Interventions for Congenital anomalies

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Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit, vitamins and minerals particularly folic acid, and maintain a healthy weight Educating and counselling parents and community on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications	Adequate dietary intake of vitamins and minerals, folic acid, variety of vegetables and fruit and maintain a healthy weight for adolescent’s girls and mothers Avoid harmful substances, particularly alcohol and tobacco during pregnancy Ensure avoidance of travel by pregnant women (and sometimes women of childbearing age) to regions experiencing outbreaks of infections known to be associated with birth defects, Reduce or eliminating environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy, Measles-rubella (MR) vaccine Screening and treatment of infections, especially rubella, varicella and syphilis	Recognition of congenital heart anomalies signs and symptoms	Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Physical rehabilitation Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications
Primary Care
Raise awareness on the importance of birth defects as a cause of child morbidity and mortality Educate adolescent girls and mothers on healthy diet and consumption of foods rich in natural folates Information education and communication on harmful substances, particularly alcohol and tobacco Education to minimize exposure of pregnant women and workers in their workplace to risk factors for congenital anomalies (chemical, physical and biological Promote the use of iodized salt	Folic acid/multiple micronutrient supplementation in early pregnancy * Measles-rubella (MR) vaccine Avoiding teratogenic medications during pregnancy New born screening for congenital abnormalities	Clinician suspicion Pulse oximeter	Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Physical rehabilitation Occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: General
Raise awareness of health professionals on the importance of new born screening for early identification of infants born with congenital birth defects	Folic acid/multiple micronutrient supplementation during pregnancy Appropriate use of fortified foods Measles-rubella (MR) vaccine * Avoiding teratogenic medications during pregnancy Screening and treatment of syphilis in pregnant women Preconception care; hypothyroidism management, obesity control, chronic diseases e.g. diabetes, epilepsy control, hepatitis B vaccination and glycaemic control	Clinical suspicion Pulse oximeter Chest radiograph Ultrasonography (pre and post-natal) Electrocardiogram (ECG) Echocardiography	Antihypertensive Diuretics Anti-arrhythmia Early screening for early correction Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: Specialist
Raise awareness of health professionals on the importance of new born screening for early identification of infants born with congenital birth defects	Correction of some endocrine and metabolic abnormalities such as diabetes, hypothyroidism before conception Avoiding teratogenic medications during pregnancy Genetic testing and counselling for families at risk	Clinical suspicion Pulse oximeter Chest radiograph Ultrasonography (pre and post-natal) Electrocardiogram (ECG or EKG) Echocardiography Cardiac catheterization Heart magnetic resonance imaging (MRI) Chromosomal studies Genomic microarray	Corrective/plastic surgery with good follow up care (e.g.congenital heart defects, NTD, congenital talipes, cleft lip, cleft palate etc) Screening of newborn for certain metabolic, hematologic and endocrine disorders Management of newborns for certain metabolic, hematologic and endocrine disorders	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers have a healthy diet including a wide variety of vegetables, fruits, vitamins and minerals particularly folic acid and maintain a healthy weight Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications or medical radiation Train community health workers in promoting prevention and early identification of congenital anomalies	Ensure adolescent girls and mothers have a healthy diet including a wide variety of vegetables, fruits, vitamins and minerals including folic acid and maintain a healthy weight Avoidance of harmful substances, particularly alcohol and tobacco Avoidance of travel by pregnant women (and sometimes women of childbearing age) to regions experiencing outbreaks of infections known to be associated with birth defects Reduce or eliminate environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy Vaccination, especially against the rubella virus, for children and women		Early identification of congenital abnormalities and referral		Physical therapy, speech therapy, occupational therapy and support from families and community.
Primary Care
Train health staff and others involved in promoting prevention of congenital anomalies	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception * Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Early identification and referral
Referral Facility: General
Train health staff and others involved in promoting prevention of congenital anomalies;	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Medical treatment for some metabolic, endocrine and haematological conditions e.g.congenital hypothyroidism Early screening for early correction (e.g. congenital hearing loss, congenital cataract, etc.)		Physical therapy, speech therapy, occupational therapy and support from families and community.
Referral Facility: Specialist
Train health staff and others involved in promoting prevention of congenital anomalies	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Surgery with good follow up care (e.g., congenital heart defects, congenital talipes, cleft lip/palate) Screening of newborn for certain metabolic, hematologic and endocrine disorders

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers have a healthy diet including a wide variety of vegetables, fruits, vitamins and minerals particularly folic acid and maintain a healthy weight. Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications or medical radiation	Ensure mothers have a healthy diet including a wide variety of vegetables, fruits, vitamins and minerals including folic acid and maintain a healthy weight Avoidance of harmful substances, particularly alcohol and tobacco Avoidance of travel by pregnant women (and sometimes women of childbearing age) to regions experiencing outbreaks of infections known to be associated with birth defects Reduce or eliminate environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy Vaccination: Rubella for women		Early identification of congenital abnormalities and referral
Primary Care
	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception * Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Early identification and referral
Referral Facility: General
	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Medical treatment for some metabolic, endocrine and haematological conditions e.g., congenital hypothyroidism Screening for any congenital abnormalities		Physical therapy, speech therapy, occupational therapy and support from families and community.
Referral Facility: Specialist
	Folic acid supplementation in early pregnancy Correction of maternal iodine deficiency before conception Screening all women of childbearing age for rubella antibodies before conception Measles-mumps-rubella (MMR) vaccine Primary prevention of maternal infection with herpes simplex virus and Toxoplasma gondii to prevent mother-to-child transmission Avoiding teratogenic medications during pregnancy		Surgery with good follow up care for adult congenital heart disease (ACHD) Screening of metabolic, hematologic and endocrine disorders,		Physical therapy, speech therapy, occupational therapy and support from families and community.

Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit, vitamins and minerals particularly folic acid; and maintain a healthy weight Educating and counselling parents and community on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications	Adequate dietary intake of vitamins and minerals, folic acid, variety of vegetables and fruit and maintain a healthy weight for adolescent’s girls and mothers Avoid harmful substances, particularly alcohol and tobacco during pregnancy Ensure avoidance of travel by pregnant women (and sometimes women of childbearing age) to regions experiencing outbreaks of infections known to be associated with birth defects Reduce or eliminating environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy Measles-rubella (MR) vaccine Screening and treatment of infections, especially rubella, varicella and syphilis	Recognition of congenital heart anomalies signs and symptoms	Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Physical rehabilitation Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications
Primary Care
Raise awareness on the importance of birth defects as a cause of child morbidity and mortality Educate adolescent girls and mothers on healthy diet and consumption of foods rich in natural folates Information education and communication on harmful substances, particularly alcohol and tobacco Education to minimize exposure of pregnant women and workers in their workplace to risk factors for congenital anomalies (chemical, physical and biological Promote the use of iodized salt	Folic acid/multiple micronutrient supplementation in early pregnancy * Measles-rubella (MR) vaccine Avoiding teratogenic medications during pregnancy New born screening for congenital abnormalities	Clinician suspicion Pulse oximeter	Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Physical rehabilitation Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications
Referral Facility: General
Raise awareness of health professionals on the importance of new born screening for early identification of infants born with congenital birth defects	Folic acid/multiple micronutrient supplementation during pregnancy Appropriate use of fortified foods Measles-rubella (MR) vaccine Avoiding teratogenic medications during pregnancy Screening and treatment of syphilis in pregnant women Preconception care: hypothyroidism management, obesity control, chronic diseases e.g. diabetes, epilepsy control, hepatitis B vaccination and glycaemic control	Clinical suspicion Pulse oximeter Chest radiograph Ultrasonography (pre and post-natal) Electrocardiogram (ECG or EKG) Echocardiography	Antihypertensive Diuretics Anti-arrhythmia Early screening for early correction Immediate transfer of suspected congenital heart anomalies to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: Specialist
	Correction of some endocrine and metabolic abnormalities such as diabetes, hypothyroidism before conception Avoiding teratogenic medications during pregnancy Genetic testing and counselling for families at risk	Clinical suspicion Pulse oximeter Chest radiograph Ultrasonography (pre and post-natal) Electrocardiogram (ECG or EKG) Echocardiography Cardiac catheterization Heart magnetic resonance imaging (MRI) Chromosomal studies Genomic microarray	Antihypertensive Diuretics Anti-arrhythmia Cardiac catheterization Balloon valvuloplasty Heart surgery Heart transplant Foetal cardiac intervention Prophylactic antibiotics	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones