Antenatal Care: Interventions SBA - Presentation 3 (b) Maternal Health Division Ministry of Health & Family Welfare Government of India Antenatal Care: Interventions

Antenatal Care: Interventions Iron-folic acid (IFA) supplementation Injection tetanus toxoid (Inj.TT) administration Malaria prophylaxis and treatment Folic acid supplementation (400 µg) upto 12 weeks of pregnancy to prevent neural tube defects Regular consumption of iodised salt Antenatal Care: Interventions

Antenatal Care: Interventions Why is IFA supplementation needed? To meet the increased demand of iron and folic acid during pregnancy Additionally Ensure regular intake of IFA tablet Counsel for increase in dietary intake of iron rich food : green leafy vegetables, jaggery, whole pulses, meat, fish, chicken, eggs, groundnuts etc Antenatal Care: Interventions

Antenatal Care: Interventions What is the prophylactic dose of IFA? Dose : 1 tablet of IFA (100mg elemental iron+0.5 mg of folic acid) Duration : At least 100 days starting at 14-16 weeks Continue for 3 months postpartum Given for preventing anemia even if Hb>11gm/dl Antenatal Care: Interventions

Antenatal Care: Interventions What is the therapeutic dose of IFA if Hb < 11 gm/dl? Dose : 1 tablet twice a day of IFA (100mg elemental iron+0.5 mg of folic acid) Duration : At least 100 days during pregnancy Continue for 3-6 months in postpartum period Follow up Repeat Hb after 1 mth : If increased, continue the same treatment If no increase refer to MO for further investigations Antenatal Care: Interventions

Antenatal Care: Interventions What are the indications for referral in women with anemia? Women with severe anemia, that is, Hb < 7 gm% Anemic women with breathlessness and or tachycardia HR > 100 beats / min Start with therapeutic dose of IFA and REFER the woman immediately to MO at FRU Antenatal Care: Interventions

Prescribing IFA tablets: Counseling Tablets to be taken regularly preferably early morning on an empty stomach If nausea or pain abdomen, it may be taken after meals or at night Stools will be dark in color while on tablets May have constipation, relieved by taking plenty of fluids and roughage Antenatal Care: Interventions

Prescribing IFA tablets: Counseling Absorption of iron is interfered if taken with tea, coffee or foods rich in fluoride Enhanced if taken with lemon water or orange juice Encourage her to take plenty of fruits and vegetables like mango, guava, orange, amla etc containing vitamin C Emphasize the importance of high protein diet like black gram, ground nuts, whole grains, milk, eggs etc Give advice not to stop the medication on her own Antenatal Care: Interventions

Injection tetanus toxoid administration Importance For preventing maternal and neonatal tetanus Dosage schedule : Two doses 0.5 ml I/M in upper arm First dose - As soon as woman registers for ANC Second dose - 4 weeks after the first dose even if it is after delivery If previously fully vaccinated within 3 years, give only one dose as early as possible Inform that there may be slight swelling, stiffness or pain at the injection site or in the arm Antenatal Care: Interventions

Malaria prophylaxis and treatment All clinically suspected cases should be investigated for malaria by Microscopy or Rapid Diagnostic Kit (RDK) No prophylaxis in pregnant women In non endemic areas : All clinically suspected cases should be investigated by RDK In highly endemic areas : All pregnant women are routinely tested for malaria at 1st AN visit and then every month If positive, the woman is referred to PHC for treatment Antenatal Care: Interventions

Antenatal Care: Interventions Thank you Antenatal Care: Interventions