Immunization of Under Five Children Among Antenatal Clinic

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Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

Immunization is a modern miracle; it has saved millions of lives worldwide and its origin dates back ancient Greece. In the 14th century the Chinese discovered and used a primitive form of vaccination called variolation. The aim was to prevent small pox by exposing healthy people to tissue from the scabs caused by the disease this is the first recorded attempt at vaccination. The British physician Dr. Edward Jenner in 1796 discovered vaccination in its modern form and proved to the scientific community that it worked. He was considered the founder of vaccinology in the west after he inoculated a 13year old boy with vaccine of a virus (cow pox) and demonstrated immunity to small pox. By 1798, the first small pox vaccine was developed.Immunization is the most effective method of preventing infectious diseases. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restrictions of disease such as polio, measles and tetanus. Generally immunization involves stimulating immune responses with infectious agents, i.e. priming the immune system with an immunogen with the intention of creating specific resistance to an infectious disease. Simply put a process by which an individual’s immune system becomes fortified against an agent.

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Antenatal care (ANC) coverage is a success story in Africa, since over two-thirds
of pregnant women (69 percent) have at least one ANC contact. However, to
achieve the full life-saving potential that ANC promises for women and babies,
four visits providing essential evidence based interventions – a package often
called focused antenatal care – are required. Essential interventions in ANC Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay
include identification and management of obstetric complications such as preeclampsia, tetanus toxoid immunisation, intermittent preventive treatment for
malaria during pregnancy (IPTp), and identification and management of
infections including HIV, syphilis and other sexually transmitted infections (STIs).
ANC is also an opportunity to promote the use of skilled attendance at birth and
healthy behaviours such as breastfeeding, early postnatal care, and planning for
optimal pregnancy spacing.
Many of these opportunities continue to be missed, even though over two-thirds
of pregnant women receive at least one antenatal visit. How can we strengthen
ANC to provide the priority interventions, especially given Africa’s current
critical shortage of human resources for health? Are there particular
barriers or challenges to increasing coverage and quality that could be
overcome? How can the multiple programmes that rely on ANC –
malaria, HIV/AIDS, tetanus elimination, control of STIs – be integrated
and strengthen the “vehicle” of ANC, rather than adding to the current
overload?
Antenatal Care
Ornella Lincetto, Seipati Mothebesoane-Anoh, Patricia Gomez, Stephen Munjanja
CHAPTER 2 III
52 Opportunities for Africa’s Newborns
The package
Preventing problems for mothers and babies depends on
an operational continuum of care with accessible, high
quality care before and during pregnancy, childbirth, and
the postnatal period. It also depends on the support
available to help pregnant women reach services,
particularly when complications occur.9 An important
element in this continuum of care is effective ANC. The
goal of the ANC package is to prepare for birth and
parenthood as well as prevent, detect, alleviate, or manage
the three types of health problems during pregnancy that
affect mothers and babies:
• complications of pregnancy itself
• pre-existing conditions that worsen during pregnancy
• effects of unhealthy lifestyles
Problem
Good care during pregnancy is important for the health of the mother and the development of the unborn Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay
baby. Pregnancy is a crucial time to promote healthy behaviours and parenting skills. Good ANC links the
woman and her family with the formal health system, increases the chance of using a skilled attendant at
birth and contributes to good health through the life cycle. Inadequate care during this time breaks a
critical link in the continuum of care, and effects both women and babies:
Effects on mothers: It has been estimated that 25 percent of maternal deaths occur during pregnancy,
with variability between countries depending on the prevalence of unsafe abortion, violence, and disease
in the area.1 Between a third and a half of maternal deaths are due to causes such as hypertension
(pre-eclampsia and eclampsia) and antepartum haemorrhage, which are directly related to inadequate
care during pregnancy.2 In a study conducted in six west African countries, a third of all pregnant women
experienced illness during pregnancy, of whom three percent required hospitalisation.3 Certain
pre-existing conditions become more severe during pregnancy. Malaria, HIV/AIDS, anaemia and
malnutrition are associated with increased maternal and newborn complications as well as death where
the prevalence of these conditions is high. New evidence suggests that women who have been subject to
female genital mutilation are significantly more likely to have complications during childbirth, so these
women need to be identified during ANC.4 Gender-based violence and exposure to workplace hazards
are additional and often underestimated public health problems. Rates of depression may be at least as
high, if not higher, in late pregnancy as during the postnatal period.5 Some African societies believe that
grieving for a stillborn child is unacceptable, making the death of a baby during the last trimester of
pregnancy even harder to process and accept.
Effects on babies: In sub-Saharan Africa, an estimated 900,000 babies die as stillbirths during the last
twelve weeks of pregnancy. It is estimated that babies who die before the onset of labour, or antepartum
stillbirths, account for two-thirds of all stillbirths in countries where the mortality rate is greater than 22
per 1,000 births – nearly all African countries.6;7 Antepartum stillbirths have a number of causes, including
maternal infections – notably syphilis – and pregnancy complications, but systematic global estimates for
causes of antepartum stillbirths are not available. 8 Newborns are affected by problems during pregnancy
including preterm birth and restricted fetal growth, as well as other factors affecting the baby’s
development such as congenital infections and fetal alcohol syndrome.
The social, family, and community context and beliefs affect health during pregnancy either positively or
negatively. Some cultures promote special foods and rest for pregnant women, but in others, pregnancy is
not to be acknowledged. In these cases, women continue to work hard, and nutritional taboos may deprive
them of essential nutrients, adding to nutritional deficiencies, particularly iron, protein, and certain vitamins.
In one tribe in Nigeria, pregnant women cannot say they are pregnant, and if they feel unwell, they have to
say that they have “swallowed a cockroach.”
This chapter will outline the ANC package, highlighting the shift to a four-visit model of focused antenatal Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay
care for the majority of women. We describe the current coverage and trends in Africa and explore
opportunities to strengthen antenatal care at the health facility, through outreach and in the community.
Finally, we suggest practical actions to help address key challenges in providing quality care to mothers and
babies during the critical time of pregnancy and integrating the multiple interventions and programmes
targeting this time period.
Opportunities for Africa’s Newborns 53
III
BOX III.2.1 The essential elements of a
focused approach to antenatal care
• Identification and surveillance of the pregnant woman
and her expected child
• Recognition and management of pregnancy-related
complications, particularly pre-eclampsia
• Recognition and treatment of underlying or concurrent
illness
• Screening for conditions and diseases such as anaemia,
STIs (particularly syphilis), HIV infection, mental health
problems, and/or symptoms of stress or domestic
violence
• Preventive measures, including tetanus toxoid
immunisation, de-worming, iron and folic acid,
intermittent preventive treatment of malaria in
pregnancy (IPTp), insecticide treated bednets (ITN)
• Advice and support to the woman and her family for
developing healthy home behaviours and a birth and
emergency preparedness plan to:
o Increase awareness of maternal and newborn
health needs and self care during pregnancy and the
postnatal period, including the need for social support
during and after pregnancy
o Promote healthy behaviours in the home,
including healthy lifestyles and diet, safety and injury
prevention, and support and care in the home, such
as advice and adherence support for preventive
interventions like iron supplementation, condom use,
and use of ITN
o Support care seeking behaviour, including
recognition of danger signs for the woman and the
newborn as well as transport and funding plans in
case of emergencies
o Help the pregnant woman and her partner prepare
emotionally and physically for birth and care of their
baby, particularly preparing for early and exclusive
breastfeeding and essential newborn care and
considering the role of a supportive companion
at birth
o Promote postnatal family planning/birth spacing
Source: Adapted from references15;16
ANC also provides women and their families with
appropriate information and advice for a healthy
pregnancy, safe childbirth, and postnatal recovery,
including care of the newborn, promotion of early,
exclusive breastfeeding, and assistance with deciding on
future pregnancies in order to improve pregnancy
outcomes. An effective ANC package depends on
competent health care providers in a functioning health
system with referral services and adequate supplies and
laboratory support. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay
ANC improves the survival and health of babies directly
by reducing stillbirths and neonatal deaths and indirectly
by providing an entry point for health contacts with the
woman at a key point in the continuum of care. A new
analysis done for this publication using previously
published methodology 10 suggests that if 90 percent of
women received ANC, up to 14 percent, or 160,000
more newborn lives, could be saved in Africa. (See data
notes on page 226 for more details) Compared with other
components of maternal, newborn, and child health
(MNCH) packages such as childbirth and postnatal care,
the additional lives saved is fewer, partly because ANC
already has relatively high coverage and saves many lives
already, so the gap between current coverage and full
coverage is smaller. However, the benefits of ANC are
greater than mortality reduction alone, and given the
relatively low cost of ANC, this package is among the
most cost effective of any public health package.10;11
ANC indirectly saves the lives of mothers and babies by
promoting and establishing good health before childbirth
and the early postnatal period – the time periods of
highest risk. ANC often presents the first contact
opportunity for a woman to connect with health
services, thus offering an entry point for integrated care,
promoting healthy home practices, influencing careseeking behaviours, and linking women with pregnancy
complications to a referral system. Women are more likely
to give birth with a skilled attendant if they have had at
least one ANC visit.12 Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay
Which ANC? While research has demonstrated the
benefits of ANC through improved health of mothers
and babies, the exact components of ANC and what to
do at what time have been matters of debate. In recent
years, there has been a shift in thinking from the high
risk approach to focused ANC. The high risk approach
intended to classify pregnant women as “low risk” or
“high risk” based on predetermined criteria and involved
many ANC visits. This approach was hard to implement
effectively since many women had at least one risk factor,
and not all developed complications; at the same time,
some low risk women did develop complications,
particularly during childbirth. Focused or goal oriented
ANC services provide specific evidence-based
interventions for all women, carried out at certain critical
times in the pregnancy. The essential elements of this
package are outlined in Box III.2.1.13;14
54 Opportunities for Africa’s Newborns
How many visits? A recent multi-country randomised
control trial led by the WHO17 and a systematic review13
showed that essential interventions can be provided over
four visits at specified intervals, at least for healthy
women with no underlying medical problems.18 The
result of this review has prompted WHO to define a new
model of ANC based on four goal-oriented visits.13;14;17
This model has been further defined by what is done in
each visit, and is often called focused antenatal care. The
optimum number of ANC visits for limited resource
settings depends not only on effectiveness, but also on
costs and other barriers to ANC access and supply. A
recent study from southern Tanzania found that health
workers spent an average of 46 minutes providing focused
ANC to a first time client, and 36 minutes for a revisiting
client. This was thirty minutes more on average than the
current practice and poses challenges for service delivery.19
When? For many of the essential interventions in ANC,
it is crucial to have early identification of underlying
conditions – for example, prevention of congenital
syphilis, control of anaemia, and prevention of malaria
complications. Hence the first ANC visit should be as
early as possible in pregnancy, preferably in the first
trimester. The last visit should be at around 37 weeks or
near the expected date of birth to ensure that appropriate
advice and care have been provided to prevent and
manage problems such as multiple births (e.g. twins),
postmaturity (e.g. birth after 42 weeks of pregnancy,
which carries an increased risk of fetal death), and
abnormal positions of the baby (e.g. breech, where the
baby’s head is not the presenting part at birth).
What? The first assessment in ANC is to distinguish
pregnant women who require standard care, such as the
four-visit model, from those requiring special attention
and more visits. Depending on the setting, approximately
25-30 percent of women will have specific risk factors
which require more attention. These women need more
than four visits. Table III.2.1 contains an overview of the
interventions at each ANC visit based on the four-visit
model as applied in focused ANC. Most of the
interventions recommended in the table are supported by
scientific evidence, are low cost, and can be implemented
in first level facilities in all countries in Africa. The
research model used urine dipsticks to check for
bacteriuria at every visit, but this intervention is currently
not included in WHO Pregnancy, Childbirth, Postpartum,
and Newborn Care: a guide to essential practice, which
presents recommendations applicable at the first level of
care.20 In referral hospitals or settings with additional
capacity, however, this intervention may be considered
because of the effect on reducing preterm birth and
neonatal sepsis. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

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Records held by women: A number of studies have
shown the benefits of home-based ANC records,
including the plan for birth and emergency
preparedness.21;22 Women who hold their own records are
more likely to keep follow up appointments, ask
questions about their health, and feel in control of their
pregnancy. In designing their own ANC records,
countries should ensure that all essential information is
readily available to the caregiver. A prototype form is
included in the new WHO model of ANC, together with
the relevant information for implementing quality ANC
services.17 In most sub-Saharan African countries, the
ANC record is part of a complete pregnancy record that
covers childbirth and postnatal care as well as family
planning.
The role of the community: Family and community
involvement is crucial for healthy home behaviours
during pregnancy and has been shown to be a major
determinant of use of ANC services. Establishing links
between the community and the facility can increase
utilisation of services, including ANC, and impact
maternal and neonatal mortality as well as stillbirths.23
The male partner or the mother or mother in law should
be welcome to attend an ANC session with the woman.
Their support can help the woman follow the ANC
recommendations, encourage shared decision making,
and improve the health for both mother and newborn.
Unsupported pregnant women, especially adolescents,
need services that are specifically targeted to their needs.
Service providers should do all they can to seek out
women unable or unwilling to attend a clinic and take
the services to them. Community health workers (CHW)
can play a key role by identifying all pregnant women in
the community and provide counselling on healthy
lifestyles, birth planning, complication readiness, and the
need for ANC and skilled care at birth. This helps create
links between the community and the healthcare system,
and reinforcing these health messages can take some of
the burden off service providers in ANC clinics. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

There has been confusion and misunderstandings about vaccines. But vaccinations are an important part of family and public health. Vaccines prevent the spread of contagious, dangerous, and deadly diseases. These include measles, polio, mumps, chicken pox, whooping cough, diphtheria, and HPV.

The first vaccine discovered was the smallpox vaccine. Smallpox was a deadly illness. It killed 300 million to 500 million people around the world in the last century. After the vaccine was given to people, the disease was eventually erased. It’s the only disease to be completely destroyed. There are now others close to that point, including polio. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

What are vaccines?
A vaccine (or immunization) is a way to build your body’s natural immunity to a disease before you get sick. This keeps you from getting and spreading the disease.

For most vaccines, a weakened form of the disease germ is injected into your body. This is usually done with a shot in the leg or arm. Your body detects the invading germs (antigens) and produces antibodies to fight them. Those antibodies then stay in your body for a long time. In many cases, they stay for the rest of your life. If you’re ever exposed to the disease again, your body will fight it off without you ever getting the disease.

Some illnesses, like strains of cold viruses, are fairly mild. But some, like smallpox or polio, can cause life-altering changes. They can even result in death. That’s why preventing your body from contracting these illnesses is very important.

How does immunity work?
Your body builds a defense system to fight foreign germs that could make you sick or hurt you. It’s called your immune system. To build up your immune system, your body must be exposed to different germs. When your body is exposed to a germ for the first time, it produces antibodies to fight it. But that takes time and you usually get sick before the antibodies have built up. But once you have antibodies, they stay in your body. So the next time you’re exposed to that germ, the antibodies will attack it, and you won’t get sick. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

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Path to improved health
Everyone needs vaccines. They are recommended for infants, children, teenagers, and adults. There are widely accepted immunization schedules available. They list what vaccines are needed, and at what age they should be given. Most vaccines are given to children. It’s recommended they receive 14 different vaccines by their 6th birthday. Some of these come in a series of shots. Some vaccines are combined so they can be given together with fewer shots.

The American Academy of Family Physicians (AAFP) believes that immunization is essential to preventing the spread of contagious diseases. Vaccines are especially important for at-risk populations such as young children and older adults. The AAFP offers vaccination recommendations, immunization schedules, and information on disease-specific vaccines. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

Is there anyone who can’t get vaccines?
There are some people who can’t or shouldn’t receive vaccinations. These include young infants (under 2 months) and people with certain medical issues. There is also a small number of people who don’t respond to a particular vaccine. Because these people can’t be vaccinated, it’s very important everyone else gets vaccinated. This helps preserve the “herd immunity” for the vast majority of people. This means that if most people are immune to a disease because of vaccinations, it will stop spreading. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

Are there side effects to vaccines?
There can be side effects after you or your child get a vaccine. They are usually mild. They include redness or swelling at the injection site. Sometimes children develop a low-grade fever. These symptoms usually go away in a day or two. More serious side effects have been reported, but are rare.

It takes years of development and testing before a vaccine is approved as safe and effective. Scientists and doctors at the U.S. Food and Drug Administration (FDA) study the research before approving a vaccine. They also inspect places where the vaccines are produced to make sure all rules are being followed. After the vaccine is released to the public, the FDA continues to monitor its use. It makes sure there are no safety issues.

Vaccines are safe. The benefits of their use far outweigh any risks of side effects.

What would happen if we stopped vaccinating children and adults?
If we stopped vaccinating, the diseases would start coming back. Aside from smallpox, all other diseases are still active in some part of the world. If we don’t stay vaccinated, the diseases will come back. There would be epidemics, just like there used to be. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

This happened in Japan in the 1970s. They had a good vaccination program for pertussis (whooping cough). Around 80% of Japanese children received a vaccination. In 1974, there were 393 cases of whooping cough and no deaths. Then rumors began that the vaccine was unsafe and wasn’t needed. By 1976, the vaccination rate was 10%. In 1979, there was a pertussis epidemic, with more than 13,000 cases and 41 deaths. Soon after, vaccination rates improved and the number of cases went back down.

Things to consider
There have been many misunderstandings about vaccines. There are myths and misleading statements that spread on the internet about vaccines. Here are answers to 5 of the most common questions/misconceptions about vaccines. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

Vaccines do NOT cause autism.
No studies have found a link between a vaccine and the likelihood of developing autism. The only paper that suggested a link has been discredited. The doctor who wrote it lost his medical license. Research is showing that infants may be born with autism, before any vaccinations are given.

Vaccines are NOT too much for an infant’s immune system to handle.
Infants’ immune systems can handle much more than what vaccines give them. They are exposed to hundreds of bacteria and viruses every day. Adding a few more with a vaccine doesn’t add to what their immune systems are capable of handling. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

Vaccines do NOT contain toxins that will harm you.
Some vaccines contain trace amounts of substances that could be harmful in a large dose. These include formaldehyde, aluminum, and mercury. But the amount used in the vaccines is so small that the vaccines are completely safe. For example, over the course of all vaccinations by the age of 2, a child will take in 4mg of aluminum. A breast-fed baby will take in 10mg in 6 months. Soy-based formula delivers 120mg in 6 months. In addition, infants have 10 times as much formaldehyde naturally occurring in their bodies than what is contained in a vaccine. And the toxic form of mercury has never been used in vaccines.

Vaccines do NOT cause the diseases they are meant to prevent.
This is a common misconception, especially about the flu vaccine. Many people think they get sick after getting a flu shot. But flu shots contain dead viruses—it’s impossible to get sick from the shot. Even with vaccines that use weakened live viruses, you could experience mild symptoms similar to the illness. But you don’t actually have the disease. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay

We DO still need vaccines in the U.S., even though infection rates are low.
Many diseases are uncommon in the U.S. because of our high vaccination rate. But they haven’t been eliminated from other areas of the world. If a traveler from another country brings a disease to the U.S., anyone who isn’t vaccinated is at risk of getting that disease. The only way to keep infection rates low is to keep vaccinating. Immunization of Under Five Children Among Antenatal Clinic (ANC) Essay