Report on one year post basic vocational attachment

PANGUMA CHC, LOWER BAMBARA CHIEFDOM KENEMA DISTRICT

AUGUST 23, 2023

BY josiah andrew sao. 39853
(COMMUNITY HEALTH OFFICER)
DECLARATION
I ……………………………………………. declared that this is the reports of
my one year post basic job-related attachment at the Panguma Community
Health Center Lower Bambara Chiefdom, Kenema District.
Community Health Officer (CHO)
Signature: …………………

SUPERVISED BY
Mr. Christopher Barjie
CHO In-charge
Panguma CHC
Signature/Stamp: ……………………

SLACHO Kenema District Chairman/Representative

Mr. Christopher Barjie
Signature/Stamp: ……………………

ACRONYMS
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ANC – Ante Natal Clinic
CHA – Community Health Assistant
CHC – Community Health Centre
CHO – Community Health Officer
CHT – Community Health Technician
CHWs – Community-based lay Health Workers
MAM – Moderate Acute Malnutrition
MCH-Aide – Maternal and Child Health Aide
ORS – Oral Rehydration Salt
PHU – Peripheral Health Unit
SAM – Severe Acute Malnutrition
SECHN – State Enrolled Community Health Nurse
SSS – Sugar Salt Solution
TBA – Traditional Birth Attender
UFC – Under-Fives Clinic
VDC – Village Development Committee

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CONTENTS
DECLARATION................................................................................................1
ACRONYMS.......................................................................................................2
INTRODUCTION..............................................................................................4
CHAPTER ONE.................................................................................................5
OUTREACH CLINICS...................................................................................................................5
1. 1 REPORT ON OUTREACH CLINIC.............................................................................5
CHAPTER TWO................................................................................................8
UNDER-FIVES CLINIC.................................................................................................................8
2.1 REPORT ON UNDER-FIVES CLINIC.........................................................................8
2.2 HEALTH EDUCATION TALK TO MOTHERS ATTENDING THE UNDER-
FIVE’S CLINIC.........................................................................................................................12
CHAPTER THREE..........................................................................................22
ANTI-NATAL CLINIC (ANC)....................................................................................................22
3.1 REPORT ON ANTE-NATAL CLINIC........................................................................22
3.2 REPORT ON THE FUNCTIONS OF THE CHW......................................................23
CHAPTER FOUR............................................................................................24
MATERNITY................................................................................................................................24
4.1 REPORT ON MATERNITY........................................................................................24
CHAPTER FIVE..............................................................................................26
GENERAL CLINIC......................................................................................................................26
5.1 REPORT ON GENERAL CLINIC..............................................................................26
CHAPTER SIX.................................................................................................27
RECORDS.....................................................................................................................................27
6.1 REPORT ON RECORDS.............................................................................................27
CHAPTER SEVEN..........................................................................................31
ENVIRONMENTAL HEALTH AND COMMUNITY ACTIVITIES......................................31
7.1 REPORT ON ENVIRONMENTAL HEALTH AND COMMUNITY ACTIVITIES
31
CHAPTER EIGHT...........................................................................................32
ADMINISTRATIVE ACTIVITIES.............................................................................................32
8.1 REPORT ON ADMINISTRATIVE ACTIVITIES.....................................................32

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 INTRODUCTION
Subsequent my graduation as a community health 0fficer, I was posted to the Panguma
CHC for a period of one year (September 2022 to August 2023). Panguma is the Chiefdom
headquarter town for Lower Bambara Chiefdom in the Kenema District. It is a big town with
approximate population of 7,965 people as of 2022 census with a community health center
and a Government Hospital; Both serving as the main health facilities for the entire Lower
Bambara chiefdom, Dodo Chiefdom and even beyond.
The township has seven primary schools, Two Senior secondary schools, a market,
mosques and churches, a police post, local court Barry and a chiefdom administrative
building, few drug stores. The main economic activity of the inhabitants is farming though;
trading is another source of income. The religion with the highest congregation is Islam
followed by Christianity.
The Panguma CHC (in the same compound with the Government Hospital) is located on
the main Dodo - Kenema highway and on the right-hand side when entering the town from
Kenema, fenced with Cement Blocks. There are about 10 medical staff working at the CHC,
8 with pin code and 2 without (volunteers), 2 CHOs, 1 Midwife, 1 Lab technician (volunteer),
4 SECHN, 2MCH aide (1 volunteer) and non-medical staff; 1 vaccinator and 1 portal.
The CHC consists of one main but big structure divided into different department’s
based on work purpose. The CHC consisting of the OPD department is only there to give day
care management to patents and refer all critical cases to the hospital sector.

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 CHAPTER ONE

OUTREACH CLINICS
Objectives
The following were the objectives set for the outreach clinics:
 To assist with at least two outreach clinics every month.
 To do the vaccinations at one of these clinics every month, recording the number and
types of vaccines administered under the supervision of the EPI staff,
 To have an evidence of your outreach work neatly recorded in an exercise book for
review by supervisor

1. 1 REPORT ON OUTREACH CLINIC

The tasks on outreach clinic were fully undertaken during the course of my staying and
several reviews and corrections done as necessary. The table below was drawn to show the
record on few number of under-five children vaccinated, names, sex, age in month and type
of vaccine, three children per month for documentation purpose.

TABLE 1.1 SAMPLE OF UNDER-FIVES VACCINATION REPORT

No. Name Sex Age in Vaccination Vaccine Given
Mont

of the Children months Schedule

h

1 Fatu Kawa F 2 days At birth OPV0, BCG

SEPTEMBER

2 Ibrahim Bah M 4 months 14 weeks 3rd OPV, Dpt-HepB-Hib,

Pneumococcal, IPTi2, IPV
3 Ginnah Gbassay F 6 months 6 months Vitamin A

4 Hawa Sama M 3 months Week 10 2nd OPV, DPT-HepB-Hib,

OCTOBER

Pneumococcal, Rotavirus, IPTi1

5 Fatmata Konneh F 4 months Week14 3rd OPV, Dpt-HepB-Hib,
Pneumococcal, IPTi2, IPV
6 Yatta vandi F 10 months 9 months Yellow fever, MCV1, IPTi3

7 Musa Sheriff M 6 months 6 months Vitamin A

NOVEMBER

8 Zaniab Konneh F 11 months 9 months Yellow fever, MCV1, IPTi3

9 Fatmata Swaray F 8 months 6 months Vitamin A

10 Kadiatu Kallon F 2 months 6 weeks 1st OPV, DPT-HepB-Hib,

DECEMBER

Pneumococcal, Rotavirus, Vitamin A

11 Mamie Sama F 5 days At birth BCG, OPV 0

12 Amara Kamara M 16 months 15 months MCV2

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13 JANUARY Musa Kanneh M 12 months 12 months De-worming, Vitamin A

14 Abigial F 5 months 14 weeks 3rd OPV, Dpt-HepB-Hib,

Kongoma Pneumococcal, IPTi2, IPV

15 Bintu Bah F 10 months 9 months Yellow fever, MCV1, IPTi3

16 Musa Konneh F 12 months 12 months De-worming, Vitamin A

FEBRUARY

17 Theresa Mbayo F 9 months 9 months Yellow fever, MCV1, IPTi3

18 Mamie Kanu F 10 months 9 months Yellow fever, MCV1, IPTi3

19 Haja Sahmie F 3 months 10 weeks 2nd OPV, DPT-HepB-Hib,

Pneumococcal, Rota2, IPTi1
MARCH

20 Massah Bassie F 3 months 10 weeks 2nd OPV, DPT-HepB-Hib,

Pneumococcal, Rota2, IPTi1
21 Lucy Kamara F 8 months 6 months Vitamin A

22 Musa Vandy M 11 months 9 months Measles 1, Yellow fever

APRIL

23 Hannah Conteh F 4 months 14 weeks 3rd OPV, Dpt-HepB-Hib,

Pneumococcal, IPTi2, IPV
24 Mamie Kanu F 8 months 6 months Vitamin A
25 Haja Salamie F 3 months 10 weeks 2nd OPV, DPT-HepB-Hib,
Pneumococcal, Rota2, IPTi1
MAY

26 Magret Mbayoh F 2 months 6 weeks 1st OPV, DPT-HepB-Hib,

Pneumococcal, Rotavirus, Vitamin A
27 Yatta Gandi F 2 months 6 weeks 1st OPV, DPT-HepB-Hib,
Pneumococcal, Rotavirus, Vitamin A
28 Theresa Kallon F 3 months 10 weeks 2nd OPV, DPT-HepB-Hib,
Pneumococcal, Rota2, IPTi1
JUNE

29 Mariama Konneh F 5 months 14 weeks 3rd OPV, Dpt-HepB-Hib,

Pneumococcal, IPTi2, IPV
30 Fatty Kai F 8 months 6 months Vitamin A
31 Mamie Kai F 2 months 6 weeks 1st OPV, DPT-HepB-Hib,
Pneumococcal, Rotavirus, Vitamin A
JULY

32 Aminata Roger F 5 months 14 weeks 3rd OPV, Dpt-HepB-Hib,

Pneumococcal, IPTi2, IPV
33 Fatmata Juldeh F 8 months 6 months Vitamin A

34 Josephine Sheriff F 9 months 9 months MCV 1, Yellow fever

AUGUST

35 Mariatu Swaray F 10 months 9 months Yellow fever MCV1

36 Mariama Kamara F 9 months 9 months MCV 1, Yellow fever

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COMMENTS: From the table above, it can be deduced that some parents bring their
children very late for vaccination and this can be verified by closely looking at the ages and
vaccination scheduled date.
For instance, in August, Mariatu Swaray was scheduled for Yellow fever and MCV1
9months vaccination but, she was brought at age of 10 months instead.

The under mentioned villages are some of the outreach villages within the catchment area;
Baoma, Guala, Njagor and Kenema Golema

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 CHAPTER TWO

UNDER-FIVES CLINIC
Objectives
 Do at least one under five clinic per week
 Keep record of number of children weighed (attendance)
 Follow-up all severed malnourished children seen during each clinics season in the
facility: Evidence of follow-up showing home and visit record book kept at health
center.
 During your stay give at least ten (10) different health education talks to mothers
attending the UFC. Retain “Lesson plans” which must carry the signature of the in-
charge or the MCH aide, to verify that the talks were given and the date of the same.

2.1REPORT ON UNDER-FIVES CLINIC

This task on conducting under-fives clinic and attendance was done with record kept at
the CHC. The table below shows the number of children weighed at the facility from October
2022 to September 2023 by month.
Table 2.1 Number of children weighed in each month from September 2022 to
August 2023

Under-fives attendance at the Panguma CHC

MONTH ATTENDANCE PER
MONTH
Sep-23 133
Oct-22 120
Nov-22 130
Dec-22 90
Jan-23 75
Feb-23 80
Mar-23 78
Apr-23 70
May-23 85
Jun-23 90
Jul-23 110
Aug-23 130
ANNUAL TOTAL 1191

Out of the several children weighed during my staying, children who were either
malnourished or at risk of malnutrition were captured and follow up made at intervals
(3months follow up for each group).

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 Group A September to December 2022
For group A, children weighed in September, who were malnourished and/or at risk of
malnutrition were chosen and follow up made on them for three months. The malnourished
children were selected in the first week of October, follow up visit made at least one home
visit and a final evaluation made at the CHC.
The tables below show the initial and final anthropometric measures the malnourished
children under consideration
Table 2.2 September to December follow up on malnourished children

September to December First week in September Last week in December 2022

Initial Anthropometric Final Anthropometric
Follow up schedule measure measure
Age Z- Z-
NO in Se WT HT scor WT HT score
. Name Address month x Kg cm e SD MUAC Kg cm SD MUAC
66.
Musa Sandi Samabu
1 10 M 6.5 65 <-3 9.6 7.3 5 >-1 12.8
Alhaji Kallon Siifulla
2 22 M 9 78.5 <-3 10 10.2 80 <M 13
Mohamed
Folima
3 Sannoh 18 M 8.5 75.5 <-3 10.8 9.6 78 -1 12.8
Kemah Sheku Gorahun
4 20 F 7 70 <-3 10 8.5 71 <M 13
Kadie Sannoh Gobaru
5 23 F 7.3 70 <-3 11 8.8 74 <M 13.3

Group B January to March 2023

For group B, children weighed in January, who were at malnourished and/or at risk of
malnutrition were chosen and follow up made on them for three months. They malnourished
children were selected in the first week of January, follow up visit made at least one home
visit and a final evaluation made at the CHC.
The table below shows the initial and final anthropometric measures the malnourished
children under consideration
Table 2.3 January to March follow up on malnourished children
January to March 2023 First week in January Last week in March 2023

Initial Anthropometric
follow up schedule measure Final Anthropometric measure

Age Z-
NO in WT HT score WT HT Z-score
. Name Address month Sex Kg cm SD MUAC Kg cm SD MUAC

1. Abu Kallon Vama 20 M 9 78.5 <-3 10 10.2 80 <M 13

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2. Kadiatu Kamara Gorahun 20 F 7 70 <-3 10 8.5 71 <M 13

3. Zainab Sesay Vama 13 F 5.7 63 <-3 9.8 7 65 <M 12.7

4. Sheku Vandi Samabu 14 M 6.5 60 <-3 10 7 63 >M 13.5

5. Moiré Amara Gorahun 15 M 6.9 65 <-3 10.5 7.8 69 <-1 14

6. Daniel James Sisila 32 M 10 87 <-3 11.5 13 90 M 13.9

Group C April to June 2023

For group C, children weighed in April, who were at malnourished and/or at risk of
malnutrition were chosen and follow up made on them for three months. They malnourished
children were selected in the first week of April, follow up visit made at least one home visit
and a final evaluation made at the CHC.
The table below shows the initial and final anthropometric measures the malnourished
children under consideration
Table 2.3 April to June follow up on malnourished children

April to June First week in April Last week in June 2023

follow up schedule Initial Anthropometric measure Final Anthropometric measure

Age in WT HT Z-score WT HT Z-score
NO Name Address month Sex Kg cm SD MUAC Kg cm SD MUAC
Kadiatu
Siifulla
1 Kanneh 24 F 6.2 70 <-3 11 8.5 72 <M 12.8
68.
Fatmata Sheriff Konnehla
2 22 F 6 5 <-3 11 8.2 70 M 13
3 Alie Sama Sisila 25 M 7.6 78 <-3 11.2 9.9 80 <M 13.2
Mamie Sama Vama
4 12 F 5 63 <-3 9.8 7.1 65 M 12.7
Sheku Vandi Samabu
5 12 M 4.5 60 <-3 10 7 63 >M 12.5
Salia Konneh Gobaru
6 15 M 5.6 65 <-3 10.5 7.2 68 <-1 13
Mohamed
Gorahun
7 Kanneh 30 M 9.3 87 <-3 11.5 12.6 89 M 13.9

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 Group D July to August 2023
For group D, children weighed in April, who were at malnourished and/or at risk of
malnutrition were chosen and follow up made on them for three months. They malnourished
children were selected in the first week of July, follow up visit made at least one home visit
and a final evaluation made at the CHC.
The table below shows the initial and final anthropometric measures the malnourished
children under consideration
Table 2.3 July to August follow up on malnourished children
July to August First week in July Last week in August 2023
Follow up schedule Initial Anthropometric Final Anthropometric
measure measure
NO Name Address Age Sex WT HT Z- MUAC WT HT Z- MUAC
. in Kg cm score Kg cm score
mont SD SD
h
1 Musa Sandi Samabu 10 M 6.5 65 <-3 9.6 7.3 66.5 >-1 12.8
2 Alhaji Kallon Siifulla 22 M 9 78.5 <-3 10 10.2 80 <M 13

3 Mohamed Sannoh Folima 18 M 8.5 75.5 <-3 10.8 9.6 78 -1 12.8

4 Kemah Sheku Gorahun 20 F 7 70 <-3 10 8.5 71 <M 13

5 Kadie Sannoh Gobaru 23 F 7.3 70 <-3 11 8.8 74 <M 13.3

6 Bockarie Vandi Folima 24 M 9 74 <-3 11.2 9.9 80 <M 13

7 Amie Kallon Vama 12 F 5.7 63 <-3 9.8 7 65 <M 12.7

8 Sheku Vandi Samabu 12 M 6.5 60 <-3 10 7 63 >M 13.5

9 Morie Amara Gorahun 15 M 6.9 65 <-3 10.5 7.8 69 <-1 14

10 Abu Sesay Sisila 30 M 10 87 <-3 11.5 13 90 M 13.9

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 2.2 HEALTH EDUCATION TALK TO MOTHERS ATTENDING THE UNDER-
FIVE’S CLINIC

LESSON PLAN
General introduction of the presenter

1. TOPIC: Benefits of Breastfeeding

Time: 15-20 minutes

Material: Flip chart
Participants: Lactating mothers
Place: Outpatient department.
Date: 14th September 2022

Objectives
At the end of the presentation participants should be able:
 To define Breastfeeding
 To know when to breast Feed
 To know how to breast feed
 To know benefits of breastfeeding

BODY
Breastfeeding: simply means feeding babies and young children with natural milk from a
lactating mother`s breast. Breastfeeding can start immediately after the baby is born and
discontinues any time after 18months of live.
When to breast feed: At any time, the baby or young child wants to breast feed (on
demand).
How to breast feed: Bring your baby closer to you in whatever breastfeeding position is
most comfortable for both. Also use a breastfeed pillow for support.
To make sure baby gets a proper breast feeding, ensure good position and attachment of your
baby.
Benefits of breastfeeding to both mother and child
I. Creates mother and child bond
II. It`s cheaper, nutritious and safer for children
III. Maternal psychological satisfaction
IV. Good growth and development of the child

Questions & answers:

Conclusion or summary: Breastfeeding is the feeding of a baby and young children
with mother`s breast milk, immediately after birth followed by on demand and any position
suitable for both.

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 2. TOPIC: Exclusive Breastfeeding
Time: 15-20 minute
Participants: Lasting Mothers
Place: General Clinic department.
Material: Flip chart
Date: 4th October 2022
Objectives
At the end of the presentation participants should be able:
 To define exclusive Breastfeeding
 To know the benefits of exclusive Breastfeeding
BODY
Exclusive breastfeeding: –these simply means to breastfeed the baby immediately after
birth and continue on demand with breast milk only without any additional food until the
baby is six months of age.
BENEFIT OF EXCLUSIVE BREAST FEEDING
I. It protects your baby
II. It serves as the safest means of family planning
III. It promotes normal healthy growth and development of the child

Questions & Answers

 What is exclusive breastfeeding?
 How breast feeding benefits your babies?

Conclusion/summary
Exclusive breastfeeding means that the infant receives only breast milk within first six
months of live as it makes your baby happy and healthy.

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 3. TOPIC: Care of the umbilical cord
Time: 15-20 minutes
Place: Labor ward
Participants: Lactating Mothers
Material: van-card
Date: 2nd November 2022

Objective
At the end of the presentation participants should be able to know:
 the meaning of umbilical cord care
 how to care for their baby’s umbilical cord
 the signs of cord infection
 when to visit the clinic

BODY
Umbilical cord care: -this is the care of the cord after delivery. It will take some time 1-
2weeks before the stamp dries up and fall off. It will take a little care and attention to prevent
irritation and infection.

How do I care for my baby’s umbilical cord?

 Keep the area clean
 Keep the area dry
 Only give sponge baths
 Allow the cord to heal naturally

What are the signs of infection?

 Continues to bleed
 Base appears red or swollen
 Produces a foul smelling discharge
 Seems painful to your baby.

When should I visit the clinic?

 If there are signs of infection
 If the cord is actively bleeding

Questions & Answers: see above

Conclusion/summary
Umbilical cord care is the care of the cord after delivery and should be kept clean and dried to
make your baby healthy.

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 4. TOPIC: Benefits of the family planning
Time: 15-20 minutes
Place: Family planning Unit
Participants: Pregnant woman and lactating Mothers
Date: 13th December 2023

Objectives
At the end of the presentation participants should be able to know:
 the meaning of family planning
 methods of family planning
 benefits of family planning
BODY
Family planning: this simply means how a family decide on number children they want
to have and when to have them (birth control in terms of number of children and birth
spacing) at least two-year interval.

Methods of family planning

The following are the common family planning methods:
Oral contraceptive pills: it`s a little tablet taken once a day. One of its advantages is highly
effective when taken correctly and sometimes reduces heavy and painful periods. Its
disadvantages include; it does not protect you against STIs and forgetting to take your pills
means you are not for that day.
Intrauterine device (IUD): is plastic/copper material containing hormone (progesterone)
which is fitted inside the woman`s uterus and gives 3 to 10 yrs. prevention. It is 99%
effective but its negative side is that it causes irregular bleeding and spotting, it does not
protect you against STIs.
Condom (Both male & female): It is the only form of contraceptive that protects against
most STIs as well as preventing pregnancy.
Contraceptive injection (Depo-Provera): is a liquid solution given as IM injection
(buttock/upper arm) and give 12week prevention period. It is very effective and does not
interrupt sex. It may cause disrupted periods or irregular bleeding and does not protects
against STIs.
Emergency contraceptive pill: effective for 3ays and can be taken immediately before/after
sex.
Exclusive breastfeeding practice, calendar method (not reliable) and implant (Jadell)

Benefits of family planning

 Improves maternal health and child survival
 Prevent maternal exhaustion

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  Improves on economic and social status through empowering women
 Reduces number of unwanted pregnancies and abortions
 Reduces adolescent pregnancies.

5. TOPIC: BENEFITS OF VACCINES AND IMMUNIZATIONS

Place and Time: Under-fives clinic and 15-20mins
Participants: Lactating mothers
Method: presentation and discussion
Date: 10th January 2021

Objectives
At the end of the presentation participants should be able to know:
 the meaning of vaccination
 common vaccines and the diseases they prevent
 benefits of vaccines and immunization
BODY
Vaccination is the administration of a vaccine (biological preparation) to help the immune
system develop resistance against diseases.
Table 2.1 Common vaccines and the disease they prevent
Vaccine type Disease
BCG (Bacille Calmette-Guerin) Tuberculosis
OPV (oral polio vaccine ) & IPV Polio
(inactivated polio vaccine)
PENTA (DPT/HepB/Hib) Diphtheria, Pertussis (whooping cough),
Tetanus, Hepatitis B, Haemophilus
influenza, Pneumonia
Rota vaccine Diarrhea
PCV Pneumonia
Vitamin A *not a vaccine Vitamin A deficiency
Yellow fever Yellow fever
Measles Measles
Benefits of vaccines and immunization
 It reduces child morbidity and mortality rate
 It improves active immunity
 It makes the child healthy
 It saves lives
 Eradication of diseases

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 6. TOPIC: DIARRHEA
Place: Under-fives clinic
Time: 15-20mins
Participants: Lactating mothers
Method: Presentation and discussion
Date: 17th Febuary 2023

Objectives
At the end of the presentation participants should be able to know:
 Meaning of diarrhea
 Types of diarrhea
 causes of diarrhea
 How to treat dehydration at home?
 How to prevent diarrhea

BODY
Diarrhea is the passage of more than three loose or watery stools in a 24hrs period.
Diarrhea gradually leads to dehydration and death.

Types of diarrhea
I. Acute watery diarrhea – last several hours or day
II. Bloody diarrhea/dysentery – passage of bloody stool
III. Persistent diarrhea – longer than two weeks

Causes of diarrhea
There are several causes of diarrhea which include the following; viruses (rotavirus), bacteria
(Escherichia coli and Shigella), parasites (amoeba and giardia).

How to treat dehydration at home?

Give fluids like ORS/SSS, jelly water, plane rice water and breastfeeding as tolerated

How to prevent diarrhea

 good hand hygiene via effective hand washing
 via vaccination (get your child immunized)
 good environmental hygiene

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 7. TOPIC: PREPARATION OF SSS
Place and Time: Under-fives clinic, 15-20mins
Participants: Lactating Mother
Method: Practical Demonstration
Date: 7th March 2023

Objectives
At the end of the presentation participants should be able to know:
 the meaning of SSS
 how to prepare SSS at home

BODY
Meaning of SSS: SSS means sugar salt solution. it is a mixture of sugar and salt in water
to form a solution which is used in treating dehydration at home when there is no ORS (oral
rehydration salt)

How to prepare SSS at home

Materials: table salt, sugar, clean drinking water, teaspoon, pint and bowl/liter
Method:6 level teaspoon of sugar + 1 level teaspoon of salt + 1Liter (3 pints or 5 cups of
200mls) of clean drinking water and stir until the salt & sugar dissolves completely.

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 8. TOPIC: HANDWASHING
Place and Time: Under-fives clinic, 15-20min
Participants: Lactating Mother
Method: Practical Demonstration
Date: 6th April 2023

Objectives
At the end of the presentation participants should be able to know:
 the meaning of hand washing
 when to do hand washing
 how to do hand washing
 benefits of hand washing

BODY
Hand washing is the process of making our hands clean and safe by washing our hands with
soap and water of ash and water.

When to do hand washing: Perform Hand washing

 before and after feeding your child
 after visiting the toilet
 after cleaning/changing the diapers
 before, during and after cooking
 before and after visiting the heath facility or the sick
 before and after eating
 after sneezing, cough and blow your nose

How to do hand washing

 Wet your hand with water and apply soap or ash
 Rub your hands palm to palm, backs, between fingers and under nails
 Scrub your hands for at least 20sec
 Rinse your hands well with clean water
 Dry your hands using a clean towel or air dry.

Benefits of hand washing

 It makes our hands clean and safe
 Helps to prevent diarrhea
 Helps to prevent respiratory infection like covid-19
 Helps to prevent skin and eye infection

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 9. TOPIC: WEANING FOOD
Place and Time: Under-fives clinic, 15-20mins
Participants: Lactating Mother
Method: Presentation
Date: 9th May 2023

Objectives
At the end of the presentation participants should be able to know:
 the meaning of weaning food
 when to introduce weaning food
 commonly available weaning food
 how to locally prepare benni mix

Weaning is the introduction of a complementary feed to the child who has been on breast
milk only (breastfeeding). The type of food that is used is called weaning food.

when to introduce weaning food: this should start when your infant is around six
month of age and should begin gradually.

Commonly available weaning food: these includes benni mix, corn flour, soft cooked
sweet-potato, beans, mashed banana, cereal milk

How to locally prepare benni-mix

Materials: Benni, rice (powdered and dried), beans, dry fish, some sugar
Method: 2 cups of Benni (dried and powdered) + 10 cups of rice + 1 cup of beans + some dry
fish and sugar.

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 10.TOPIC: MALNUTRITION
Place and Time: Under-fives clinic
Participants: Lactating Mother
Method: Presentation
Date: 14th June 2023

Objectives
At the end of the presentation participants should be able to know:
 meaning of malnutrition
 types of malnutrition
 how to prevent malnutrition

BODY
Malnutrition means the body is not getting the adequate food in their correct proportion.
We can have under-nutrition and over-nutrition in our community.
A. Under-nutrition means you are getting lesser than what your body needs. examples of
under-nutrition are;
I. Marasmus – you starving or lack energy (carbohydrate)
II. Kwashiorkor – you lack protein
III. Marasmic-kwashiorkor – you lack both protein and energy
IV. Micro-nutrients deficiency
B. Over-nutrition means you are getting excess than what your body needs. example of
over-nutrition is obesity.

How to prevent malnutrition

 Practice exclusive breastfeeding (only breastfeeding in the first 6 months of live)
 Introduce appropriate weaning food at the appropriate time
 Adopt healthy feeding habit
 Always check if you are eating a well balance diet.

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 CHAPTER THREE

ANTI-NATAL CLINIC (ANC)

Objectives
 Do at least five (5) Ante – natal clinics at the health center and five (5) at the outreach
point during your stay and retain recur.
 Analyze the at – risk cases seen, home visits to at risk patient must be made as
necessary and recorded in the home visit book. Visit at least five different villages
where trained CHWs are working and write short report on the function of each of the
CHW.

III.1 REPORT ON ANTE-NATAL CLINIC

Several ante-natal clinics were conducted both at the CHC and at outreach stations as per
schedule, reviews and corrections made. The table below shows the list of pregnant women
who were at risk due to different obstetric origins.

Table 3.1 Risk assessment of pregnant women

Name Address Gravidity Abortion Presentation Gestationa At Risk Action
/parity / still l Age Condition
/ alive birth

Musu Kanneh , Folima G7P5A3D2 1 Cephalic 24 Hypertension CHC

38yrs &
multiparity

Lucy Kamara, Gobaru G2P2A2D0 1 Cephalic 32 APH referral

16yrs

fatmata kallon, Vaama G2P2A2D0 0 Breach 34 Previous C/S referral

30yrs

massah sesay. Sesayla G1P1A1D0 0 Cephalic 36 Eclampsia referral

18yr

Hawa sheriff. Samabu G3P2A2 D0 0 cephalic 26 STI CHC

27yrs

yatta sandi. 35yrs Sefula G4P4A3 D1 2 cephalic 28 Anaemia CHC

Haja Sheriff,28yrs Gorahun G5P5A4 D1 0 cephalic 25 APH referral

mamie sama. Damawuloh G8P8A4 D4 1 cephalic 36 Pre- referral

36yrs Eclampsia

Lucinda Morie Folima G4P4A3 D1 0 Breach 32 Breach referral

25yrs presentation

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 III.2 REPORT ON THE FUNCTIONS OF THE CHW
Following discussions with Community-based lay Health Workers (CHWs) at different
villages within the catchment area, it was noted that CHWs perform the following functions;
1. Health promotion in community in terms of when and where to seek health care
services (Health-seeking behaviors).
2. Assess and treat common and mild cases of malaria, diarrhea and pneumonia in
children age 2-59 months.
3. Do rapid diagnostic testing and treatment for malaria in children age 5years and
above.
4. Promote infection, prevention and control practices in their communities.
5. Complements the roles of other health workers particularly the maternal and child
health aides to reduce maternal and child morbidity and mortality in their community
(ante-natal clinic and vaccination coverage).

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 CHAPTER FOUR
MATERNITY
Objectives of this unit of the report include the following; under the supervision of the in-
charge/midwife:
 to conduct at least two deliveries in each month during the last ten months in the
health center
 to do a delivery note on each of these deliveries and make the report and pathograph
available to supervisors for review
 to repair at least one episiotomy and provide report on this, including its follow up
 to conduct at least one assisted delivery and write a report and make available for
review by supervisors

IV.1 REPORT ON MATERNITY

The delivery note on each delivery was written including the pathograph and submitted for
review by my supervisor. Below are few of those delivery notes for report purpose.
Table 4.1 Showing delivery note of a normal labor

Patient Details Delivery Note

Lucy Koroma, 28yrs Patient arrived at 12:20AM with Hx of labour pain 5hrs ago
G3P2A2 from Njagor and ruptured membrane 2hrs ago. Pathograph open at
village on 3/1/2023 12:30AM - no meconium stained liquor, vitals normal HR-
Gestational age: 38weeks, 100b/m, RR-22b/m, BP-110/70mmHg, T-370C. cervix 4cm
vertex presentation and dilated and decent 3cm. Fetal heart sound heard-142b/m.
longitudinal lie. spontaneous contraction continues and assessment done 1 to
2hourly.After 4hours cervix was fully dilated and child
delivered at 5:20 am alive, a male baby, birth weight 3.2kg,
APGAR score 9/10. 3rd stage monitored closely till
completion – cord tied and cut, placenta delivered and normal
lobes. Vitamin K 1mg given and tetracycline eye ointment
applied. Comment: General conditions of both the baby and
mother are satisfactory.
Neonatal care given and breastfeeding started.
Mamie Konneh, 18yrs Patient arrived at 4:30PM with Hx of labour pain 3hrs ago.
G1P0A0 from Baoma Pathograph open at 5PM – vitals normal HR-110b/m, RR-
village on 20/3/2023 22b/m, BP-100/65mmHg, T-36.50C. cervix 3cm dilated and
Gestational age: 37weeks, decent 5cm, membrane artificially ruptured and contraction at
vertex presentation and 5/10min. Fetal heart sound heard-142b/m. spontaneous
longitudinal lie. contraction continues and assessment done 1 to 2hourly. After
7hours cervix was fully dilated and child delivered at 12:50am
alive, a male baby, birth weight 3.4kg, APGAR score 9/10.
3rd stage monitored closely till completion – cord tied and
cut, placenta expelled and normal lobes following few
minutes of oxytocin 10IU. Perineum tears 2 degrees. Repair
done under supervision, vitamin K 1mg given and tetracycline
eye ointment applied. Comment:
Comment: General conditions of the baby and mother are
satisfactory. Continue site bath daily.
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 Neonatal care given and breastfeeding started.

Two episiotomy repairs were performed under the supervision due to delay second stage of
labour (adequate maternal effort/power) but narrow passage and big passenger. Lidocaine 1%
given as anesthetic agent.

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 CHAPTER FIVE

GENERAL CLINIC
Objectives of this unit include the following;
 to assist the in-charge at the general clinic both at the health center and outreach
points weekly
 to do home visit to severely ill patients and record in the home visit book

5.1REPORT ON GENERAL CLINIC

The conduct of general clinic both at the health center and outreach were done regularly
under supervision and efficiency and effectiveness attained. A total of 553 above fives clinic
attendees were seen both at the health center and outreach clinic over a one-year period.
Home visit of ill patients and follow ups on those referred to other health facilities for further
investigation and management were done with record kept at the CHC.
Table 5.1 General clinic attendance at the Gorahun CHC Sept.2020 to Augt.2021

MONTH ATTENDANCE PER

MONTH
Sep-23 140
Oct-22 145
Nov-22 131
Dec-22 130
Jan-23 114
Feb-23 102
Mar-23 113
Apr-23 100
May-23 80
Jun-23 92
Jul-23 120
Aug-23 122
ANNUAL TOTAL 1382

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 CHAPTER SIX
RECORDS
Objectives
 to analyze the health data collected at the PHU and outreach points during your first
six months of your stay
 attendance at general clinic with most common conditions seen
 ANC attendance and at-risk conditions
 the number of children weighed at the under-fives clinic
 the number of malnourished children seen
 present your analysis total for the months’ period of the cases seen at the center and at
the outreach point
 Write up a brief history, physical examination, diagnosis and the management of ten
cases you have seen and managed during your attachment (to be written up in an
exercise book). Include in your management any prescription written and what
follow-up was made.

6.1REPORT ON RECORDS
Table 6.1 The attendance of a general clinic with the most common
conditions seen at Gorahun CHC
Diseases Conditions
Month Malaria PUD U Diarrhea ARI/ HTN STIs TB/ Typhoi RTA Others
TI & Pneu HIV d
Dehydra moni
tion a
October 70 5 8 5 8 5 15 2 13 8 6
November 65 6 6 6 7 6 10 1 10 10 4
December 46 8 10 4 5 3 14 3 15 14 8
January 50 6 7 7 6 5 12 0 12 4 5
February 35 10 9 6 5 4 11 2 8 5 7
March 40 14 6 8 12 4 8 2 9 6 4
TOTAL 306 49 46 36 43 27 70 10 67 47 34

ANALYSIS: From the table above showing the general clinic attendance (Above
5 years) indicate that the majority of the cases seen in the aforementioned
category is led by malaria 41.6% with the highest cases 306, within the six-
months period. Followed by STIs and Typhoid at 9.5% and 9.1% respectively.

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The least disease condition in the category under consideration is TB/HIV 1.4%
of the general clinic attendance within 6 months.

Table 6.2 Ante-Natal Clinic (ANC) Attendance September 2022 to February

2023
Month Attendance at Attendance Number of At- Monthly Total
the Health center at the risk
Outreach
points
September 45 9 1 54
October 21 9 1 30
November 25 12 2 37
December 28 12 0 40
January 38 3 0 41
February 37 5 0 42
Total 194 50 4 244

ANALYSIS: There were 244 patients seen both at the health center and outreach within
six months, 194 and 50 respectively. The month with highest ANC attendance both at health
center and outreach clinic is September 2023 with 54 attendees. March also has the highest
attendance at health center visit with 45 pregnant women. November and December 2022 has
the highest outreach attendance with 12 each. Finally, total at risk patients within the six
months’ period is 4 with obstetrics complications.

Figure 1. Bar graph of ANC attendance at CHC VS Outreach clinic in six

months

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 ANALYSIS: Out of 244 pregnant women seen both at the health center and outreach
clinic, 80% of attendance was at the CHC and only 20% attendance was at the outreach
clinic. Furthermore, the result also shows that 20% of pregnant women would have been
missed if no outreach clinic was conducted.

TABLE 6.3 Shows Total U5 Children Weighed Vs. Malnourished within Six
Months September 2022 to February 2023

Month U5 U5 Total U5 Total U5 children

children children malnourished weighed
weighed weighed children
at CHC at
Outreach
clinic
September 73 5 9 78
October 100 20 2 120
November 105 25 3 130
December 84 6 3 90
January 65 10 4 75
February 70 10 6 80
Total 497 76 27 573

ANALYSIS: 573 total U5 children were weighed within six months ( September 2020 to
February 2021) with 497 and 76 children weighed at CHC and outreach clinic respectively.
27 of these children were found to be malnourished (11 SAM and 16 MAM). In November
130 U5 children weighed, highest U5 turnout, and the least in January with 75.
Bar Graph Shows Total U5 Children Weighed Vs. Malnourished within Six
Months September 2022 to February 2023

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ANALYSIS: About 4.7% of all U5 children weighed within six months were malnourished
and were put Outpatient therapeutic feeding programe and follow up made. About 95.3% of
the U5 children weighed were well nourished and implies that there are 20 more well-
nourished children to a malnourished child in the community.

History, physical examination, diagnosis and the management (prescription and follow up) of
at least TEN CASES were successfully carried out as part of my daily activities for clients
presenting to the facility and at outreach clinics for care and records kept at CHC. Several
referrals made for cases requiring further investigations and management to the appropriate
referral facilities.

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 CHAPTER SEVEN

ENVIRONMENTAL HEALTH AND COMMUNITY ACTIVITIES

Objectives include the following;
 Do a profile of one of the villages with a minimum population of 100 people in the
catchment area and update the village register with the village profile to include the
following:
 a map of the village
 population structure i.e. total number, age, sex
 immunization status of children under one year and 1 to 5 years
 key community owned facilities including market and places of worship
 water supply – number of well (protected and unprotected)
 sanitation report of village (refuse disposal and general cleanliness of villages)
This profile is to be written up and left at the health center for record purpose after it has been
reviewed by the supervisors.
 do an informal listen survey in the village selected for the profile to find the
‘generative theme` or ‘burning issue` for that village
 Analyze your findings and present the problem to the village community for their
discussion and possible solution(s) using the psycho-social method. Write a brief
report on this exercise. You are advised to involve the PHU staff in this work so that a
follow up is maintained after your departure.
 Determine if there are VDC in the village within three-mile radius of the health center
and attend as many meeting with them as possible. If there is none, work with the
villagers to establish one.
 Do monthly school visitations in the catchment area; write brief reports on these in an
exercise book of the health education activities carried out in the school(s) each
month.

7.1 REPORT ON ENVIRONMENTAL HEALTH AND COMMUNITY

ACTIVITIES
A profile of Kpetema, a village with a population of about 100 people and within three-mile
radius of the CHC static town, a profile was done and reviewed by the supervisor.
Brief report on informal listen survey in the Kpetema village selected for the profile to find
the ‘generative theme` or ‘burning issue` for that village; inadequate toilet facility, lack of
appropriate waste disposal sites and adequate pure and safe drinking water sources still
remain the main burning issues stated by the informants during the informal listen survey.
The village already has a Village Development Committee (VDC) but seems in active.
Efforts were however made to revitalize the VDC and much improvement was done before
my departure.

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 CHAPTER EIGHT

ADMINISTRATIVE ACTIVITIES
Objectives of this chapter include the following; with the approval of the in-charge you
will be responsible:
 to the supervise the portal/cleaner to maintain cleanliness of both the in and out of the
building and its surrounding
 during the last three months of your stay at PHU, you will be responsible for
organizing:
o duty roster
o home visiting schedule
o outreach clinic schedules
 to assist in the requisitions for drugs and equipment
 to check the inventory once every quarter during your stay at the health center
Neatly record these administrative tasks that were done and make them available for review
by supervisors.
8.1 REPORT ON ADMINISTRATIVE ACTIVITIES
As outlined in the objectives of this chapter, the supervision of the portal to ensure that the
CHC and its surroundings are kept cleaned and safe was done and as well took part in doing
so.
During the last three months of your stay at PHU, I carried out my responsibilities
organizing:
I. The duty rosters of the month of July, August and September 2023 respectively.
II. home visiting schedules in July, August and September
III. outreach clinic schedules in July, August and September
Furthermore, I assisted the in-charge in requisitions of drugs and equipment, and inventory
checked once every three months (quarterly) and have the records reviewed by the
supervisor.

THANK YOU

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