Q13.

CHILD HEALTH CARD

A. Describe the features of the child health card introduced in 2018

1. New card is white in colour with a blue theme for boys and oink theme for girls (old is
either blue or pink) (NEW)
2. List of vaccines and the diseases prevented in English, Shona and Ndebele (NEW)
 BCG: TB
 Hepatitis B: Hepatitis and Liver cancer
 Pentavalent: Diphtheria, Pertussis, Tetanus, Meningitis, Influenza and Cancer of the
liver
 OPV/IPV: Polio
 PCV 13: Pneumonia
 Rotavirus: Rotavirus diarrheoa

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 Measles Rubella: Measles and Rubella
 Td: Tetanus and Diphtheria
 HPV: Cervical cancer
 Vit A: Night blindness

3. Demographics
BI
BA
 Name of child
 Surname of child
 Sex
 Date of birth
 Place of birth
OF

 Health centre
 Physical address
 Contact number
 Mother’s name
PR

 Father’s name

4. Notes
5. Picture
 Mother, father and child with pink or blue background depending on sex of the child

6. Good infant feeding practice

 Exclusive BF for the first 6 months
 Introduction of complimentary feeding at 6months
 BF cessation at 24months or beyond unless when counselled by a health worker

7. Salt and sugar solution preparation in English, Shona and Ndebele

 Advice to give it when child has diarrheoa and to continue BF and feeding
  Advice to consult community health worker and take the child to a health facility for
further management
 Method: 6 level teaspoons sugar + 1L boiled water + ½ level teaspoon salt

8. Details of birth
 DOB, Duration of labour, Mode of delivery, APGAR, Head circumference, Birth
weight, Birth length
9. Instructions to record any of the following on the growth chart
 Childhood illness eg diarheoa, introduction of solids, milestones (crawling, talking),
BF cessation, birth of next child, hospital admission, death of mother

10. Risk factors

 BW<2.5kgs, 5th child or more, multiple births, MTCT, birth interval<2yrs, single
parent, maternal death, severe jaundice, birth asphyxia, death of a child under 5yrs
in family

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11. General growth patterns
 Good (increasing growth), Danger (plateau), Dangerous (decreasing growth)

12. Charts BI
 Height for age and weight for age for girls and for boys, up to age 5yrs
BA
13. Anthropometric measurements
 Date, weight, height, MUAC
OF

14. Infant feeding records

 From birth to 5yrs
 Exclusive BF, Complimentary foods intro, continuation of BF, food groups given,
number of meals per day
PR

 Codes for breast milk only, BM & water, BM & other liquids, BM & solids, formula
only, other milks

15. Care (HIV Infection)

 Whether or not mom is on ART
 Whether or not ARV prophylaxis was given at birth
 HIV testing details: type of test, date of test, test number, test result, date referred
for ART, date initiated on ART
 Follow up care: ART, Cotri
 Care comments

16. Vaccination schedule (NEW)

 Birth: BCG, heps B
 6weeks: pentavalent1, pneumococcal1, OPV1, Rota1
 10weeks: pentavalent2, pneumococcal2, OPV2, rota2
  14weeks: pentavalent3, pneumococcal2, OPv3, IPV
 9months: measles rublella1, typhoid
 18months: measles rubella2, DPT booster, OPV booster
 5years: Td1 booster
 10years: Td2 booster, HPV (girls)
 11years: HPV (girls)

17. Vaccination record

 Vaccine, dose number, batch number

18. Vaccination date reminder (NEW)

19. Vitamin A supplementation record
 Instructions to commence at 6months and then every 6months thereafter until age
5yrs

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20. Deworming Record (NEW)

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B. Discuss how the additional features impact on child survival
BA
1. Vaccines and the disease prevented
 Educate caregivers on importance and health workers to counsel caregivers
 Greater uptake of programme with raised awareness (leading causes of mortality eg
pneumonia, diarrheoa, TB, meningitis as well as prevention of adult disease eg liver
OF

disease and cervical cancer)

2. Vaccination schedule
a. Heps b at birth
PR

 Prevent hcc and liver failure in adults which causes premature deaths
 90% of chronic heps develops from childhood infection as children are less able
to clear infection
 95% of children develop immunity after 3 to 4 doses

b. Intro of IPV at 14weeks

 Preparation to switch from trivalent OPV 9 (virus type 1, 2 and 3) to bivalent
OPV9 virus types 1and 3)
 Poliovirus type 2 in OPV poses a risk of circulating vaccine derived poliovirus (a
mutated virus) and vaccine associated polio
 IPV boosts immunity to types 1 and 3
 IPV maintains immunity to type 2 poliovirus
 c. Intro of typhoid vaccine at 9months
 Zimbabwe is an endemic area for typhoid and has had several outbreaks
 Latest outbreak was identified to be due to a bug that is resistant to the usual
treatment (ciprofloxacin)
 Confers immunity for 5 to 7 years as well as herd immunity
 Access to clean water and sanitation will take long to achieve in the current
economic status so the vaccine is a cost effective way of interrupting
transmission in the meantime

d. Td at 5 and 10 years
 The vaccines at 6, 10, 14weeks as well as the booster at 18months have a
waning immune response.
 The boosters at 5 and 10 years provide a longer lasting immune response for the
prevention of morbidity and mortality from tetanus and diphtheria
 Coupled with maternal immunization, the boosters also help in the prevention

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of neonatal tetanus related morbidity and mortality

e. HPV at 10 and 11 years

BI
 Cervical cancer is the leading cause of cancer related morbidity and mortality in
developing countries such as Zimbabwe
 Despite these high numbers of deaths, there is poor uptake of secondary
BA
preventative measures such as cervical cancer screening and treatment of
precancerous lesions in the developing world
 The vaccine confers protection against the carcinogenic HPV types 16 and 18
(bivalent vaccine) as well as the non-cancer causing types 6 and 11 (quadrivalent
OF

vaccine) which are notorious for causing benign lesions such as warts
 The targeted population of girls (ages 10 to 14) is best strategic to immunize
girls before sexual debut which averages at 18.7 years in Zimbabwe with a
considerable 6% of girls having a sexual debut before age 15
PR

f. Vaccination date reminder

 Tracking of child vaccinations is made easier
 Ensures that caregivers don’t miss scheduled vaccination days
 Beyond certain ages, catch up immunization with certain vaccines becomes
inapplicable hence this tracking becomes important in disease prevention

3. Deworming
 2 to 5 year olds are most at risk of severe morbidity from schisto and helminth
infections
 Also protects against adult morbidity and mortality from long term consequences
such as bladder cancer from schisto
 Cheap and cost effective intervention that can reduce healthcare costs significantly
 Benefits in children
i. Increased weight gain
 ii. Improves anaemia
iii. Improves cognitive development
iv. Decreases malnutrition which contributes to about 50% of child deaths
worldwide
v. Improves school attendance and adult performance and possibly
earnings such that they are more able to provide for families
vi. Indirect effect when school going children are dewormed is in smaller
siblings who do not receive intervention, in the form of improved
cognitive development
vii. Indirect effect on the community as a whole to reduce transmission of
worm infections

Not necessarily new but

a. Picture
 Stresses the importance of involving both parents in care of the child

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 Male inclusion is especially important in the African community where there is
male dominance and men are the ultimate decision makers
 Awareness of child needs in men improves care

BI
 Involvement allows them to be educated of things such as household food
allocation which should prioritise children, followed by pregnant moms,
followed by women and then men as opposed to the African belief that men
BA
take precedence in this

b. Infant feeding guide

 Prevention of malnutrition and achieving the benefits of well nourishment
OF

c. SSS
 Home treatment for diarrheoa
 Diarrheoa related deaths are highly preventable with these low cost
PR

interventions

NB: The benefits in adulthood ultimately impact on child survival as healthy, productive, ALIVE
adults are better able to take care of children, ensuring well nourishment and good child care