Key and Supporting

Messages

Cou nselling C a r ds For

Comm u nit y Volu nteer s
Acknowledgements
The Ministry of Health would like to very sincerely thank the University Research
Co., LLC (URC) Nulife Program, with support from the United States Agency
for International Development (USAID), the United Nations Children’s Fund
(UNICEF), the World Health Organization (WHO) and the World Food Program
(WFP) for the technical and financial support which was so essential for the
development, printing and dissemination of these National Counselling Cards
for Community Volunteers and other elements of the integrated set of infant
and young child feeding counselling materials.

Sincere gratitude is extended to all development partners and community

members who participated in the multiple technical working groups, review
committees and field testing of these materials, for their contributions from
the time of their inception through the final stages. Non-governmental
organisations including the International Baby Food Action Network (IBFAN),
the Elizabeth Glazier Pediatric AIDS Foundation (EGPAF), CARE International,
Protecting Families Against HIV/AIDS (PREFA), Catholic Relief Services (CRS),
Save the Children in Uganda (SCIUG) and many others invested substantial
time and resources. The process has been very labour intensive and the
development would not have been possible if it were not for the untiring efforts
and commitment of these organisations and individuals.
Special recognition is made to the Nutrition Unit and the Division of Health
Promotion and Education of the Ministry of Health, and also members of the
Maternal and Child Health Cluster, Senior Management Committee, Health
Policy Advisory Committee and Top Management Committee of the Ministry
of Health for their technical input in finalizing the current Policy Guidelines on
Infant and Young Child Feeding and in reviewing and refining the integrated
set of counselling materials.

This key messages booklet, accompanying the National Counselling Cards for
Community Volunteers, was adapted from material originally developed by
University Research Co, LLC in Tanzania under the Quality Assurance Project/
Health Care Improvement Project. The material was also based on material
developed under the privately-funded CARE USA Infant and Young Child
Feeding in Emergencies (IYCF-E) Initiative, in partnership with URC/CHS and
the Dadaab IYCF Team.

3
Positive Counselling Skills

Positive Counselling Skills are important for Positive Counselling Skills

Positive Counselling Skills are important for all community volunteers.

all community volunteers.

Listening and learning skills
1) Use helpful non-verbal communication:
• Keep head level with caretaker(s)
• Pay attention
• Reduce physical barriers
• Take time
• Touch appropriately
2) Ask open questions

Listening and learning skills 3) Use responses and gestures that show interest
4) Reflect back what the caretaker says
5) Avoid using “judging” words

General counselling guidelines

1) Use helpful non-verbal communication:

• Organise your counselling tools before beginning a counselling
session. Use the appropriate counselling cards that are needed.
• Listen to the concerns of the caretaker(s).
• Greet the caretaker(s) and establish confidence. • Praise what the caretaker(s) are doing right.
• If the woman is pregnant, refer to counselling cards and leaflet on • Identify feeding difficulties, if any, and causes of the difficulties.
maternal nutrition (Card 1) and the cards on early initiation (Card
2) and exclusive breastfeeding (Card 4). • Observe baby and caretaker(s).

• Keep head level with caretaker(s) • All pregnant and lactating women should be counselled with Cards • Answer questions that caretaker(s) have (if any).
13 and 14, explaining the risks of passing HIV to the baby. All • Discuss with the caretaker(s) different feasible options to overcome
mothers should be encouraged to have an HIV-test and to disclose the difficulties.
their status. • Present options and help the caretaker(s) select one that they are
• If she has an infant less than 2 years old, ask the caretaker about the willing is most appropriate given her own Special Situation.

• Pay attention
age of her baby and current feeding practices. Use the counselling
cards that correspond with the age of the child and also the cards
that discusses the next development stage (Cards 7, 8, 9 and
10).

• Reduce physical barriers

• Take time
• Touch appropriately

2) Ask open questions

3) Use responses and gestures that show interest

4) Reflect back what the caretaker says

5) Avoid using “judging” words

General counselling guidelines

• Organise your counselling tools before beginning a counselling session. Use
the appropriate counselling cards that are needed.
• Greet the caretaker(s) and establish confidence.
• If the woman is pregnant, refer to counselling cards and leaflet on maternal
nutrition (Card 1) and the cards on early initiation (Card 2) and exclusive
breastfeeding (Card 4).
• All pregnant and lactating women should be counselled with Cards 13 and
14, explaining the risks of passing HIV to the baby. All mothers should be
encouraged to have an HIV- test and to disclose their status.
• If she has an infant less than 2 years old, ask the caretaker about the age
of her baby and current feeding practices. Use the counselling cards that
correspond with the age of the child and also the cards that discusses the
next development stage (Cards 7, 8, 9 and 10).
• Listen to the concerns of the caretaker(s).

1
• Praise what the caretaker(s) are doing right.
• Identify feeding difficulties, if any, and causes of the difficulties.
• Observe baby and caretaker(s).
• Answer questions that caretaker(s) have (if any).
• Discuss with the caretaker(s) different feasible options to overcome the
difficulties.
• Present options and help the caretaker(s) select one that she is willing is
most appropriate given her own Special Situation.

2
Counselling Card 1
Maternal Nutrition during Pregnancy and Breastfeeding

Key Messages:
• Eat one extra meal a day during
pregnancy in addition to regular
meals, and two extra meals during
breastfeeding.
Card 1

• Eat plenty of fruits and vegetables

with every meal.

• Drink enough liquids every day (8 glasses or 3 full NICE cups).

• Avoid taking tea or coffee with meals because they interfere with iron
absorption and may contribute to aneamia. It is better to drink tea or
coffee an hour before or after a meal.

• Throughout your pregnancy and for at least 3 months after your baby is
born you need iron and folic acid to prevent anaemia. It is better to take
iron tablets with meals to increase absorption and avoid potential side
effects, particularly nausea.

• Always use iodised salt to prevent poor brain development, poor physical
growth and goiter. Iodised salt also protects against unexplained
abortions, miscarriages and stillbirths.

• Get a vitamin A capsule from the nearest health facility and take
immediately after delivery or within 8 weeks to help build your baby’s
immune system through your breast milk.

• Take de-worming tablets as prescribed to treat worms and to prevent

anemia.

• Do not use alcohol, narcotics or tobacco products.

3
 • Sleep under an insecticide-treated mosquito net to prevent malaria. Take
antimalarials as prescribed by a health worker.

• Attend antenatal care at least four times during pregnancy and always
follow your health worker’s recommendations.

Special note for the adolescent mother:

• Before the age of 18 your body is still growing.

• You need extra care, more food and more rest than an older pregnant or
breastfeeding mother to enable your body to grow fully and ensure that it
produces enough milk for your baby.

4
Counselling Card 2
Early Initiation of Breastfeeding

Key Messages:
• Putting a baby on the breast
immediately after birth provides
the best start for your baby and can
save his or her life.
Card 2

• Immediate skin to skin contact

provides warmth and promotes
bonding. As soon as your baby is born, have the midwife put the naked
baby between your breasts, cover him or her lightly and keep the baby
there for at least one hour. Let the baby on your chest start suckling when
he or she starts showing signs of interest.

• Put your baby on the breast within one hour of birth to help expel the
placenta and reduce bleeding.

• Breastfeeding while the breast is still soft helps a baby learn to suckle.

• The thick yellowish milk known as colostrum is very healthy and helps
protect your baby from illness.

• Colostrum will help to expel your baby’s first dark stool.

• Water or pre-lacteals (sugar water or liquids/fluids) are NOT necessary

and dangerous . They cause a delay in your milk “coming in” (or start
flowing).

• Even though your baby feeds for short periods of time, this small amount
of milk is enough.

• During these early hours, feed your baby often (every 11/2 to 2 hours)
for short feeding times. Frequent feeding will help your milk to flow
sufficiently over the next few days.

5
Counselling Card 3
Positioning and Attachment

Key Messages:
• Correct positioning and attachment
help to ensure that the baby suckles
well and the mother produces a
good supply of breast milk. Cradle position Cross cradle for Cross position Lying down Under arm Under arm position
small Infants for twins position for twins

Card 3

• Correct positioning and attachment

help to prevent sore and cracked nipples.

Positioning
• Ensure that your baby is well-positioned by baby’s:
— tummy facing your tummy
— head and body in line
— whole body supported
— nose facing the nipple

• Your baby should be able to look up at your face. The baby should not be
held flat to the mother’s chest or abdomen.

• You should hold your breast with your fingers in a “C shape”, the thumb
being above the dark part of the breast (areola) and the other fingers
below.

• Fingers should not be in “scissor hold” because this method tends to

put pressure on the milk ducts and can take the nipple out of the infant’s
mouth.

• There are different ways to position the baby:

— Cradle position (most commonly used)
— Cross cradle position (suitable for small infants)
— Side-lying position (can be used right after delivery, to rest while
breastfeeding or at night)
— Under-arm position (best used after a Caesarean section,
when the nipples are painful and to breastfeed twins or small infants)
6
Attachment
• When you first begin to breastfeed, you may need to help the baby attach
well to the breast to avoid hurting your nipples.

• Touch the baby’s lips with your nipple. When the baby’s mouth opens
wide, move the baby quickly onto the breast, aiming the lower lip slightly
below the nipple.

• The baby’s tongue should be over the bottom gums. If the baby is in a
poor position, or if you feel any pain, then gently take the baby off the
breast and start again.

• Check that your baby is feeding well by seeing that the baby’s:
— mouth is wide open and has most of the darker skin (areola) in his
or her mouth
— lower lip is turned outward
— chin is touching the breast
— cheeks are rounded
— taking slow deep sucks, sometimes pausing

• You may also hear the baby swallowing.

• Let your baby empty one breast first and come off the breast on his or
her own. This will ensure that your baby gets the most nutritious and
satisfying milk. If still hungry, offer your baby the other breast.

7
Counselling Card 4
Exclusive Breastfeeding for the First 6 Months

Key Messages:
• Feeding the baby ONLY breast
milk up to 6 months helps a mother
to recover from child birth and
protects her from getting pregnant
Card 4
too soon.

• Do not give anything else, NOT even water (nor tea, glucose water,
gripe water, other animal milks, infant formula or porridge). Resist
pressure from others.

• Even if you work outside home you can maintain exclusive breastfeeding
(Card 17).

• If the mother is complaining about lack of breast milk go to

Card 5.

• Breast milk provides all the food and water a baby needs during the first
6 months of life.

• The thick yellowish milk known as colostrum that is produced during

the first few days after delivery is very important because it protects your
baby from many diseases.

• Do not give any food or drink to your newborn baby, the yellowish milk
is enough. Giving something else than breast milk will interfere with
breast milk production.

• Even during very hot weather, breast milk will satisfy the baby’s thirst
during the first 6 months. The mother may need additional water to
satisfy her own thirst.

• If the baby takes water or other liquids, she or he suckles the breast less
and the mother produces less milk. This leads to poor growth.

8
• Breastfeeding the baby often, at least 10 times, day and night, helps
to produce lots of breast milk to ensure that the baby grows healthy.

• Breastfeeding protects the baby from diarrhoea and respiratory

infections.

• Breast milk is inexpensive, always available and does not need any
preparation.

9
Counselling Card 5
Feeding more often Increases Your Breast Milk
Supply

Key Messages:

Note for the community volunteer:

Many mothers think they are not
producing enough breast milk. If a
mother expresses this concern, it is
Card 5

important to ask questions to find out the

following:

• (Ask to see the GPM card) Is the baby gaining weight following the
growth curve?
• Is the baby having at least 6 wets in 24 hours?
• Is the baby relaxed and satisfied after feeds, or frustrated and crying?
• (If the baby is under 6 months) Is the baby receiving anything else
than breast milk?

Ask the mother to do the following:

• Breastfeed frequently, 12 times a day if the baby wants.
• (If the baby has been receiving other foods) Stop giving the other
foods. This will make your baby suckle more and increase your milk
production.
• Breastfeed day and night.
• Encourage longer breastfeeds
• If the baby is ill or sleepy, encourage the mother to wake him or her
and offer the breast often.
• Encourage the mother to give the breast for comfort.
• Observe positioning and attachment of the baby and correct
accordingly (Refer to Card 4).
• Encourage support from the family to perform household chores.
• Avoid bottles, teats and spouted cups.

10
Counselling Card 6
How to Hand Express Breast Milk

Key Messages:
• Wash your hands with soap and
running water.
• Make sure the container you will use
to express your breast milk is clean. Card 6

• Sit or stand in a comfortable

position, in a quiet place.
• Use any hand for either breast. Put your thumb on the breast above the
dark area around the nipple. Place your first finger below the nipple and
the dark area. Support your breast with your remaining fingers.
• Compress the breast while moving your hand away from the chest wall.
This should not hurt. If it does, then you are not doing it right.
• Press the same way on each side of the dark area around the nipple in
order to empty all parts of the breast. Do not squeeze the nipple itself or
rub your fingers over the skin
• Express one breast for 3 to 5 minutes until the flow slows down and then
switch to the other breast. Then do each breast again. Change your hands
when the one hand gets tired. It usually takes 20 to 30 minutes to express
all of the milk.
• If your milk does not come easily, massage your breasts. A warm cloth or
drink, a back massage or thinking about your baby might also help.
• Store your expressed breast milk in a clean covered container until you are
ready to feed your baby. Expressed milk can be stored for up to 8 hours in
a cool place.
• Always feed the baby using a clean open cup. Even a newborn baby learns
quickly how to drink from a cup. DO NOT use bottles, teats or cups with
a mouth piece. They are difficult to clean and can cause your baby to
become sick.
11
Counselling Card 7
Complementary Feeding 6 months
Key Messages:
6 months

• At about 6 months, your baby is

developmentally ready and needs
other foods in addition to breast milk.

• Continue breastfeeding your baby

on demand, day and night to
Card 7
maintain his or her health and
strength as breast milk continues to
be the most important part of your
baby’s diet.
• Always give breast milk first before giving other foods. HIV positive
mothers who have decided to stop breastfeeding should feed their babies
at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.)

• Think of the following characteristics when giving complementary foods

to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V
= Variety (different kinds of foods), A = Active/responsive feeding, and H
= Hygiene (FATVAH).

• F Feed your baby 3 times a day.

• A Start with 2-3 heaped tablespoons per feed.

• T/V Introduce soft food (mashed potato, mashed banana, porridge). Be

careful not to make the baby’s food too thin.

• A Be patient and actively encourage your young child to eat.

– Use a separate plate for the child to make sure he or she eats
all the food given.

• H To give water and any liquid foods always use a clean open cup. DO
NOT use bottles, teats or spouted cups to feed your baby. They are very
difficult to keep clean and can make your baby sick with diarrhoea.
– Foods given to the baby must be prepared in hygienic
conditions to avoid diarrhoea and illness.

12
Counselling Card 8
Complementary Feeding 7- 8 months

Key Messages: 7-8 months

Complementary Feeding from
9–11 Months
12

• Continue breastfeeding your

baby on demand, day and night
to maintain his or her health and
strength as breast milk continues to
be the most important part of your Card 8

baby’s diet.

• When feeding a baby between 7 - 8 months old always give breast milk
first before giving other foods. HIV positive mothers who have decided to
stop breastfeeding should feed their babies at least 1 full NICE cup of milk
every day. (A full NICE cup is 500 ml.)

• Think of the following characteristics when giving complementary foods

to your baby: F = Frequency, A = Amount, T = Thickness (consistency),
V = Variety (different kinds of foods), A = Active/responsive feeding, and
H = Hygiene (FATVAH).

• F Feed your baby 3 times a day.

• A Gradually increase the amount of food at least one-third (1/3) of a NICE

cup. (A full NICE cup is 500 ml.) Babies have small stomachs and can only
eat small amounts at each meal.

• T Mash and soften the foods so the baby can easily chew and swallow;
breastmilk or animal milk can be used to prepare the soft food, do not
add water. Be careful not to make the baby’s food too thin.

• T Thicken the baby’s food as the baby grows older, making sure that he or
she is still able to easily swallow without choking.

13
• V Every day, or as often as possible, your baby needs at least a small bit of
a food from each of the following groups :
a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc.
b) Fresh or dry beans, peas
c) Meat, chicken, fish or eggs
d) Vegetables like dark green vegetables (dodo, nakati, buga) and
tomato, eggplant, carrot, cabbage etc.
e) Fruits like passion fruit, mango, pawpaw, orange, banana,
watermelon, pineapple, avocado etc.
f) Oil or ghee

• A Be patient and actively encourage your young child to eat.

– Use a separate plate for the child to make sure he or she eats
all the food given.

• H To give water and any liquid foods always use a clean open cup. DO
NOT use bottles, teats or spouted cups to feed your baby. They are very
difficult to keep clean and can make your baby sick with diarrhoea.
– Foods given to the baby must be prepared in hygienic
conditions to avoid diarrhoea and illness.

Examples of Balanced Baby Foods

• A thick porridge is made out of a flour of either maize or cassava or millet
or soya. Sugar, oil, milk, groundnuts, eggs and fruits can be mixed into
the porridge.

• Mashed food is a mixture of a food like matooke, potatoes, cassava,

posho (maize or millet) and fish, meat, beans or groundnut and/or simsim
paste. Also vegetables like greens, pumpkin, carrot, eggplant, avocado or
tomato should be mixed in the baby food.

14
Counselling Card 9
Complementary Feeding 9-11 months
Key Messages: 9-11 months
Complementary Feeding from
12
• Continue breastfeeding your 9–11 Months

baby on demand, day and night

to maintain his or her health and
strength as breast milk continues to
be the most important part of your
baby’s diet.
Card 9

• When feeding a baby between 9 -11 months old always give breast milk
first before giving other foods. HIV positive mothers who have decided to
stop breastfeeding should feed their babies at least 1 full NICE cup of milk
every day. (A full NICE cup is 500 ml.)

• Think of the following characteristics when giving complementary foods

to your baby: F = Frequency, A = Amount, T = Thickness (consistency),
V = Variety (different kinds of foods), A = Active/responsive feeding, and
H = Hygiene (FATVAH).

• F From 9 months onwards, feed your baby 4 times a day (3 meals and 1
snack).
Snacks:
– extra foods between meals that are easy to prepare
– these extra foods are in addition to the meals—they do not replace meals
– good snacks provide energy and nutrients (not to be confused with
sweets)
– most snacks can be eaten as finger foods such as pieces of ripe mango,
pawpaw, banana and vegetables

• A Give your baby a little more than one-third (1/3) of a NICE cup at each
feed. (A full NICE cup is 500 ml.) Babies have small stomachs and can only
eat small amounts at each meal.

• T Mash and soften the foods so the baby can easily chew and swallow;
breastmilk or animal milk can be used to prepare the soft food, do not
add water. Be careful not to make the baby’s food too thin.

15
• T Thicken the baby’s food as the baby grows older, making sure that he or
she is still able to easily swallow without choking.

• V Every day, or as often as possible, your baby needs at least a small bit of
a food from each of the following groups :
a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc.
b) Fresh or dry beans, peas
c) Meat, chicken, fish or eggs
d) Vegetables like dark green vegetables (dodo, nakati, buga) and
tomato, eggplant, carrot, cabbage etc.
e) Fruits like passion fruit, mango, pawpaw, orange, banana,
watermelon, pineapple, avocado etc.
f) Oil or ghee

• A Be patient and actively encourage your young child to eat.

– Use a separate plate for the child to make sure he or she eats
all the food given.

• H To give water and any liquid foods always use a clean open cup. DO
NOT use bottles, teats or spouted cups to feed your baby. They are very
difficult to keep clean and can make your baby sick with diarrhoea.
– Foods given to the baby must be prepared in hygienic
conditions to avoid diarrhoea and illness.

Examples of Balanced Baby Foods

• A thick porridge is made out of a flour of either maize or cassava or millet
or soya. Sugar, oil, milk, groundnuts, eggs and fruits can be mixed into
the porridge.

• Mashed food is a mixture of a food like matooke, potatoes, cassava,

posho (maize or millet) and fish, meat, beans or groundnut and/or simsim
paste. Also vegetables like greens, pumpkin, carrot, eggplant, avocado or
tomato should be mixed in the babyfood.

16
Counselling Card 10
Complementary Feeding 12-24 months
Key Messages:
12-24 months
Complementary Feeding from
9–11 Months
12
• Continue breastfeeding your young
child on demand, day and night
to maintain his or her health and
strength.

• In your young child’s 2nd year, Card 10

breastmilk continues to make up 1/3 of his or her diet. HIV positive

mothers who have decided to stop breastfeeding should feed their babies
at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.)

• Think of the following characteristics when giving complementary foods

to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V
= Variety (different kinds of foods), A = Active/responsive feeding, and H
= Hygiene (FATVAH).

• F From 12 months onwards, feed your young child 5 times a day (3 meals
and 2 snacks).
Snacks
– extra foods between meals that are easy to prepare
– these extra foods are in addition to the meals—they do not
replace meals
– good snacks provide energy and nutrients (not to be confused
with sweets)
– most snacks can be eaten as finger foods such as pieces of ripe
mango, pawpaw, banana and vegetables

• A Give your young child one-half (1/2) of a NICE cup at each feed.
(A full NICE cup is 500 ml.)

• T The child can eat family foods but make sure to cut the food into small
pieces so that the young child can easily chew and swallow.

17
• T Thicken the young child’s food as the child grows older, making sure
that he or she is still able to swallow easily without choking.

• V Every day, or as often as possible, your baby needs at least a small bit of
a food from each of the following groups (V):
a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc.
b) Fresh or dry beans, peas
c) Meat, chicken, fish or eggs
d) Vegetables like dark green vegetables (dodo, nakati, buga) and
tomato, eggplant, carrot, cabbage etc.
e) Fruits like passion fruit, mango, pawpaw, orange, banana,
watermelon, pineapple, avocado etc.
f) Oil or ghee

• A Be patient and actively encourage your young child to eat.

– Use a separate plate for the child to make sure he or she eats
all the food given.

• H To give water and any liquid foods always use a clean open cup. DO
NOT use bottles, teats or spouted cups to feed your baby. They are very
difficult to keep clean and can make your baby sick with diarrhoea.
– Foods given to the baby must be prepared in hygienic
conditions to avoid diarrhoea and illness.

18
Counselling Card 11
Feeding the Sick Child Less than 6 months

Less than 6 Months

• Breastfeed more during illness. This
will help your baby to fight sickness,
recover more quickly and not lose
weight.
• Breastfeeding also provides comfort Card 11

to a sick baby.
• If your baby refuses to breastfeed, continue to encourage your baby until
he or she takes the breast again.
• Give only breast milk and prescribed medicines to your baby.
• If your baby has been very ill, you may need support to re-establish
exclusive breastfeeding.
• If the baby is too weak to suckle, express breastmilk to give the baby,
either by cup or by hand expression directly into the baby’s mouth. This
will also help the mother to keep up her milk supply and prevent breast
swelling.
• Practice exclusive breastfeeding from 0 - 6 months.

NOTE: The mother may need support to re-establish exclusive

breastfeeding.

Feeding after recovery

• When a baby is recovering from an illness, he or she will breastfeed more
than usual.The baby is replacing what he or she lost during illness. This
can be tiresome for the mother.
• Take enough time to actively encourage your child to breastfeed more
frequently when his or her appetite has returned.

19
Counselling Card 12
Feeding the Sick Child Above 6 months

More than 6 Months
• Increase the frequency of breastfeeding
and offer additional food to your child
to maintain his or her strength, reduce
weight loss and to recover faster.

• Ecourage your child to breastfeed, eat

Card 12 and drink more. A child needs more
food and drinks during illness.

• DO NOT use bottles, teats or spouted cups, since these are difficult to
clean.
• Take time to patiently encourage your sick child to eat as his or her
appetite may be decreased because of the illness.
• Give your child small frequent meals.
• Feed your child foods that he or she likes in small quantities throughout
the day.
• Offer your child simple foods like porridge and fruits, even if he or she
does not express interest in eating.
• Avoid spicy or fatty foods.

Feeding after recovery

• When a baby is recovering from an illness, he or she will breastfeed and
eat more than usual.The baby is replacing what he or she lost during
illness. This can be tiresome for the mother.
• Give him or her one additional meal of solid food each day during the
next two weeks after he or she has recovered. This will help your child
regain weight lost during the illness.
• Take enough time to actively encourage your child to eat this extra food
and breastfeed more frequently when his or her appetite has returned.

20
Counselling Card 13
Risk of Transmission
• If a mother is HIV positive… what is the chance If a Mother
If a mother isis HIV Postive

Card 13
HIV-positive...
What is the risk of HIV passing to her baby when
of HIV passing to her baby when NO preventive NO preventive actions are taken?

actions are taken?

— Think of 100 babies born to women with HIV…

Did you know that about 40 of these babies will
get infected if no actions are taken to prevent
the spread of HIV from the mother to her child?
However the other 60 will not become infected Out of 100 babies born to HIV-positive mothers:
The majority of babies (60) Most babies (25) become Other babies (15) are

with HIV.
are not infected with HIV, infected with HIV during infected with HIV through
but should be protected. pregnancy, labor and birth. breastfeeding.

Protect your babyProtect

– get tested
yourand know your HIV status!
baby-
get tested and know your HIV status!

— Of the 40 HIV infected babies, 25 will be infected

during pregnancy, labor and delivery and 15 during breastfeeding.

• An HIV positive woman can pass HIV to her baby during pregnancy, labor,
delivery or through breastfeeding.

• Not all babies born to women with HIV become infected with HIV.

• Certain factors can increase the chance of passing HIV through breastfeeding—
for example if you have been recently infected with HIV or if you have an
infection in your breast while you are breastfeeding.

• Mixed feeding (breastfeeding combined with feeding your baby other types
of milk or food at the same time) almost doubles the chance of passing HIV
to your baby, compaired to exclusive breast feeding.

• An HIV positive woman should seek treatment from a health worker if she
has any infections and prevent HIV re-infection by making choices for safer
sex (e.g. use condoms during pregnancy and during breastfeeding).

21
Counselling Card 14
Risk of Transmission

If a Mother
Key Messages:
If a mother isis HIV Postive
Card 14

HIV-positive...
. . . but mother and baby take ARV’S and practice
exclusive breastfeeding, the risk of
passing HIV to her baby decreases.

• If a mother is HIV positive… what is the

chance of passing HIV to her baby when
mother and baby take anti-retrovirals and
practice exclusive breastfeeding?

• Think of 100 babies born to women with HIV…

Out of 100 babies born to HIV-positive mothers who take ARVs:
The majority of babies Most of these babies (10) Breastfed babies (5)
Did you know that if the mother and baby
are given ARV’S and she practices exclusive
(85) are not become infected with HIV can become infected. Exclusive
infected with HIV. during pregnancy, labor and and safer breastfeeding
birth. reduces the risk.

Protect your baby – get tested and know your HIV status!
Protect your baby-
get tested and know your HIV status!
breastfeeding the risk of passing HIV to the baby
decreases?

—85 out of 100 babies will not be infected.

— Only 10 of the 100 babies will become infected during pregnancy, labor
and delivery.

— Only 5 of the 100 babies will be infected through breastfeeding. However

breastfeeding should be done exclusively.

• HIV transmission can be reduced even more when other preventative

actions, like safer delivery, are practised.

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Counselling Card 15
Infant feeding mode and risk of HIV Transmission

If you are HIV-positive

Key Messages: What is the risk of HIV transmission when you are using:
Only Breast Milk Only Replacement Milk Practicing Mixed Feeding
(Formula or Cow’s Milk) (Breast milk plus other milk, liquids or foods)

• It is important for you to know that

all feeding options have risks for
your baby. The reason for discussing
these risks is to help you decide how Healthy babies Babies with

to feed your baby.

Babies who die from diarrhoea
without HIV infection pneumonia and other infection’s HIV-infection

Card 14
Card 15 Protect your baby- get tested and know your HIV status!

• It is possible to reduce the risk of

illness (such as diarrhoea and respiratory infections like pneumonia).
These pictures show the kind of risks associated with the different feeding
options. It is important for you to understand these risks.

• Exclusive Breastfeeding (giving ONLY breast milk for the first 6 months):
reduces the chance of passing HIV to your baby by half compared with
mixed feeding (giving both breast milk and other milks/foods).

• Exclusive Replacement Feeding (giving ONLY formula or modified fresh

animal milk for the first 6 months): there are no chances of HIV infection
through breastfeeding, but there are more chances of your baby dying
from diarrhoea, pneumonia and other infections.

• Mixed Feeding (giving both breast milk and other milks or foods):
compared to exclusive breastfeeding, mixed feeding greatly increases the
chances of passing HIV to your baby. It also increases the chances of your
baby suffering from other illnesses and dying because he or she is not
protected through breast milk.

23
Counselling Card 16
Feeding a Low Birth Weight Baby

Note for the community

volunteer:

• Explain the problem of Low Birth

Weight: a Low Birth Weight baby
Cross Cradle Position

needs special care and feeding

Under Arm Position Kangaroo Care • If very small refer for further
management
Card 16

• If medium size the mother should breastfeed as much as possible. Babies

with difficulties in attachment and sucking should be given additional
expressed breast milk in an open cup (Use Card 6 for hand expression).

• The mother needs support for correct attachment. The cross cradle and
underarm positions are good positions for feeding low birth weight
babies because they allow the mother to better control the positioning of
the baby’s mouth on the nipple.

• Direct breastfeeding may not be possible for several weeks, but the
mother should be encouraged to express breast milk and feed the breast
milk to the infant using a clean open cup. The baby should be put on the
breast frequently to get him or her used to the breast and to keep the milk
flowing.

• If the baby sleeps for too long, the caretaker should unwrap and hold him
or her to awaken before feeding.

• The mother should watch baby’s sleep and wake cycle and feed during
quiet-alert states.

• Crying is the last sign of hunger. The mother should recognize earlier
signs of hunger (including rooting, licking movements, flexing arms,
clenching fists, tensing body and kicking legs) and feed the baby.

24
Kangaroo Mother Care
• Different caretakers can care for the baby using the Kangaroo
method

• Position: place the naked baby on the caretaker’s naked chest with
his or her legs flexed and secure the baby in a cloth that passes just
under the infant’s ears and is tied around the caretaker’s chest.

• Warmth is needed:
— keep skin-to-skin contact, both naked
— cover the baby’s head with a hat

25
Counselling Card 17
Working Mother and Sick Mother

Working Mother

Note for a working mother with

formal employment: According to the
Ugandan law, a mother
has the right to paid maternity
Card 17 leave of 60 working days, and a
father to 4 days of paternity leave.
Get your employer’s support to :

Note for all working mothers:

Even when you go back to work you should continue to breastfeed. You can:
• Express breast milk to be fed to the baby from a cup while you are away
• Express breast milk at work to keep the milk flow going and to prevent
breast swelling
• If possible, carry the baby to the place of work or have someone bring the
baby when you have a break
• Take extra time for the feeds before leaving for work and when you come
back from work
• Increase the number of feeds while you are around; e.g. increase night
and weekend feedings
• Get extra support

Sick Mother:

• It is very important for the baby to continue to breastfeed for the baby’s
health and to prevent breast problems.
• It is important that you continue to eat, even when you do not have
appetite.
• During illness you have an increased need for nutrients. You also need
extra food to produce breast milk. Therefore taked extra care in what you
eat and how it is prepared.

26
Following nutrition advice can be given to a sick mother:
• Eat a variety of favorite foods
• Eat small frequent meals
• Make sure you take more liquids (e.g. water, juice, porridge, soup)
• Avoid fried foods or strong smelling foods
• Prepare foods in other ways than usual (e.g. mashed foods, more soups)
• Avoid foods that cause stomach discomfort
• Continue eating, even when you have diarrhoea
• Get extra support
• Make sure that the person preparing the food washes his or her hands
before food preparation

Breastfeeding mothers need to:

• Eat two extra meals a day in addition to regular meals
• Eat plenty of fruits and vegetables with every meal
• Drink plenty of liquids every day (8 glasses or 3 full NICE cups)
• Avoid taking tea or coffee with meals because they interfere with iron
absorption and may contribute to aneamia. It is better to drink tea or
coffee an hour before or after a meal.

27
Counselling Card 18
Regular Growth Promotion and Monitoring Prevents
Malnutrition

Note for the community

volunteer:
• A healthy child grows well. Any reduced
growth shows that something is wrong.

Card 18
• Infants and young children should gain
a certain amount of weight every month.

• A child should be weighed once every month from birth until he or she is
two years old.

• It is much easier to take corrective action in an early stage of reduced growth

than when the child has already become malnourished.

• If the child does not gain enough weight, try to find out the cause.

• Discuss the possibility of continuing frequent breastfeeding or relactation

where appropriate (Cards 4, 5, 6).

• If the baby is older than six months, discuss the appropriate complementary
foods/ nutrition education using the appropriate age. (Cards 7, 8, 9, 10).

• If the child has been or is sick, treat the child and discuss the feeding
recommendations.

28
Counselling Card 19
Good Hygiene Practices prevent Disease
Good Hygiene Practices Prevent Disease

• Wash your hands with soap (or ash)

and running water before preparing
food, before eating, and before
feeding young children.

• Wash children’s hands with soap (or

ash) and water before they eat. Card 19

• Wash your children’s hand’s with soap (or ash) and running water after they
have passed stool.

• Wash your hands with soap (or ash) and water after using the latrine or
cleaning the baby’s bottom.

• Feed your baby using clean hands, clean utensils and clean cups.

• DO NOT use bottles, teats or spouted cups, they are difficult to clean and
may cause your baby to get diarrhoea.

• Keep foods in covered container in a clean, cool and dry place.

29
 Methods
LAM (Exclusive breastfeeding) Ovulation (Observing vaginal wetness) Abstinence (Avoiding intercourse)
aditional or Ifhera woman LAM (Exclusive breastfeeding) Ifbasis
exclusively breastfeeds
baby (day and night), she can
Ovulation
a woman observes on a daily (Observing vaginal wetness)
the changes in her vaginal
Abstinence
Woman or couples can avoid (Avoiding intercourse)
pregnancy if they completely
tural methodsavoid becoming pregnant IF her Ifhera woman exclusively breastfeeds
wetness (mucous or vaginal flow) If a woman observes on a avoid
baby (day and night), she can
daily sexual intercourse. This Woman or couples can avoid
basis the changes in her vaginal pregnancy if they completely
baby is less than six months old she and her partner will know the means avoiding sexual
LAM
Ovulation
Counselling Card 20
and IF her period does not return.
This method is very secure only
up to 6 months.
avoid becoming pregnant days
baby is less than six months
IF of
her
avoidold
the month when she must
sexual intercourse
and IF her period does not return.
(penetration).
This method is very secure only
wetness (mucous or vaginal flow)
relationships
she and her partner will know
days of the month when she must
avoid sexual intercourse
the
penetration
or avoiding
of the woman’s
vagina with the man’s penis.
avoid sexual intercourse. This
means avoiding sexual
relationships or avoiding
penetration of the woman’s
Abstinence up to 6 months. (penetration). vagina with the man’s penis.

Male Condom
rrier or one-time How to achieve Optimal Child Spacing
Male latex
This is a thin but resistant Condom
Diaphragm
This is a flexibleDiaphragm
“hat” shaped
Spermicides
Spermicides
These are temporary methods

e methods bag that is place over the man’s

erect penis before each sexual bag that is place over the
device,
This is a thin but resistant latex made of rubber that is
inserted
man’s by a woman herself device, made of rubber that
(foam or tablets) that a womanThese are temporary methods
This is a flexible “hat” shaped
canisplace within her vagina within
(foam or tablets) that a woman
relationship. It prevents the sperm erect penis before each before
sexual sexual intercourse to inserted by a woman herselfone hour before having sexual can place within her vagina within
Male condom from entering the uterus. Using prevent
relationship. It prevents the spermpregnancy. It covers the relationships in order to help avoid
before sexual intercourse to one hour before having sexual
Diaphragm condoms also helps to reduce from entering the uterus. cervix so that sperm cannot enter
Using pregnancy.
prevent pregnancy. It covers the They also have a relationships in order to help avoid
sexually transmitted infections the uterus. It should be used
condoms also helps to reduce cervix so that sperm cannotprotective
enter effect against STIs. pregnancy. They also have a
Spermicide (STIs and HIV/AIDS). sexually transmitted infections
(STIs and HIV/AIDS).
together with a special gel. the uterus. It should be used
together with a special gel. Key Messages:
protective effect against STIs.

Oral Contraceptives Injectables (Depro-Provera®) Norplant

mporary
• Optimal child spacing means:
Oral Contraceptives Injectables (Depro-Provera®) Norplant
This is a pill or tablet that a woman This is a medicine that a nurse or This method consists of 6 thin
rmonal methods
takes everyday to avoid LAM This is a pill or tablet that doctor
Male Condom
takes everyday to avoid
a woman injects with a needle into This is a medicine that a nurse
Abstinence
(Avoiding intercourse)
tubesorof medicine that prevent This method consists of 6 thin
doctor injects with a needle into tubes of medicine that prevent
pregnancy. They(Exclusive
also help to
breastfeeding) the arm or buttocks of the woman pregnancy. They are inserted in
pregnancy. They also help to the arm or buttocks of the woman pregnancy. They are inserted in
Oral contraceptives
regulate menstrual disorders. Oral to avoid pregnancy. Each infection a woman’s upper arm by a trained

— having your children 3 to 5 years apart

regulate menstrual disorders. Oral
INJECTION
to avoid pregnancy. Each infection a woman’s upper arm by a trained
contraceptives usually come in lasts 3 months. Injectables can
INJECTION
health care provider. Protection
Injectables cartons of 28 pills. Some pills are
contraceptives usually come in lasts 3 months. Injectables can health care provider. Protection
cartons of 28 pills. Somebepills
usedareby women who are be used by women who are lasts up to 5 years, but the tubes
lasts up to 5 years, but the tubes
Norplant made for women who are made for women who are breastfeeding. breastfeeding. can be taken out at any time. can be taken out at any time.
breastfeeding. breastfeeding.

Female or
rmanent Sterilization Female Injectables
Male
Sterilization Sterilization
Oral Contraceptives
(Depro-Provera®)
Implants
Male Sterilization IUCD (Copper T) IUCD (Copper T) — waiting at least 6 months after
ng-term methods
stopping to breastfeed to get pregnant
This is a simple and very secure This is a simple and veryThis is a simple and very secure This is a simple and very secure
secure This method is a small device This method is a small device
operation for women who don’t operation for women who operation
don’t for men who don’t want operation for men who don’t inserted
want into the woman’s uterusinserted into the woman’s uterus
want to have any more children. want to have any more to children.
have any more children. It takes to have any more children. by
It takes
a trained service provider. It by
is a trained service provider. It is
Female sterilization
It takes less than 20 minutes. The It takes less than 20 minutes. The 15 minutes. The man less than 15 minutes. The made man of plastic and copper, in the made of plastic and copper, in the
less than

again
Male sterilizationwoman goes home within 2 to 6 woman goes home within goes2 to 6 within 2 to 4 hours. goes home within 2 to 4 hours.
home form of a “T”. It can protect a form of a “T”. It can protect a
hours. Sexual relations do not hours. Sexual relations do not relations do not change. Sexual relations do not change.
Sexual woman for up to 10 years or woman for up to 10 years or
IUCD change and the woman continues change and the woman continues more, but can be removed at any more, but can be removed at any
to have her period.Tubal Ligation to have her period.
Vasectomy IUD time. time.

Card 20

• Optimal child spacing promotes child survival through having:

— more time to breastfeed and care for your child
— more money for child care because you will have less school fees
to pay, less clothes to buy, less food to buy etc.
— more time for your body to recover and prepare for the next
pregnancy

• Feeding your baby only breast milk for the first 6 months helps to space
births in a way that is healthy for you and your baby.

• By exclusively breastfeeding your baby for the first six months you can
prevent pregnancy only if:
— you feed the baby only breast milk
— your baby is less than 6 months old
— your menstrual period has not returned

This child spacing method is called LAM. If any of these three conditions
change, you are no longer protected against pregnancy.

Note for the community volunteer :

When dealing with an HIV-positive mother:
• She should consider taking care of this child and avoid getting pregnant
again.
• Depending on LAM only is not enough. She should use condoms to prevent
re-infection and to prevent infecting her partner.

30
Counselling Card 21
When to take your Child to a Health Facility

• Young children can become

suddenly ill and may need to be Difficulty breathing Diarrhoea

seen urgently by a health worker.

• Take your child to a health worker if Refusal to feed

he or she shows any of the following Card 21

Vomiting
Fever Malnutrition

signs:
— Fever ( possible risk of malaria)
— Refusal to feed and being very weak
— Chest infection (cough and difficult breathing)
— Diarrhoea (more than 3 loose stools in 24 hours and/or blood in the stool,
sunken eyes)
— Vomiting (cannot keep anything down)
— Malnutrition (loss of weight or swelling of the body)

• You should also take your child for routine immunizations, Vitamin A
supplementation twice yearly and continued growth monitoring until he
or she is 2 years of age.

• If you are HIV positive, your children can be tested at 10 weeks of age so
that you can know if they are infected with HIV and they can begin to
receive treatment and care.

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Technical and financial support was provided through the generosity of the American people,
under USAID Cooperative Agreement 617-A-00-08-00006-00. January 2009.