Paediatrics essays

10. a) List the components of focused antenatal care in Zimbabwe

b) Discuss the possible impact of focused ANC on health of both mothers and infants

Answer
a) Components of focused antenatal care in Zimbabwe include
 Health Promotion and disease prevention
- Immunisation against tetanus with tetanus toxoid at booking
- Reduction of iron deficiency anaemia by initiating iron supplementation with
ferrous sulphate and also promoting folate supplementation before conception up
to three months into the pregnancy
- Protection against malaria for women in endemic areas such as Nyanga and
Mutoko by initiating intermittent preventive treatment for malaria during
pregnancy(IPTp) which includes three tablets of a combination of pyrimethamine
and sulphadoxine which are given after quickening 4 weeks apart until delivery

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- Prevention of mother to child transmission of HIV by starting newly diagnosed
HIV infected pregnant women on ART as well as continued care for those already
known to be HIV infected BI
- Presumptive treatment of hookworm with albendazole in endemic or high burden
areas to reduce iron deficiency anaemia
- Protection against Vitamin A and or iodine deficiency
BA
 Early detection and treatment of complications and existing diseases such as severe
anaemia, infection, vaginal bleeding, pre-eclampsia/eclampsia, abnormal fetal growth
and fetal malposition after 36 weeks
- Existing conditions such as malaria, tuberculosis, HIV, syphilis and other sexually
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transmitted infections, diabetes mellitus, heart disease and malnutrition among

others
 Birth preparedness and complication readiness
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b) Focused antenatal care is an individualized and quality care provided to a pregnant

woman which emphasizes on the woman's overall health, her preparation for
childbirth and readiness for complications during her term of pregnancy. With the
maternal mortality ratio in Zimbabwe being 462 per 100 000 live births as per 2019
research and the infant mortality being50 per 1000 live births according to ZDHS
2015, focused antenatal care has the benefits of lowering both maternal and infant
mortality.

The major causes of infant mortality include neonatal complications such as

prematurity, birth asphyxia, congenital malformations, sepsis and diarrhoea. These
causes can be reduced by focused antenatal care especially when pregnancy
complications such as diabetes mellitus, pre-eclampsia, infections such as malaria are
quickly and adequately managed. Early detection of infection and early access to care
in health institutions during labour reduces perinatal mortality by early decision to go
for a Caesarian section and institution of comprehensive of emergency obstetric and
neonatal care. Provision of maternal folate supplementation reduces the incidence of
congenital malformations such as spinal dysraphism which contributes to neonatal
morbidity and mortality. The provision of iron supplementation in focused antenatal
care also helps to reduce iron deficiency anaemia in the infant which can complicate
in heart failure. The administration of tetanus toxoid in the antenatal period helps to
reduce the incidence of neonatal tetanus. As Zimbabwe moves towards elimination of
mother to child transmission of HIV (eMTCT), the success can be attributed towards
focused antenatal care and the integration of the PMTCT program with the antenatal
care services. With health promotion and educating pregnant women and their
families on nutritional and nourishing diets, this helps reduce maternal malnutrition
and reducing preventable low birth weight infants. Early detection of intrapartum
complications reduces the incidence of birth asphyxia which can cause cerebral palsy
with high morbidity.

Not only does focused antenatal care have an impact on the infant’s health but it also

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impacts maternal health. The prevention and management of maternal malaria in
endemic areas, mothers are protected from the complications of severe anaemia,
miscarriages caused by malarial infection as well. The supplementation of iron during
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pregnancy benefits women or young girls that had anaemia from chronic blood loss
either from excessive menstrual loss or from worm infestation or inadequate diet that
would have progressed with the pregnancy without much management on the
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underlying problem. This has the benefit of preventing the development of chronic
problems such as heart failure secondary to chronic anaemia. The promotion of HIV
testing, counselling and initiation of Antiretroviral therapy during pregnancy helps to
reduce the incidence of opportunistic infections and complications of unmanaged HIV
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infection in women of reproductive age. Since HIV and its complications can
contribute to maternal mortalityThe overall benefit of fANC is the promotion of early
access to care as society is more sensitised to health issues faced by expecting
mothers as well as being keen to promote their health in the community. With quality
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individualised care and monitoring of the pregnant woman, complications of

pregnancy that have the potential of causing future morbidity such as hypertension
and pre-eclampsia can be detected early before end organ damage which can
compromise the mother’s health and ability to care for her newborn.