"#$%&$&'()&*+!6'+4)* As you already know from the previous Modules on Antenatal Care and Labour and Delivery Care, the time immediately following childbirth is a period of high risk for mothers and newborns. Around RIPDWHUQDOGHDWKVDQGRIQHZERUQGHDWKVRFFXULQWKH¿UVWVHYHQ GD\VDIWHUWKHELUWKDQGDURXQGKDOIRIWKHVHGHDWKVRFFXULQWKH¿UVWKRXUV. A newborn baby LVDERXWWLPHVPRUHOLNHO\WRGLHLQWKH¿UVWGD\RILWVOLIHWKDQDWRQHPRQWKRIDJH7KXV the postnatal period is a time when your close attention and care can make a huge improvement in the life chances of women and children in your community. (DUO\QHRQDWDOPRUWDOLW\ GHDWKVRIQHZERUQVLQWKH¿UVWVHYHQGD\V VLJQL¿FDQWO\FRQWULEXWHV WRWKHRYHUDOOXQGHU¿YHFKLOGPRUWDOLW\RIDQDWLRQ81,&()KDVVKRZQWKDWHDUO\QHRQDWDO PRUWDOLW\DORQHDFFRXQWVIRUDERXWRIGHDWKVRIFKLOGUHQDJHGXQGHU¿YH\HDUVDQGQHDUO\ RIGHDWKVRILQIDQWVDJHGXQGHURQH\HDU1HZERUQVZKRVHPRWKHUVKDYHGLHGGXULQJ labour and delivery, or in the postnatal period, have an even greater chance of dying themselves, partly due to the lack of postnatal maternal care, but also because the causes of maternal mortality and morbidity also pose a high risk to the baby. Therefore, the skilled care provided during labour and delivery has to continue during the immediate postnatal period for both the mother and the baby – ideally
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