Malawi PMTCT Trainer Manual

Malawi PMTCT Trainer Manual

Glossary
Acquired immunodeficiency syndrome / A: Acquired – not inherited.
I: Immuno – because it attacks the immune system.
D: Deficiency – of certain white blood cells in the immune system.
S: Syndrome – meaning a group of symptoms or illnesses that occur as a result of the HIV infection.
AIDS is the most advanced stage of HIV infection.
Acute illness / Anyillnessthat lasts less than four weeks.
Anaemia / A condition in which a reduced number or volume of red blood cells or decreased haemoglobin result in less oxygen being carried to other cells in the body.
Antenatal care / Care of a pregnant woman and her unborn child or foetus before delivery.
Antibiotic / A medicine that kills infection-causing organisms.
Antibody / A specialised serum protein produced by the immune system in response to exposure to a foreign protein or antigen.
Antigen / A substance that can trigger an immune response causing the production of antibodies as part of the body's defence against infection and disease.
Antiretroviral prophylaxis / Short-term use of antiretroviral drugs to reduce HIV transmission from mother to infant.
Antiretroviral treatment / Long-term use of antiretroviral drugs to treat maternal HIV/AIDS and prevent PMTCT.
Artificial rupture of membranes / When a healthcare worker uses a hand to insert an amniotic hook, or a Kocher clamp, into the vagina, then guides the clamp or hook towards the membranes along the fingers in the vagina. Placing two fingers against the membranes, the HCW gently ruptures with the instrument in the other hand allowing the amniotic fluid to drain slowly around the hand.
Asymptomatic / Without symptoms of illness or disease.
BabyFriendlyHospital Initiative / The BFHI aims togive every baby the best start in life by creating a health care environment where breastfeeding is the norm, thus helping to reduce the levels of infant morbidity and mortality in each country.
Bacille of Calmette and Guerin / A tuberculosis vaccine
Bacterium / A type of germ that causes infection.
Barrier methods / A contraceptive method that prevents semen and other bodily fluids from passing from one partner to another. Barrier methods such as the male and female condom, also reduce the risk of STDs.

Behaviour change intervention / A health promotion approach that is used to support an individual’s ability to adopt and maintain new behaviours.
Bloodborne pathogen / Microorganisms, such as viruses or bacteria, that are carried in blood and can cause disease.
Breastmilk substitute / Any food being represented as a partial or total replacement for breastmilk, including commercial infant formula and home-modified animal milk.
CD4 cells / T-lymphocyte cells in the immune system involved in protection against infections. HIV infects and kills CD4 cells.
CD4 count / A test that measures the number of CD4 cells in the blood, thus reflecting the state of the immune system. A normal count in a healthy adult is 600–1200 cells/mm3.
Central Nervous System / A part of the body composed of the brain, spinal cord, and meanings (protective membranes surrounding them). The central nervous system is often affected in advanced AIDS, causing dementia.
Cessation of breastfeeding / Completely stopping breastfeeding, including suckling.
Chorioamnionitis / Inflammation of the membranes covering the foetus.
Chronic illness / Any persistent medical condition that lasts more than four weeks.
Combination ARV therapy / Use of three or more antiretroviral medications to more effectively combat HIV disease and suppress viral load.
Commercial infant formula / Specially formulated powdered milk made specifically for infants and sold in shops/stores or provided to HIV-positive mothers to prevent HIV transmission to infants
Commercial sex worker / A woman or man who offers sexual servicesfor gain. The terms prostitute or prostitution are used more frequently used outside the AIDS area.
Complementary food / A food provided to a baby, who is older than 6 months of age, in addition to breastmilk or a breastmilk substitute.
Condom / See Female condom and/or Male condom.
Cotrimoxazole Preventive Therapy / Also known as trimethoprim/sulphamethoxazole, Bactrim, or Septra. A combination antibiotic drug effective at preventing and treating Pneumocystis pneumonia (PCP); also serves as a prophylaxis againstsome bacterial pneumonias, some forms of salmonella sepsis, toxoplasmosis and certain causes of diarrhoea.
Counselling / The confidential dialogue between an individual and a care provider.
Cryptococcus / A fungal organism that infects the central nervous system (brain, and spinal cord) causing cryptococcal meningitis. Some of the symptoms include fever, headache, vomiting, and loss of appetite. A serious opportunistic infection in persons living with HIV/AIDS.

Cryptosporidium / An organism that infects the intestines (gut). Some of the symptoms include diarrhoea, pain, and weight loss.
Cup feeding / Being fed from or drinking from an open cup.
Dehydration / Loss of fluid from body tissues.
Diarrhoea / More than three loose, watery stools within a 24-hour period.
Dual Protection / The use of one or more methods of contraception that prevent STIs, including HIV, and unintended pregnancy.
Encephalopathy / Degeneration (failing) of the brain that causes decreased functioning in activities of daily living and progresses over weeks or months.
Enzyme / A protein that helps promote biochemical reactions but that is not affected by them.
Enzyme Linked Immunosorbent Assay / A laboratory assay (test) to identify the presence of HIV antibodies in body fluids.
Epidemic / A disease affecting a large number of individuals within a population, community, or region at the same time.
Evaluation / Evaluation is the process of gathering and analysing information for the purpose of determining whether a programme is carrying out the activities as planned, and the extent to which the programme has achieved its stated objectives.
Exclusive breastfeeding / Infant feeding method whereby all the infant’s fluid energy and nutrients are provided by breast milk.

• The baby should not be given any drinks or foods other than breast milk except for drops or syrups consisting of vitamins, mineral supplements, or medicine when indicated.
• Feeding of expressed breast milk is considered EBF
• No pacifiers or dummies or artificial teats are given to the baby
• There should be no limits placed on the number of breast feeds
• There should be no limits placed on suckling time or length of a breast feed
• The newborn babies should breastfeed eight to twelve times in 24 hours, including night feeds

External Cephalic Version / A way to try to turn a baby from breech presentation to cephalic (head-down) presentationwhile it's still in the mother's uterus.
Failure to
Thrive / Weight loss or gradual but steady deterioration in weight gain from the expected growth, as indicated in a child's growth card.
Family Planning / Family Planning implies the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.
Female condom / The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse, providing protection against both pregnancy and STIs. It forms a barrier between the penis and the vagina, cervix and external genitalia.
Fungus / A germ that can cause infection, including a yeast infection such as thrush.
Gastroenteritis / Gastroenteritis means inflammation of the stomach and small and large intestines.
Germs / Organisms, including bacteria, viruses, and fungi, that can cause infection.
Haematocrit / The percentage of red blood cells in the blood.
Haematologic / Relating to blood.
Haemoglobin / An iron-bound protein found in red blood cells that carry oxygen from the lungs to other cells in the body.
Healthcare worker / A doctor, nurse, midwife, programme manager, or others whose activities include working directly with patients or clients in a healthcare setting.
Helminth infection / Intestinal disease caused by wormlike parasites.
Hepatic / Relating to the liver.
Hepatitis / Inflammation of the liver that may be caused by bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood.
Hepatomegaly / Swollen or enlarged liver.
Herpes / A virus that causes sores in the mouth, on the genitals, or elsewhere on the body.
Highly Active Antiretroviral Therapy / Stands for the use of at least three ARV drugs in combination to suppress viral replication and progression of HIV disease by reducing the viral load to undetectable levels.
HIV rapid test / A simple test for detecting HIV antibodies in blood or other body fluids that produces results in less than 30 minutes.
HIV testing, parallel / Clients are tested using two whole blood rapid HIV tests simultaneously (in parallel) using a highly sensitive and a highly specific test.
HIV testing, serial / Clients are tested with a highly sensitive rapid HIV test where negative result is definitive and a positive result requires another specific confirming rapid HIV test
HIV-related condition / Any disease or other physical condition that is a result of HIV or is exacerbated by HIV causing illness in a person with HIV, particularly as the immune system is weakened.
Home-based care / The provision of treatment and care in the home.
Home-modified animal milk / Formula made from fresh liquid or full cream powder animal milk modified using a standard or specific recipe.
Human immuno-deficiency virus / The virus that causes AIDS.
Immune system / A collection of cells and proteins that works to protect the body from invasion by foreign bacteria, viruses and fungi.
Immunisation / Vaccination to protect against a specific infection by injecting a weakened or killed form of a disease-causing organism into the body to activate the body’s immune response without causing the full-blown disease. Currently there is no vaccine or immunisation to protect against HIV.
Immuno-compromised / Having a weak or damaged immune system as measured by a low CD4 count. Also, see Immunosuppressed.
Immuno-suppressed / When the body’s immune function is damaged and incapable of performing its normal functions.
Implementation / The phase of the programme cycle where specific action steps are taken in an attempt to reach a specific goal, such as the implementation of ARV prophylaxis to reduce PMTCT.
In utero / Refers to events that occur in the uterus (womb) during pregnancy.
Income Generating Activity / Term referring to livelihoods, or an initiative that affects the economic aspects of people's lives through the use of economic tools such as credit.
Indicators / Measures used to describe a situation. They provide information on the status of activities related to each step of the PMTCT programme cycle.
Infant who is HIV-exposed / Infant born to a mother infected with HIV, and exposed to HIV through pregnancy, in childbirth, or during breastfeeding.
Infection / Invasion and growth of germs in the body.
Information, Education and Communication
/ One strategy of Malawi’s HIV response. IEC attempts to change or reinforce a set of behaviours in a "target population" regarding a specific problem, for example adoption of safer sexual behaviours and acceptance of PMTCT services. IEC strategies help to foster positive health practices to contribute to a reduction in the number of new cases of HIV.
Integrated Management of Childhood Illness / IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
Intermittent Presumptive Treatment for Malaria / Intermittent presumptive treatment (IPT) in pregnancy involves giving a curative treatment dose of an effective antimalarial drug at predefined intervals during pregnancy.
Intervention / An action or strategy to address a particular problem or issue and to accomplish a specific result.
Intrapartum / Occurring during labour and delivery (childbirth).
Intrauterine Contraceptive Device / A device inserted into the uterus (womb) to prevent conception (pregnancy). The IUD can be a coil, loop, triangle, or T-shape. It can be plastic or metal.
Insecticide-Treated Bed net / A bed net that has been treated with insecticide to protect against mosquitoes and malaria. ITNs have been shown to reduce morbidity and mortality from malaria substantially.
Lymphadenopathy / A swelling of the lymph glands in the body. The most common areas of swelling with HIV infection are the neck, under the arms, and in the groin.
Lymphocyte / A type of white blood cell, produced in the lymphoid organs that is primarily responsible for immune responses. Present in the blood, lymph and lymphoid tissues.
Male condom / A sheath that is worn over the penis during sexual intercourse (vagina, oral or anal)in order to prevent pregnancy or spread of sexually transmitted infections.
Mastitis / An inflammation of the breast. It is a condition that commonly results from inadequate or poor drainage of milk from the breast. Mastitis can be infective or noninfective in origin.
Medication adherence / Taking medicine exactly as recommended by a healthcare provider without missing doses.
Mixed Feeding / Whenan infant who is breastfed is given other liquids such as water, tea, formula, cow’s milk or foods such as porridge or rice during the first six months of life.
Monitoring / Monitoring is routine tracking of key parts of a programme using recordkeeping and regular reporting.

Mother-to-child transmission

of HIV / Transmission of HIV from a woman infected with HIV to her child during pregnancy, childbirth, and breastfeeding. Also referred to as vertical transmission or perinatal transmission.
Mycobacterium Avium Complex / Organisms that invade the intestines (gut) and other organs.
Nevirapine / A non-nucleoside reverse transcriptase inhibitor (NNRTI), used for PMTCT prophylaxis and (in combination with other drugs) ARV therapy. As prophylaxis or therapy, thedrug is effective in preventing HIV transmission from mothers to infants and is widely used in Malawibecause of ease of use and low cost; Viramune (trade name).
Oesophagitis / An infection or inflammation of the oesophagus.
Opportunistic infection / A disease caused by a microorganism that does not normally cause illness in a person with a healthy immune system, but that may cause serious disease when the immune system is weakened. Often referred by the more general term “HIV-related condition”.
Opt-in approach or strategy / An approach or strategy to HIV testing in which after receiving pre-test information, the client is given the choice of refusing or consenting to an HIV test. Only women who specifically request to be tested or “opt-in” are tested, and their informed consent—written or verbal—must be clearly given or stated. The opt-in approach requires an active step by the individual client to agree to be tested. (Also referred to as client initiated HIV testing and counselling.)
Opt-out strategy / An approachor strategy to HIV testing in which all women receive HIV testing and counselling unless they specifically decline to be tested or “opt-out”. HIV testing is offered as a routine part of standard care much like syphilis screening. Information may be provided individually, as in pre-test counselling, or in a group. The opt-out approach emphasizes that HIV testing is an expected part of care. However, testing is still voluntary under the opt-out approach—the client has a right to decline testing. (Also referred to as provider initiated HIV testing and counselling.)
Oral polio vaccine / Polio vaccine protects people against polio. There are two types of polio vaccine: Inactivated polio vaccine, called IPV, which is given as a shot (the polio virus used in this vaccine is killed); and live oral polio vaccine, called OPV, which is a liquid that is swallowed (the virus used in this vaccine is attenuated or weakened). Both OPV and IPV can protect against polio.
Oral thrush / A fungal infection of the mouth that looks like white patches or curdled milk.
Output indicators / Evidence of programme results, such as the number of people trained.
Pandemic / A disease occurring over a wide geographic area and affecting an exceptionally high proportion of the population, e.g., malaria, HIV.
Perinatal transmission / See Mother-to-Child Transmission of HIV; Also known as vertical transmission.
Persistent Generalised Lymphadenopathy / Chronic, diffuse, noncancerous lymph node enlargement. PGL in HIV infection is a condition in which lymph nodes are chronically swollen in at least two areas of the body for 3 months or more with no obvious cause other than the HIV infection.

Platelet / A type of blood cell (thrombocyte) that promotes blood clotting. Also see Thrombocytopoenia.
Pneumocystis
Pneumonia / A severe, life-threatening lung infection caused by Pneumocystisjiroveci[1] that causes fever, dry cough, and difficulty breathing. PCP is a major cause of illness and death in persons with impaired immune systems.
Polymerase Chain Reaction / A viral assay (test) that detects the presence or the amount of a virus in the blood. For HIV, the DNA-PCR indicates the presence of the virus. The HIV RNA-PCR measures the amount of virus, often referred to as the viral load.
Post-exposure prophylaxis / Short-term use of ARV drugs following occupational exposure such as a percutaneous injury (e.g., needle stick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids containing visible blood to reduce the likelihood of infection.
PEP is a key part of a compressive Universal Precautions strategy for reducing exposure to infectious agents in the workplace.