Self-Assessment Questions (SAQs) for Study Session 1

Answer

• a.Correct: neonate is a newborn baby.
• b.Partially correct: it is the care given to the baby and the mother immediately after birth and for the first 6 weeks of life.
• c.Correct: the neonatal mortality rate is newborn deaths in the first 28 days, per 1,000 live births.
• d.Correct: the early neonatal period is from birth to the first seven days.
• e.Partially correct: it is the number of mothers who die during birth and as a result of complications immediately following childbirth. In Ethiopia the MMR is very high with around 673 deaths per 100,000 live births. Note that whereas the neonatal mortality rate is measured per 1,000 live births, the MMR is measured per 100,000 live births.
• f.Wrong: it is the number of deaths in the first week of life per 1,000 live births. This is also very high in Ethiopia, with around 39 deaths per 1,000 live births.
• g.Correct: the neonatal period is from birth to the 28th day.
• h.Wrong: it is the process in which our lungs absorb oxygen and release waste carbon dioxide. It occurs from the moment of birth.
• i.Correct: in more detail what happens is that the liver fails to remove a protein called bilirubin, which is released in the process of breaking down ‘old’ red blood cells. A sign of neonatal jaundice (i.e. a build-up of bilirubin) is when the skin appears yellow, especially on the baby’s palms and soles.

Answer

There are many points you could make to the Finance Minister. Here are some of the key ones:

• Ethiopia has some of the highest rates of maternal mortality and early neonatal mortality in the world (you could quote him the actual figures).
• The period of greatest risk (i.e. just after delivery and in the first seven days of life and up to 28 days) is also when there is the lowest coverage of maternal and child health care in Ethiopia.
• High quality postnatal care has to happen in the first few hours or it is too late, but also that effective postnatal intervention has the potential to reduce the neonatal mortality by 10-27%. This will help Ethiopia meet the Millennium Development Goals to reduce maternal and child deaths.
• We already know the main causes of death in the postnatal period (you could give him the list) and we broadly know what to do about them – it is mainly a question of a trained health worker being there to do it.
• You might also point out that to be really effective, postnatal care needs also to involve the community (getting them engaged in the whole process, facilitating behaviour-change from harmful traditional practices, etc.), and explain to him how you will be doing this, e.g. talking to key ‘gatekeepers’ and enlisting the help of the Traditional Birth Attendants (TBAs) in the community.

Answer

Danger signs in the postnatal mother:

Key signs to look for include dehydration, a poorly contracted uterus, fresh bleeding, a drop in blood pressure and a rising pulse. Longer term dangers to be aware of include blood clots and depression.

Danger signs in the newborn:

Immediate things to check: is the baby breastfeeding properly, is the skin colour normal or yellowish, is there any fever, is the baby cold or too warm to the touch, is the breathing normal, is there any bleeding, has the baby got swollen or red eyelids? You would also check if the baby is preterm so as to know if it is at increased risk for some complications.You probably got most of these. If not, or if you can’t remember what they indicate, re-read Section 1.5.2 ‘Evaluating the newborn baby’.