The Continuum of Care for Zika-affected Children and Families

The good news is that there was a dramatic reduction in the number of Zika infections in 2017. The bad news? Zika is unlikely to disappear, and health systems across the Americas are still woefully unprepared to deal with the virus and its consequences.

A key challenge is the provision of high-quality, patient-centered care and support – medical, psycho-emotional, and social – for children and families affected by Zika, a challenge that continues to evolve as the initial cohort of Zika-affected babies begins to age.

As a first step to providing care, health systems must be able to identify children presenting with microcephaly, a potential birth defect associated with Zika infection during pregnancy, or any other detectable abnormality associated with the virus. A baseline assessment conducted by URC’s ASSIST Project in the Dominican Republic, El Salvador, Guatemala, and Honduras found that fewer than 30 percent of newborns were being properly evaluated for microcephaly. To complicate matters, new research shows that some babies exposed to Zika in utero can appear healthy at birth and then develop problems and developmental issues as they age. Comprehensive medical and developmental follow-up is essential for all infants exposed to Zika virus prenatally.

Health systems also must remain focused on continued prevention efforts. ASSIST’s baseline data shows that fewer than one in five women are aware that Zika can be sexually transmitted, and health providers have admitted that discussing and recommending use of condoms is a challenging conversation to have with pregnant women.

ASSIST is working with targeted facilities in the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Paraguay to build the capacity of health practitioners to identify problems and make changes to improve:

  • Zika-related services in antenatal care including prevention
  • Newborn screening for congenital Zika syndrome and initial care
  • Care and support for affected infants, including psycho-emotional support for mothers and families

ASSIST-supported clinic-level quality improvement teams continue to strengthen the delivery of Zika services. One method showing success is the use of video communication technology patterned on the Project ECHO (Extension for Community Healthcare Outcomes) model of care to provide local clinicians with mentoring via video. The mentoring via video allows clinicians to access the knowledge and support they need to manage patients with complex conditions.

ASSIST will continue to support and expand health system capacities to prevent and manage complications of Zika virus and work to mitigate the devastating medical and psycho-emotional consequences of the outbreak.

 

A family from the municipality of Palín in Escuintla, Guatemala whose daughter Dulce was born with congenital Zika syndrome with microcephaly. ASSIST staff work with local health facilities to ensure Dulce and her family receive the care they need. Credit: Amalia Lima, Director of Health Center in Palín
A family from the municipality of Palín in Escuintla, Guatemala whose daughter Dulce was born with congenital Zika syndrome with microcephaly. Credit: Amalia Lima, Director of Health Center in Palín.
Date 
January 31, 2018
Authors 
Alison Lucas, Jorge Hermida