Table 1 Focus and timing of home visits for INSIST community intervention
Visit | Timing | Key behaviours promoted | Additional behaviours promoted | Equipment |
|---|---|---|---|---|
1 | As soon as pregnant woman identified | • Birth attendant should wash hands and wear gloves | • Birth preparedness: preparing for facility delivery and saving money; and preparing in case of unexpected home delivery, preparing clean cloths, soap, clean blade for cutting & clean thread for tying cord, gloves for birth attendant | Counselling card |
2 | Four weeks after visit 1 | • Early and exclusive breastfeeding | • Check on birth preparedness issues from previous visit | Counselling card |
3 | At the beginning of 9th month of gestation | • Early and exclusive breastfeeding including position | • Check on birth preparedness issues from previous visits | Counselling card with doll |
• In case of home birth: | • Warmth: immediate drying and wrapping, delayed bathing, keep the vernix | |||
 ○ Birth attendant should wash hands and wear gloves, including while tying and cutting the cord | ||||
 ○ Identification of low birth weight babies using foot size as a proxy | • Danger signs for sick newborns | |||
 ○ Immediate referral for very small or premature babies, and those who don’t cry | • In case of home birth, cord should be cut with clean blade and tied with clean thread | |||
 ○ Skin to skin care for small babies | ||||
4 | Day of delivery | • Observe breastfeeding and counsel on positioning | • Check on warmth and knowledge of danger signs (as above) | Counselling card – measure foot size using scale |
• Reminder of exclusive breastfeeding | • Put nothing on cord | |||
• In case of home birth: | ||||
 ○ Identification of low birth weight babies using foot size as a proxy | ||||
 ○ Immediate referral for very small or premature babies | ||||
 ○ Skin to skin care for small babies | ||||
5 | Third day after delivery | • Observe breastfeeding and counsel on positioning | • Put nothing on the cord | Counselling card |
• Reminder of exclusive breastfeeding | ||||
1st extra visit for small baby | Day after visit 5 | • Skin to skin until the baby doesn’t want to be carried skin to skin | Counselling card | |
2nd Extra visit for small baby | Day after visit 6 | • Skin to skin until the baby doesn’t want to be carried skin to skin | Counselling card |