The Continuum of Care for Zika

Alison Lucas

Knowledge Management and Communications Specialist, USAID ASSIST Project/URC

Jorge Hermida

Senior QI Advisor, MNCH, and Latin America Regional Director, USAID ASSIST Project/URC

In 2016, scientists confirmed the link between Zika infection during pregnancy and severe birth complications, most notably microcephaly.  Thankfully, cases of Zika infection in Latin America and the Caribbean dropped dramatically in 2017; however, Zika is unlikely to ever disappear completely from the region.

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 first generation of Zika-affected babies begins to age.

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.

As a first step to providing care, health systems must be able to identify children with the symptoms of microcephaly, a potential birth defect associated with Zika infection during pregnancy, or any other detectable abnormality associated with the virus. The USAID ASSIST Project found that fewer than 30 percent of newborns were being properly evaluated for microcephaly in a baseline assessment conducted in the Dominican Republic, El Salvador, Guatemala, and Honduras in January through March 2017.

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 with prenatal exposure to Zika virus.

Health systems also must remain focused on continued prevention efforts. ASSIST’s baseline data from the four countries show that fewer than one in ten women are aware that Zika can be sexually transmitted.  Health providers have admitted that discussing and recommending condom use 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 help health practitioners learn to identify gaps in meeting standards of care and make changes to improve:

  • Zika-related services in antenatal care including prevention;
  • Newborn screening for congenital Zika syndrome and initial care; and
  • 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 intervention showing success is the use of mentoring local clinicians through video communication technology, a method shown to be effective by the University of New Mexico’s Project ECHO (Extension for Community Healthcare Outcomes). The mentoring through 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.

Learn more about ASSIST's work in Zika.

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