from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH, WD_BREAK
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()
sec = doc.sections[0]
sec.left_margin = sec.right_margin = Inches(1)
sec.top_margin = sec.bottom_margin = Inches(1)

st = doc.styles["Normal"]
st.font.name = "Times New Roman"
st.element.rPr.rFonts.set(qn("w:eastAsia"), "Times New Roman")
st.font.size = Pt(12)
st.paragraph_format.line_spacing = 1.5
st.paragraph_format.space_after = Pt(6)

for name, size in (("Heading 1", 15), ("Heading 2", 13)):
    h = doc.styles[name]
    h.font.name = "Times New Roman"
    h.element.rPr.rFonts.set(qn("w:eastAsia"), "Times New Roman")
    h.element.rPr.rFonts.set(qn("w:ascii"), "Times New Roman")
    h.element.rPr.rFonts.set(qn("w:hAnsi"), "Times New Roman")
    h.font.size = Pt(size)
    h.font.bold = True
    h.font.color.rgb = RGBColor(0, 0, 0)
    h.paragraph_format.space_before = Pt(12)
    h.paragraph_format.space_after = Pt(6)
    h.paragraph_format.keep_with_next = True


def H1(t):
    doc.add_heading(t, level=1)


def H2(t):
    doc.add_heading(t, level=2)


def P(t, bold_lead=None):
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    if bold_lead:
        r = p.add_run(bold_lead)
        r.bold = True
    p.add_run(t)
    return p


def B(items, style="List Bullet"):
    for it in items:
        p = doc.add_paragraph(style=style)
        p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
        p.paragraph_format.space_after = Pt(2)
        if isinstance(it, tuple):
            r = p.add_run(it[0])
            r.bold = True
            p.add_run(it[1])
        else:
            p.add_run(it)


def shade(cell, color):
    tcPr = cell._tc.get_or_add_tcPr()
    shd = OxmlElement("w:shd")
    shd.set(qn("w:val"), "clear")
    shd.set(qn("w:color"), "auto")
    shd.set(qn("w:fill"), color)
    tcPr.append(shd)


def T(header, rows, widths=None, caption=None):
    if caption:
        c = doc.add_paragraph()
        c.paragraph_format.keep_with_next = True
        r = c.add_run(caption)
        r.bold = True
        r.font.size = Pt(11)
    t = doc.add_table(rows=1, cols=len(header))
    t.style = "Table Grid"
    t.alignment = WD_TABLE_ALIGNMENT.CENTER
    for i, h in enumerate(header):
        cell = t.rows[0].cells[i]
        cell.text = ""
        r = cell.paragraphs[0].add_run(h)
        r.bold = True
        r.font.size = Pt(11)
        shade(cell, "D9D9D9")
    for row in rows:
        cells = t.add_row().cells
        for i, v in enumerate(row):
            cells[i].text = ""
            r = cells[i].paragraphs[0].add_run(v)
            r.font.size = Pt(11)
    for row in t.rows:
        for i, cell in enumerate(row.cells):
            for p in cell.paragraphs:
                p.paragraph_format.line_spacing = 1.15
                p.paragraph_format.space_after = Pt(2)
            if widths:
                cell.width = Inches(widths[i])
    doc.add_paragraph().paragraph_format.space_after = Pt(2)


def center(t, size=12, bold=False, after=6):
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    p.paragraph_format.space_after = Pt(after)
    r = p.add_run(t)
    r.bold = bold
    r.font.size = Pt(size)
    return p


# footer page number
fp = sec.footer.paragraphs[0]
fp.alignment = WD_ALIGN_PARAGRAPH.CENTER
run = fp.add_run()
for tag, txt in (("begin", None), (None, "PAGE"), ("end", None)):
    if tag:
        e = OxmlElement("w:fldChar")
        e.set(qn("w:fldCharType"), tag)
    else:
        e = OxmlElement("w:instrText")
        e.set(qn("xml:space"), "preserve")
        e.text = txt
    run._r.append(e)

# ---------------- Title page ----------------
for _ in range(5):
    doc.add_paragraph()
center("ASSIGNMENT", 14, True, 18)
center("NEWBORN FOLLOW-UP AFTER DISCHARGE", 22, True, 6)
center("A Public Health Perspective", 16, False, 30)
center("Subject: Community Health / Preventive and Social Medicine", 12)
center("Topic: Follow-up of the newborn after discharge from a health facility", 12, False, 40)
center("Name: ______________________________", 12)
center("Class / Roll No.: ____________________", 12)
center("Submitted to: ________________________", 12)
center("Date: _______________________________", 12, False, 40)
center("Main references: Park's Textbook of Preventive and Social Medicine; Textbook of Family Medicine, 9th edition", 11)
doc.add_page_break()

# ---------------- Contents ----------------
H1("Contents")
for line in [
    "1. Introduction",
    "2. Definitions and Magnitude of the Problem",
    "3. Rationale for Follow-up After Discharge",
    "4. Criteria for Discharge from the Facility",
    "5. Follow-up in the Public Health System in India",
    "6. Content of a Follow-up Visit",
    "7. Danger Signs and Referral",
    "8. Facility or Clinic Based Follow-up",
    "9. Follow-up of High-risk Newborns",
    "10. Health Education and Anticipatory Guidance",
    "11. Role of the Health Team, Recording and Supervision",
    "12. Challenges and Recommendations",
    "13. Recent Evidence",
    "14. Conclusion",
    "References",
]:
    p = doc.add_paragraph(line)
    p.paragraph_format.space_after = Pt(2)
doc.add_page_break()

# ---------------- 1 ----------------
H1("1. Introduction")
P("The first 28 days of life, the neonatal period, are the most vulnerable time for a child's survival. Park's Textbook of Preventive and Social Medicine states that focusing on newborns is essential if progress in under-five mortality is to continue. A large share of these deaths occurs in the first week of life, and many babies are discharged from hospital or born at home during exactly this period. Care that stops at the hospital door therefore leaves the newborn exposed at the time of highest risk.")
P("Newborn follow-up after discharge means planned, repeated contact between the health system and the baby and mother after leaving the delivery facility or special care unit. The contact may be a home visit by a community health worker or a scheduled visit to a clinic. Its purposes are to confirm that the baby is feeding, gaining weight and keeping warm, to detect illness early, to support the mother, to complete immunisation and screening, and to refer promptly when needed.")
P("In public health terms, follow-up is the link between institutional care and community care. Park's textbook stresses that the strategy of universal access to home based newborn care must complement the strategy of institutional delivery if a significant reduction in postpartum and neonatal mortality and morbidity is to be achieved. This assignment describes the rationale, the criteria for safe discharge, the national home visit schedule, the content of each visit, the recognition of danger signs, the follow-up of high-risk babies, and the roles of the health team.")

# ---------------- 2 ----------------
H1("2. Definitions and Magnitude of the Problem")
H2("2.1 Key definitions")
B([
    ("Neonatal period: ", "the period commencing at birth and ending 28 completed days after birth."),
    ("Early neonatal period: ", "the first 7 days of life. The late neonatal period is day 8 to day 28."),
    ("Neonatal mortality rate (NMR): ", "the number of deaths of children under 28 days of age in a year, divided by the total live births in the same year, multiplied by 1000 (Park's Textbook of Preventive and Social Medicine)."),
    ("Low birth weight (LBW): ", "birth weight below 2500 g, irrespective of gestational age."),
    ("Follow-up: ", "any planned contact with the newborn and mother after discharge or home delivery, for assessment, support and referral."),
])
H2("2.2 Causes of neonatal death")
P("Park's textbook explains that neonatal mortality reflects the intensity with which endogenous factors such as low birth weight and birth injuries affect infant life, and that it is directly related to birth weight and gestational age. Intrapartum related complications, low birth weight and preterm birth are causal factors in about 60 per cent of neonatal deaths. Prematurity and congenital anomalies account for about 60 per cent of newborn deaths, which often occur in the first week. A further quarter of neonatal deaths are attributed to asphyxia, again mainly in the first week. After the first week, deaths due to infection, including diarrhoea and tetanus, predominate, although tetanus has diminished sharply because of intensified immunisation.")
P("Park's textbook also records that neonatal mortality among babies of mothers with no education is nearly twice as high as among babies of mothers with secondary or higher education, and that family wealth is associated with survival. Follow-up services must therefore be designed to reach the poor, the uneducated and the remote first.")
T(["Period", "Main causes of death", "Implication for follow-up"],
  [["Early neonatal (day 0 to 7)", "Prematurity, low birth weight, congenital anomalies, asphyxia, early sepsis", "Earliest possible visit, warmth, feeding support, identification of high-risk babies"],
   ["Late neonatal (day 8 to 28)", "Infections including sepsis, pneumonia, diarrhoea, tetanus", "Repeat visits, danger sign checks, hygiene and cord care, immunisation"]],
  widths=[1.6, 2.5, 2.4], caption="Table 1. Timing of neonatal deaths and the implication for follow-up")

# ---------------- 3 ----------------
H1("3. Rationale for Follow-up After Discharge")
P("The reasons for organised follow-up can be grouped as follows.")
B([
    ("Early discharge is common. ", "The Textbook of Family Medicine notes that most mother and newborn pairs meet discharge criteria after 48 hours of care. Problems such as jaundice, poor feeding and dehydration often appear after the family reaches home."),
    ("Jaundice is the commonest cause of readmission. ", "The Textbook of Family Medicine states that hyperbilirubinaemia is the most common cause of readmission to hospital, so the early follow-up visit must reassess the baby for jaundice."),
    ("Feeding is established at home. ", "Milk production is established in the first 2 to 4 days and increases markedly on days 3 to 5, so support is most useful in this window."),
    ("Home deliveries and early discharge leave no facility contact. ", "Where delivery occurs at home, the community health worker is the only contact the newborn may have."),
    ("Infection is preventable. ", "Cord care, hand washing, warmth and exclusive breastfeeding are practical measures that the family can apply when taught and reinforced."),
    ("Screening and immunisation must be completed. ", "Newborn screening, hearing screening and the birth doses of vaccines are time-bound."),
    ("The mother needs care too. ", "Postpartum complications and postpartum depression are detected through the same visits."),
])

# ---------------- 4 ----------------
H1("4. Criteria for Discharge from the Facility")
P("Safe follow-up starts with safe discharge. The Textbook of Family Medicine (p. 537) states that discharge optimally occurs when the newborn has been observed long enough to identify medical problems and when the family is able and prepared to care for the baby at home. If either mother or baby needs a longer stay, every effort should be made to keep them together to promote bonding.")
T(["Domain", "Criterion before discharge of a healthy term newborn"],
  [["Stability", "Normal and stable vital signs for at least 12 hours, including a normal temperature in an open crib"],
   ["Elimination", "Has urinated and passed stool at least once"],
   ["Feeding", "Has fed successfully at least twice; feeding observed to confirm coordination of sucking, swallowing and breathing, and a good latch if breastfed"],
   ["Family readiness", "Parents given appropriate anticipatory guidance and able to care for the baby"],
   ["Follow-up", "Follow-up scheduled with a medical home within 2 to 3 days after discharge"]],
  widths=[1.5, 5.0], caption="Table 2. Discharge criteria for a healthy term newborn (Textbook of Family Medicine, 9th ed.)")
H2("4.1 Discharge from a Special Newborn Care Unit (SNCU)")
P("Park's textbook lists the criteria for discharge from an SNCU. The newborn should be able to maintain temperature without a radiant warmer, be haemodynamically stable with normal capillary filling time and a strong peripheral pulse, accept breast feeds well, have documented weight gain for 3 consecutive days with weight above 1.5 kg, and have the primary illness resolved. In addition, the mother should be confident of taking care of the newborn at home.")
P("A baby who leaves an SNCU is a high-risk child. The follow-up plan, including the date of the first home visit and the date of review at the facility, must be written and explained to the family before the baby leaves.")

# ---------------- 5 ----------------
H1("5. Follow-up in the Public Health System in India")
H2("5.1 Home Based Newborn Care (HBNC)")
P("Park's textbook describes HBNC as a strategy aimed at improving newborn survival. The providers of service include the anganwadi worker, ANM, ASHA and the medical officer, but the ASHA is the main person involved.")
P("The major objective of HBNC is to decrease neonatal mortality and morbidity through the following:")
B([
    "Provision of essential newborn care to all newborns and prevention of complications.",
    "Early detection and special care of preterm and low birth weight newborns.",
    "Early identification of illness in the newborn and provision of appropriate care and referral.",
    "Support to the family for adoption of healthy practices, and building the confidence and skills of the mother to safeguard her health and that of the newborn.",
], style="List Number")
H2("5.2 Responsibilities of the ASHA")
P("According to Park's textbook (pp. 520 to 521), the ASHA is responsible for the following tasks.")
B([
    "Mobilising pregnant women for full antenatal care, and undertaking birth planning and birth preparedness with the mother and family.",
    "Providing newborn care through a series of home visits, including weighing the newborn, measuring temperature, ensuring warmth, supporting exclusive breastfeeding through correct positioning and attachment, diagnosing and counselling for breastfeeding problems, promoting hand washing, and providing skin, cord and eye care.",
    "Health promotion and counselling on key newborn care messages, including discouraging unhealthy practices such as early bathing and bottle feeding.",
    "Ensuring prompt identification of sepsis or other illness.",
    "Assessing whether the baby is high risk (preterm or low birth weight) and managing such babies by increasing the number of home visits, monitoring weight gain, and supporting the mother to keep the baby warm and breastfeed frequently and exclusively.",
    "Detecting signs and symptoms of sepsis, giving first level care and referring to an appropriate centre. If the family cannot go, the ASHA ensures that the ANM visits the sick newborn on priority.",
    "Recognising postpartum complications in the mother and referring appropriately.",
    "Counselling the couple on family planning.",
    "Providing immediate newborn care for deliveries that do not occur in institutions, including home deliveries and deliveries on the way to a facility.",
])
H2("5.3 Schedule of home visits")
P("The ASHA visits all newborns up to 42 days of life according to a fixed schedule (Park's Textbook of Preventive and Social Medicine).")
T(["Situation", "Number of visits", "Days of visit"],
  [["Institutional delivery", "6", "Day 3, 7, 14, 21, 28 and 42"],
   ["Home delivery", "7", "Day 1, 3, 7, 14, 21, 28 and 42"],
   ["Caesarean section, mother returns home after 5 to 6 days", "5", "Day 7, 14, 21, 28 and 42"],
   ["Discharged from SNCU", "Remaining visits of the schedule, plus monthly follow-up", "Monthly follow-up of SNCU discharged babies for one year"],
   ["Low birth weight baby", "6 (ANM schedule) with monthly ASHA follow-up", "Day 0, 3, 7, 14, 21 and 28; monthly follow-up for two years"]],
  widths=[2.4, 1.8, 2.3], caption="Table 3. HBNC visit schedule")
P("The ASHA receives an incentive of Rs. 250 for completing the visits. Park's textbook adds that an additional Rs. 50 is paid for monthly follow-up of low birth weight babies and SNCU discharged babies, that the incentive doubles for twins and triples for triplets, and that where a woman delivers at her mother's house and then moves, two ASHAs may share the visits and the incentive. The incentive is paid on the 45th day, subject to the following conditions:")
B([
    "Record of birth weight in the mother and child protection card.",
    "Immunisation of the newborn with BCG, first dose of OPV, hepatitis B and DPT/pentavalent vaccine, with entry in the mother and child protection card.",
    "Registration of birth.",
    "Both mother and newborn are safe until the 42nd day after delivery.",
])
P("These conditions link payment to outcomes that matter to public health: weight recorded, vaccines given, birth registered and survival to 42 days.")
H2("5.4 Postnatal visits by the ANM")
P("The duties of the female health worker (ANM) listed in Park's textbook include tracking all pregnancies by name for scheduled antenatal and postnatal services, and making postnatal home visits on day 0, 3, 7 and 42 for deliveries at home and at the sub-centre, and on day 3, 7 and 42 for institutional deliveries. She gives advice on care of the mother and on care and feeding of the newborn. For a low birth weight baby, a total of six postnatal visits are made on day 0, 3, 7, 14, 21 and 28, to screen for congenital abnormalities, assess the neonate for danger signs as per the IMNCI guidelines, and refer appropriately. She also refers newborns with abnormalities, helps them obtain institutional care and provides follow-up to patients referred to or discharged from hospital.")
H2("5.5 Facility level services supporting follow-up")
P("Park's textbook lists the following essential services at the sub-centre and higher levels that support follow-up: a newborn care corner in the labour room, essential newborn care (maintaining body temperature and preventing hypothermia by warmth and Kangaroo Mother Care, maintaining the airway and breathing, initiating breastfeeding within one hour, infection protection, cord care and eye care), counselling on exclusive breastfeeding for 6 months, assessment of growth and development, full immunisation, vitamin A prophylaxis, name based tracking of infants, and identification, follow-up and reporting of adverse events following immunisation. Facility based units such as the newborn care corner, newborn stabilisation unit and special newborn care unit have improved the management of low birth weight babies.")
P("The Navjat Shishu Suraksha Karyakram (NSSK) trains health personnel in basic newborn care and resuscitation, with the objective of having a trained person at every delivery point. It addresses prevention of hypothermia, prevention of infection, early initiation of breastfeeding and basic newborn resuscitation, and so reduces the number of babies who reach follow-up already compromised.")

# ---------------- 6 ----------------
H1("6. Content of a Follow-up Visit")
P("Each contact, whether at home or in a clinic, follows a structured pattern: history, observation and examination, counselling, and decision. The ASHA tasks in Park's textbook and the assessment steps in the Textbook of Family Medicine together describe what is covered.")
H2("6.1 History")
B([
    "Feeding: frequency, duration, difficulty with latch, any bottle feeds or water given.",
    "Passage of urine and stool: number of wet diapers and the colour and consistency of stool.",
    "Sleep, activity, crying, any fever or cold feel, breathing difficulty, convulsion.",
    "Cord care practices and any application of substances to the cord or skin.",
    "Maternal health: bleeding, fever, breast problems, mood.",
])
H2("6.2 Observation and examination")
B([
    ("Weight: ", "weigh the baby and compare with birth weight. Weight loss is normal after delivery, and the expected loss is 5 to 7 per cent of birth weight. Healthy term infants usually stop losing weight by 5 days and typically regain birth weight by 2 weeks. After feeding is established, infants gain 15 to 30 g per day. A loss of more than 10 per cent is excessive. The AAP recommends prompt assessment of a breastfed infant with more than 7 per cent loss (Textbook of Family Medicine, pp. 537 to 538)."),
    ("Temperature: ", "measure and ensure warmth. Hypothermia and fever are both warning signs."),
    ("Length and head circumference: ", "measured and plotted on the growth curve at clinic visits."),
    ("Jaundice: ", "inspect in daylight. Infants with jaundice after the first week need total and direct bilirubin to exclude pathological causes."),
    ("Cord, skin and eyes: ", "look for redness, discharge or foul smell at the umbilicus, skin pustules and eye discharge."),
    ("Breastfeeding observation: ", "watch a full feed for positioning and attachment."),
])
H2("6.3 Expected voiding and stooling pattern")
P("The Textbook of Family Medicine gives a practical guide that the health worker can use to judge whether intake is adequate.")
T(["Age", "Expected output"],
  [["First 24 hours", "One void; meconium passed within the first 24 to 48 hours"],
   ["Second 24 hours", "Two or three voids"],
   ["Day 3 and 4", "Four to six voids; transitional stools by about day 3"],
   ["Day 5 onwards", "Six to eight voids; most infants have three or more yellow-green, soft stools a day"],
   ["Around 1 month", "Stool frequency may fall; some infants pass one stool a week. If feeding and urine output are good, this is normal"]],
  widths=[1.8, 4.7], caption="Table 4. Expected urine and stool pattern in the early weeks (Textbook of Family Medicine, 9th ed.)")
P("Fewer wet diapers, dark urine, delayed stooling or persistent dark stools after day 4 or 5 point to inadequate intake and require action, such as improving breastfeeding technique or referral.")
H2("6.4 Counselling and decision")
P("The visit ends with counselling on the specific problems found, a check that the mother can repeat the key messages, a decision on whether the baby can stay at home, needs more frequent visits, or must be referred, and an appointment for the next visit. The ASHA records the findings and the date of the next visit.")

# ---------------- 7 ----------------
H1("7. Danger Signs and Referral")
P("Recognising sepsis and other serious illness early is a core ASHA task in HBNC. Park's textbook directs the ASHA and ANM to assess the neonate for danger signs as per the IMNCI guidelines. The signs below follow the national IMNCI and HBNC guidance, which is widely taught, and are given here as general knowledge to complete the picture; the student should confirm the exact thresholds in the current national module.")
T(["Danger sign", "Action"],
  [["Not feeding well or has stopped sucking", "Refer urgently to the nearest facility with newborn care"],
   ["Convulsions", "Refer urgently; keep warm"],
   ["Fast breathing (60 or more breaths per minute) or severe chest indrawing", "Refer urgently"],
   ["Fever (about 37.5 C or above) or low temperature (below about 35.5 C)", "Warm the baby, continue breastfeeding on the way, refer"],
   ["Movement only on stimulation, lethargy or unconsciousness", "Refer urgently"],
   ["Yellow palms and soles, or jaundice in the first 24 hours", "Refer for bilirubin assessment and phototherapy"],
   ["Pus or redness spreading from the umbilicus, many skin pustules", "Give first level care and refer according to severity"],
   ["Weight loss above 10 per cent of birth weight or no weight gain", "Assess feeding, counsel, and refer if the problem persists"]],
  widths=[3.4, 3.1], caption="Table 5. Common newborn danger signs and the action by the community health worker")
P("Park's textbook states that if the family is unable to go for referral, the ASHA should ensure that the ANM visits the sick newborn on a priority basis. Follow-up of referred and discharged patients is part of the ANM's duties, which closes the loop between community and facility.")

# ---------------- 8 ----------------
H1("8. Facility or Clinic Based Follow-up")
P("Where a medical home or a primary health centre is available, clinic visits supplement home visits. The Textbook of Family Medicine recommends that all infants have follow-up scheduled within 2 to 3 days after discharge. The first visit in the primary care office occurs as early as 3 to 5 days of life. At this visit the provider repeats a comprehensive newborn examination and evaluates weight gain or loss, difficulty with feeding, abnormal voiding or stooling patterns, and jaundice. A second ambulatory visit is advised at 2 to 3 weeks of age to monitor weight gain and give additional support to the mother during this critical period.")
H2("8.1 Newborn screening")
P("The goal of newborn screening is to detect disease before the onset of symptoms so that early treatment can prevent complications. Screening programmes test for metabolic disorders, endocrinopathies, haemoglobinopathies, cystic fibrosis and immunodeficiencies. Blood is collected by heel prick between 24 and 48 hours of life, and some centres repeat the specimen at 10 to 14 days to reduce missed diagnoses (Textbook of Family Medicine). Screening availability varies between settings, and in India it is not universal, so the health worker should know what is offered locally and ensure the family receives results.")
H2("8.2 Hearing screening")
P("Hearing impairment occurs in approximately 1 to 3 per 1000 live births and affects language and social development. The recommendation is to screen all infants before 1 month of age, to complete audiological assessment by 3 months for those who fail, and to begin intervention by 6 months for those diagnosed with hearing loss. Otoacoustic emissions and auditory brainstem response are both appropriate; otoacoustic emissions are most often used because they are quick, easy and inexpensive and can be done while the infant is awake or asleep. Many centres use a two step approach, with an ABR following a failed OAE.")
H2("8.3 Immunisation")
P("The HBNC incentive conditions in Park's textbook confirm that BCG, the first dose of OPV, hepatitis B and the pentavalent vaccine should be given and entered in the mother and child protection card. Name based tracking of infants by the ANM helps to ensure that no child misses a dose. The follow-up visit is a convenient time to check the card and remind the family of the next date.")

# ---------------- 9 ----------------
H1("9. Follow-up of High-risk Newborns")
H2("9.1 Low birth weight and preterm babies")
P("Low birth weight babies need more frequent contact, and the HBNC strategy increases the number of home visits for them, monitors weight gain, and supports the mother and family to keep the baby warm and to feed frequently and exclusively. Park's textbook lists the leading causes of death in low birth weight babies as atelectasis, malformation, pulmonary haemorrhage, intracranial bleeding secondary to anoxia or birth trauma, and pneumonia and other infections. Infection presents the greatest hazard, and death may follow within hours of a respiratory infection.")
H2("9.2 Kangaroo Mother Care (KMC)")
P("Park's textbook describes KMC as introduced in Colombia in 1979 by Drs. Hector Martinez and Edzar Rey in response to high infection and mortality in overcrowded hospitals. It has since been adopted across the developing world and is an essential element in the continuum of newborn care. The four components, all essential, are:")
B([
    "Skin to skin positioning of the baby on the mother's chest.",
    "Adequate nutrition through breastfeeding.",
    "Ambulatory care as a result of earlier discharge from hospital.",
    "Support for the mother and family in caring for the baby.",
])
P("KMC is the practical method by which a family can keep a small baby warm at home. At each follow-up visit the health worker should check that skin to skin contact is continued for as many hours as possible and that the mother has support from family members.")
H2("9.3 SNCU graduates")
P("Babies discharged from an SNCU are followed with the HBNC visits and monthly follow-up for one year. Low birth weight babies are followed for two years (Park's Textbook of Preventive and Social Medicine). At these contacts the health worker checks growth, feeding, development, immunisation and any neurological or sensory concern, and arranges referral to specialist follow-up clinics for conditions such as retinopathy of prematurity or hearing loss.")
T(["Feature", "Normal term baby", "LBW or SNCU discharged baby"],
  [["Number of ASHA visits", "6 (institutional) or 7 (home delivery)", "Same schedule plus monthly follow-up"],
   ["Duration of follow-up", "42 days (then routine child health services)", "LBW 2 years; SNCU graduate 1 year"],
   ["Special focus", "Feeding, cord care, immunisation", "Warmth, KMC, weight gain, infection prevention, development"],
   ["Referral threshold", "Standard danger signs", "Lower; any poor weight gain or feeding difficulty"]],
  widths=[1.7, 2.4, 2.4], caption="Table 6. Follow-up of normal versus high-risk newborns")

# ---------------- 10 ----------------
H1("10. Health Education and Anticipatory Guidance")
P("Health education is the main tool of follow-up. Messages should be few, practical and repeated at each visit. The content below combines the HBNC messages in Park's textbook with the anticipatory guidance in the Textbook of Family Medicine.")
H2("10.1 Breastfeeding")
B([
    "Initiate breastfeeding within one hour of birth, and give nothing else. Exclusive breastfeeding is recommended for 6 months.",
    "Feed on demand and at early signs of hunger such as mouthing, rooting or increased alertness. Early feeding is typically every 2 to 3 hours, or 8 to 12 times in 24 hours.",
    "Offer both breasts at each feed and alternate which breast is offered first.",
    "Do not give water, glucose water or formula unless medically indicated. Discourage bottle feeding.",
    "Reassure that milk production depends on the infant's demand. Colostrum is received in the first 2 to 4 days.",
])
H2("10.2 Warmth and hygiene")
B([
    "Keep the baby warm, delay the first bath (park's HBNC messages discourage early bathing), and use skin to skin contact.",
    "Wash hands before handling the baby.",
    "Keep the umbilical cord clean and dry without repeated use of antiseptic agents or unclean applications.",
    "Care of the eyes and skin as demonstrated by the health worker.",
])
H2("10.3 Safety and sleep")
B([
    "Place infants on the back on a firm sleep surface to reduce the risk of sudden infant death syndrome.",
    "Avoid soft bedding, and avoid sharing a bed in unsafe conditions.",
    "Use a rear-facing car seat where cars are used (AAP recommendation until 2 years, per the Textbook of Family Medicine).",
])
H2("10.4 Nutrition supplements")
P("The Textbook of Family Medicine recommends vitamin D drops daily during the first 2 months for all breastfed infants. In India the national programme gives vitamin A prophylaxis later in infancy, as listed in Park's textbook.")
H2("10.5 Maternal care and family planning")
P("The follow-up visit should also cover the mother. The Edinburgh Postnatal Depression Scale is a validated tool to screen for postpartum depression, and the ASHA is trained to recognise postpartum complications and to counsel the couple on family planning. Healthy timing and spacing of pregnancies improves the survival of the next child as well.")

# ---------------- 11 ----------------
H1("11. Role of the Health Team, Recording and Supervision")
T(["Worker", "Role in newborn follow-up"],
  [["ASHA", "Home visits as per schedule, weighing, temperature, breastfeeding support, danger sign identification, first level care and referral, counselling, motivation for immunisation, record keeping"],
   ["Anganwadi worker", "Supports home based care, growth monitoring, nutrition counselling, supplementary nutrition"],
   ["ANM / female health worker", "Postnatal visits (day 0, 3, 7, 42; more for LBW), IMNCI assessment, immunisation, tracking, supervision of ASHA, priority visit to the sick newborn, follow-up of referred and discharged babies"],
   ["Medical officer", "Management of referred newborns, supportive supervision, ensuring newborn care corner and equipment, review of mortality"],
   ["Public health nurse / nursing staff", "Discharge teaching, linking the family with the ASHA and ANM, clinic follow-up, and records"]],
  widths=[1.8, 4.7], caption="Table 7. Roles of the health team in newborn follow-up")
H2("11.1 Records and tracking")
P("Recording the birth weight in the mother and child protection card, registering the birth, and maintaining name based tracking of pregnancies and infants are specific duties in Park's textbook. These records allow supervisors to identify babies who have missed visits and to calculate coverage of visits and of immunisation.")
H2("11.2 Indicators for monitoring")
B([
    "Percentage of newborns who received the first home visit within the specified day.",
    "Percentage of newborns who received all scheduled visits.",
    "Percentage of newborns with documented birth weight and immunisation.",
    "Percentage of sick newborns referred and reaching a facility.",
    "Neonatal mortality rate, which is the final outcome indicator.",
])

# ---------------- 12 ----------------
H1("12. Challenges and Recommendations")
H2("12.1 Challenges")
B([
    "Early discharge before feeding and jaundice are established, so that problems appear at home.",
    "Workload of the ASHA and ANM, and large catchment areas, which make timely visits difficult.",
    "Cultural practices such as early bathing, applying substances to the cord, pre-lacteal feeds and delayed breastfeeding.",
    "Delay in recognising danger signs by the family, and difficulty in transport for referral.",
    "Poor reach among the poor and the less educated, who carry the highest neonatal mortality.",
    "Incomplete records and limited supervision.",
    "Limited availability of newborn screening and hearing screening in public facilities.",
])
H2("12.2 Recommendations")
B([
    "Strengthen discharge counselling and give the family a written follow-up plan before leaving the facility.",
    "Share the delivery list with the ASHA and ANM so the first visit is not missed. Make the early visit routine at day 3, and day 1 for home births.",
    "Train and supervise ASHAs in measuring temperature, weighing, assessing breastfeeding and recognising sepsis.",
    "Prioritise high-risk babies such as LBW, preterm, SNCU graduates and babies of mothers with complications.",
    "Improve transport and referral linkages, and hold the ANM and medical officer accountable for sick newborns.",
    "Use community mobilisation and behaviour change communication to address harmful practices.",
    "Review every neonatal death to learn where the follow-up chain failed.",
])

# ---------------- 13 ----------------
H1("13. Recent Evidence")
P("A 2026 systematic review in the Journal of Global Health, titled \"Postnatal interventions to support newborn survival: updates for the Lives Saved Tool\" (PMID 42825351), examined postnatal interventions for newborn survival using randomised controlled trials. I could access only the citation details, not the full text, so I cannot report its estimates here. It supports the general principle in the textbooks that postnatal contact and care are evidence based means of reducing newborn deaths. A 2025 qualitative synthesis of postpartum women's experiences of postnatal care in sub-Saharan Africa (Birth, PMID 39417286) is also relevant to how families receive follow-up services. Students who wish to cite specific effect sizes should read the full papers.")

# ---------------- 14 ----------------
H1("14. Conclusion")
P("Newborn follow-up after discharge converts facility care into continuing protection at home. The neonatal period carries the highest risk to survival, and most deaths are linked to preterm birth, low birth weight, asphyxia and infection, which can be anticipated or detected with timely contact. Discharge should occur only when the baby is stable, feeding and eliminating, and the family is ready, with a visit planned within 2 to 3 days. In India the HBNC programme provides six or seven ASHA visits up to day 42, supported by ANM postnatal visits, with additional and longer follow-up for low birth weight and SNCU discharged babies.")
P("Each visit should assess weight, temperature, feeding, urine and stool pattern, jaundice, cord and skin, and should identify danger signs for urgent referral. Counselling on exclusive breastfeeding, warmth, hygiene, safe sleep and immunisation, together with attention to the mother, completes the package. The success of follow-up depends on trained and supervised workers, accurate records, working referral links and community acceptance. When these are in place, follow-up reduces neonatal mortality and morbidity and builds a sound start for the child's growth.")

# ---------------- References ----------------
H1("References")
refs = [
    "Park K. Park's Textbook of Preventive and Social Medicine. Sections: Neonatal Mortality Rate and Causes of Neonatal Mortality; Kangaroo Mother Care; Criteria for Discharge from SNCU; Home Based Newborn Care (HBNC), pp. 520 to 521; Navjat Shishu Suraksha Karyakram; Duties of Health Worker Female (ANM); Essential services at the sub-centre.",
    "Textbook of Family Medicine, 9th edition. Chapter on the newborn: Discharge from the Newborn Nursery, Care at the Primary Care Office, Assessment and Evaluation, Growth, Hyperbilirubinemia, Parental Education and Anticipatory Guidance, Breastfeeding, Newborn Screening and Hearing, pp. 537 to 538 and adjacent pages.",
    "Vaivada T, Tam Y, Dominguez G, et al. Postnatal interventions to support newborn survival: updates for the Lives Saved Tool. J Glob Health. 2026. PMID 42825351. doi:10.7189/jogh.16.04272.",
    "Moyo E, Moyo P, Dzinamarira T. Postpartum women's experiences of postnatal care in sub-Saharan Africa: a qualitative evidence synthesis. Birth. 2025. PMID 39417286.",
    "National Health Mission, India. Home Based Newborn Care Operational Guidelines (nhm.gov.in). Referred to for the HBNC visit and incentive structure, which is also described in Park's textbook.",
]
for i, r in enumerate(refs, 1):
    p = doc.add_paragraph(f"{i}. {r}")
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    p.paragraph_format.line_spacing = 1.15

doc.save("/tmp/workspace/newborn-followup/Newborn_Follow-Up_After_Discharge_Assignment.docx")
print("saved")