Professional Documents
Culture Documents
Josiah Project Writing
Josiah Project Writing
SUPERVISED BY
Mr. Christopher Barjie
CHO In-charge
Panguma CHC
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
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13 JANUARY Musa Kanneh M 12 months 12 months De-worming, Vitamin A
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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.
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
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
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2. Kadiatu Kamara Gorahun 20 F 7 70 <-3 10 8.5 71 <M 13
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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
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2.2 HEALTH EDUCATION TALK TO MOTHERS ATTENDING THE UNDER-
FIVE’S CLINIC
LESSON PLAN
General introduction of the presenter
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
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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
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.
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.
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Improves on economic and social status through empowering women
Reduces number of unwanted pregnancies and abortions
Reduces adolescent pregnancies.
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).
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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)
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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.
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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
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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.
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CHAPTER THREE
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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
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
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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.
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.
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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
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
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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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