Cover Image
close this bookOral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 p.)
View the document(introduction...)
View the documentAcknowledgments
View the documentIntroduction
View the documentApproach to training
close this folderModule One: Climate setting and assessment
close this folderSession 1 - Diarrhea dialogue: Assessing our knowledge, needs and skills
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View the documentHandout 1A: Pre-test
View the documentHandout 1B: Training objectives
View the documentTrainer Attachment 1A: Pretraining questionnaire for volunteers
View the documentTrainer Attachment 1B: Pretraining questionnaire for counterparts
View the documentTrainer Attachment 1C: Trainer pretest guide
View the documentTrainer Attachment 1D: ORT Pretest answer sheet
close this folderSession 2 - Training program evaluation
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View the documentHandout 2A: Training evaluation
close this folderModule Two: Diarrhea, dehydration and rehydration
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close this folderSession 3 - Prevention and control of diarrheal diseases
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View the documentHandout 3A: Sanitation, water quality and the spread of disease
View the documentHandout 3B: Common causes of diarrhea
View the documentHandout 3C: Methods of controlling enteric diseases
View the documentHandout 3D: Water, excrete, behaviour and diarrhoea
View the documentHandout 3E: Primary health care
View the documentTrainer Attachment 3A: The global impact of diarrhea
View the documentTrainer Attachment 3B: A story about diarrhea
View the documentTrainer Attachment 3C: Suggestions for using the picture story
close this folderSession 4 - Dehydration assessment
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View the documentTrainer Attachment 4A: Pictures of children with signs of dehydration
View the documentTrainer Attachment 4B: Guidelines for presentation of the who diarrhea treatment chart
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View the documentTrainer Attachment 4D: Creating a case study
View the documentTrainer Attachment 4E: Adaptation of the treatment chart
close this folderSession 5 - Rehydration therapy
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View the documentHandout 5A: ORT preparation worksheet
View the documentTrainer Attachment 5A: Materials and equipment needed for ORT stations
View the documentTrainer Attachment 5B: Using models to show why rehydration is important
View the documentTrainer Attachment 5C: Suggestions for a lecturette on the hows and whys of ORS
View the documentTrainer Attachment 5D: Oral rehydration therapy: the scientific and technical basis
View the documentTrainer Attachment 5E: Storing and maintaining supplies of oral rehydration salts (ORS)
View the documentTrainer Attachment 5F: Oral rehydration with dirty water?
View the documentTrainer Attachment 5G: A pinch of salt' a handful of molasses...
View the documentTrainer Attachment 5H: Cautious prescription
close this folderSession 6 - Practicing ort in the village
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View the documentTrainer Attachment 6A: Problem situations - ORT in the home
close this folderModule Three: Nutrition and diarrhea
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close this folderSession 7 - Nutrition during and after diarrhea
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View the documentHandout 7A: The diarrhoea-malnutrition complex
View the documentHandout 7B: Carry on feeding
View the documentHandout 7C: Breast to family diet
View the documentHandout 7D: Persuading children with diarrhoea to eat
View the documentTrainer Attachment 7A: Problem poster activity
View the documentTrainer Attachment 7B: Nutrition counseling demonstration
View the documentTrainer Attachment 7C: Therapy begins at home
View the documentTrainer Attachment 7D: Enriched ORT
View the documentTrainer Attachment 7E: Child description and recommended diet
close this folderSession 8 - Recognizing malnutrition
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View the documentHandout 8B: Weight for height (stature) for both boys and girls
View the documentHandout 8C: Weight for age chart
View the documentHandout 8D: How to measure weight-for-length
View the documentHandout 8E: Recording the weight on a growth chart
View the documentHandout 8F: Measures recording sheet
View the documentTrainer Attachment 8A: Comparison of anthropometric measures
View the documentTrainer Attachment 8B: Growth monitoring
View the documentTrainer Attachment 8C: Growth chart exercise
close this folderSession 9 - Preventing malnutrition
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View the documentHandout 9A: Multimixes as village level weaning foods
View the documentTrainer Attachment 9A: Ali's story
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View the documentTrainer Attachment 9C: Nutritional rehabilitation centers
View the documentTrainer Attachment 9D: Guide for multimix preparation stations
close this folderModule Four: Working with the health system
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close this folderSession 10 - National health policy and programs for controlling diarrheal diseases
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View the documentTrainer Attachment 10A: National health policy and oral rehydration therapy
close this folderSession 11 - Encouraging collaboration among services for treatment, control and prevention of diarrhea
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View the documentHandout 11A: Coordinating activities
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View the documentTrainer Attachment 11B: Examples of services and organizations with which volunteers and counterparts can collaborate
View the documentTrainer Attachment 11C: Case studies
close this folderSession 12 - Monitoring and follow up for controlling diarrheal diseases
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View the documentHandout 12B: Monitoring worksheet
View the documentHandout 12C: Ways to do monitoring
View the documentHandout 12D: Steps in problem solving
View the documentHandout 12E: Problem situations
View the documentTrainer Attachment 12A: Examples of items to monitor
View the documentTrainer Attachment 12B: Home visits
View the documentTrainer Attachment 12C: Useful tool: diary
View the documentTrainer Attachment 12D: Suggestions for a diary on ORT/CDD
View the documentTrainer Attachment 12E: Sample problem solution
close this folderModule Five: Working with the community
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close this folderSession 13 - The impact of culture on diarrhea
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View the documentHandout 13A: Sample diarrhea questionnaire
View the documentHandout 13B: Methods for gathering information
View the documentHandout 13C: Identifying helpful and harmful practices
View the documentHandout 13D: Role of traditional healing in diarrheal diseases control
close this folderSession 14 - Working with the community to prevent and control diarrheal diseases
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View the documentHandout 14A: Questions to ask about involving the community in a project
View the documentHandout 14B: Skills for development facilitators
View the documentHandout 14C: A checklist for use in identifying participatory components of projects
View the documentHandout 14D: Helping the people to organize
View the documentHandout 14E: Meetings
View the documentHandout 14G: Ways to involve women in health projects
View the documentTrainer Attachment 14A: Factors affecting participation in rural development projects
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close this folderModule Six: Community health education
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close this folderSession 15 - Planning and evaluating health education projects in ort for controlling diarrheal diseases
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View the documentHandout 15A: Planning a community health project
View the documentHandout 15B: Example of project evaluation
View the documentHandout 15C: Health education project planning worksheet
View the documentTrainer Attachment 15A: The bamboo bridge activity
View the documentTrainer Attachment 15B: Important concepts for evaluation
View the documentTrainer Attachment 15C: Guide to the health education project planning worksheet
close this folderSession 16 - Selecting and using non-formal education techniques to promote the control of diarrheal diseases
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View the documentHandout 16A: Training techniques
View the documentHandout 16B: Using pictures to stimulate discussion
View the documentHandout 16C: Guidelines for using group discussion
View the documentHandout 16D: Guidelines for demonstration
View the documentTrainer Attachment 16A: Can puppets be effective communicators?
View the documentTrainer Attachment 16B: Love him and mek him learn
View the documentTrainer Attachment 16C: Some thoughts on the use of non-formal education in the real world
close this folderSession 17 - Selecting and using visual aids to promote CDD
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View the documentHandout 17A: Ways visual aids help people learn and remember
View the documentHandout 17B: Why pictures fail to convey ideas
View the documentHandout 17C: Design considerations
View the documentHandout 17D: Using pictures to communicate effectively
View the documentTrainer Attachment 17A: Why use visual aids?
View the documentTrainer Attachment 17B: Villagers teaching us to teach them
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close this folderSession 18 - adapting and pretesting health education materials on ORT for controlling diarrheal diseases
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View the documentHandout 18A: Spreading good ideas: adapting illustrated materials
View the documentHandout 18B: Child to child health booklet
View the documentHandout 18C: Visual aids: do they help or hinder?
View the documentHandout 18D: Pretest report form
View the documentTrainer Attachment 18A: Rainy season feeding messages
View the documentTrainer Attachment 18B: Tracing techniques to adapt visual aids
View the documentTrainer Attachment 18C: How to pretest
View the documentTrainer Attachment 18D: Role play on pretesting pictures
close this folderSession 19: Designing and evaluating health education sessions on ORT for CDD
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View the documentHandout 19A: The experiential learning cycle
View the documentHandout 19B: Session assessment sheet
View the documentHandout 19C: Guidelines for session presentations
View the documentHandout 19D: Session plan worksheet
View the documentHandout 19E: Evaluation of practice session
View the documentHandout 9F: Session preparations checklist
View the documentTrainer Attachment 19A: Role play on ways people learn best
View the documentTrainer Attachment 19B: Deciding when to use experiential learning
View the documentTrainer Attachment 19C: Sample session plan
close this folderSession 20 - Health campaigns for oral rehydration and prevention of diarrhea
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View the documentHandout 20A: Delivering the goods
View the documentHandout 20B: Radio learning group campaign
View the documentHandout 20C: To drink or not to drink
View the documentHandout 20D: Educational mini-campaigns
View the documentHandout 20E: Pakistan: ORT promotion
View the documentTrainer Attachment 20A: Educating the public about oral rehydration therapy
close this folderSession 21 - Resources for health education on controlling diarrheal diseases
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View the documentHandout 21B: Filling the information gap
View the documentHandout 21C: Networking
View the documentTrainer Attachment 21A: Linking the community with outside resources
View the documentSession 22 - Practicing and evaluation health education sessions
View the documentBibliography
View the documentPeace Corps overseas offices



4 hours


An understanding of local knowledge, beliefs and practices associated with diarrhea is critical to any work done as a part of CDD. During this session, participants reflect on their own perceptions of diarrhea-what causes it and how to treat it. Then, using a questionnaire, they go out into the local community to gather information about local perception and treatment of diarrhea. When they return, participants analyze the data to identify practices which are helpful and harmful, and discuss how they might begin CDD and ORT projects that build on the traditional health care beliefs and practices in the culture.


• To gather information on local knowledge, beliefs, and practices associated with the causes and treatment of diarrhea.
(Steps 2- 4)

• To identify helpful and harmful local beliefs and practices that affect diarrhea and have highest priority for change or encouragement.
(Step 4)

• To compare the local traditional approach to diarrhea treatment with the Western medical approach.
(Steps 1-4)


Community, Culture and Care, pp. 173-242
Helping Health Workers Learn, Chapters 7 and 14


- 13A Sample Diarrhea Questionnaire
- 13B Methods for Gathering information
- 13C Identifying Helpful and Harmful Practices
- 13D Role of Traditional Healing in Diarrheal Diseases Control


Newsprint, markers and any herbs or other items associated with the treatment of diarrhea you may want to show the group (optional).


Trainer Note

Before the session, try to find out as much as you can about local beliefs and practices for the treatment of diarrhea. Also collect any herbal remedies and evidence of other cures to show participants. Use this information during Step 4 to help participants validate what they learned from their interviews with local community members and provide additional content to the session.

Nave someone translate Handout 13A (Sample Diarrhea Questionnaire) in the language used in the local area. Make any necessary arrangements for the community visit for interviews and observations. Some possible kinds of arrangements include' permission from local officials and families, as well as transportation.

It is assumed that participants have already had training and experience in how to gather information. For preservice training or other situations where participants lack these skills use Sessions 10-13 in the Technical Health Training Manual to provide the background needed.

Step 1 (20 min)

Cross-Cultural Perspective On Diarrhea

Open the session by explaining that they will be gathering information about local knowledge, beliefs and practices related to diarrhea. To do this effectively it is helpful to begin by looking at their own beliefs and practices as well as their assumptions about local beliefs and practices.

Ask participants to recall the last time they had diarrhea. Write the following questions on newsprint and ask them to write their answers on a sheet of paper.

- How did you explain the cause of that diarrhea?
- What did you do treat the diarrhea?
- From whom did you seek advice or care?
- What did you do to prevent future episodes of diarrhea?

Ask a few participants to share their answers with the group.

Now ask participants to:

- Assume the identity of a local woman,
- Think in terms of her cultural, religious and social background,
- Consider how she would feel and react to having a baby with recurrent diarrhea,
- Answer the same questions as above but from her perspective.

Have the participants write these answers beneath their initial answers. Encourage the group to use their imagination and guess if they don't know the answers.

Ask a few participants to share their answers with the group and briefly discuss how different or similar the perspectives appear to be both between cultures and among individuals. Discuss how those differences could affect CDD projects in their communities.

Step 2 (20 min)

Introducing and Adapting the Diarrhea Questionnaire

Explain to participants that during the next 90 minutes they will visit members of the local community and gather information related to the local knowledge, beliefs and practices about the causes and treatment of diarrhea. Distribute Handout 13A (Sample Diarrhea questionnaire, and ask participants to look it over.

Ask the group to discuss and delete, odd to, or modify the questions in the sample questionnaire so that they reflect the local situation.

When the questionnaire la ready, ask participants to pair off. Have each pair interview and address their questions to at least two different people or families in the community and, if possible, borrow or collect any stems associated with diarrhea treatment they may encounter during the visit (items such ass utensils, containers, herbs or medicines used in treatment or ORS solution substitutes found in the home).

Before participants leave, ask them to briefly review Handout 13B (Methods for Gathering information and ask any questions they have about how to gather the information

Trainer Note

You may want to spend some time reviewing the vocabulary needed for collecting information about diarrhea.

You may want to have participants use pictures such as those in Trainer Attachment 3B (A Story About Diarrhea from Session 3) along with their questions to make the interview more concrete and more interesting.

If a visit to the local community is impossible, an alternative is to invite in 3-5 community members to act as cultural resources. Divide participants into small groups and assign a community member to each one. Have each group do some parts or all of the diarrhea questionnaire and collect as much information as possible about local beliefs and practices.

You may want to add questions about nutrition and sanitation depending on the interests of the group.

For preservice training it may be necessary to enlist the help of first or second year volunteers to accompany participants during the visits and help out with the interviews (but not to conduct the interviews for the Trainees).

For inservice training, it is effective to have Volunteers pair off with their counterpart for this activity.

Step 3 (90 min)

Information Gather log in the Community

Have the participants conduct the interviews in the community. If appropriate, suggest specific places to visit and/or people to talk with to find the information.

Trainer Note

If this session is done at the end of the day, you might consider giving participants the evening to do their interviews and information gathering. Then, the next morning, you can reconvene and complete the remaining steps in the session.

Because visits to homes in the community are likely to stimulate interest and questions about ORT, you may want to ask participants to be prepared to tell a picture story about ORT at the end of the interview.

Step 4 (20 min.)

Processing the Community Visit

When the participants return from their visit, reconvene the group and ask two or three pairs to report on what they learned from asking questions and any other general information on cultural beliefs and practices, Ask the others to add to what these pairs report.

Ask participants to compare and discuss the differences between their own approach to the treatment of diarrhea from Step 1, the traditional, country-specific perceptions also from Step 1, and the points of view encountered during the interviews

Step 5 (30 min.)

Identifying Harmful and Helpful Practices

Affecting Diarrhea

Divide participants into four or five small groups, Distribute Handout 13C (Identifying Helpful and Harmful Practices) and give the following instructions to explain how to fill in the sheet:

- Identify practices that affect diarrhea.

- Indicate whether they are harmful, or helpful and who in the community does these things,

- Examine the harmful practices and identify those which you feel you cannot change. Briefly explain why you cannot change them.

- Rank the remaining harmful Practices in terms of priority for change. Take into account, severity of effect on health and ease of changing the behavior. Explain your ranking.

- For the Practices with the highest priority far change, describe ways you might motivate people to adopt healthier practices building on existing beliefs, practices and values in the community.

- Examine the helpful practices and list ways to encourage people to continue them.

- Describe the people or groups with whom you could first work to motivate people to change harmful practices and continue helpful ones.

Ask the groups to answer each of the questions as thoroughly as they can using the information collected from the questionnaire and interviews. Where appropriate, provide any additional information you may have on local beliefs and practices related to diarrhea to help the group complete the task.

Step 6 (30 min.)

Reporting on Small Group Analysis

Ask one group to report their answers. Have the other groups add additional answers

When the questions are answered, have the Trainees). focus on their conclusions about which behaviors are considered to be important to change first. Have them comment on why they arrived at these conclusions, how their perceptions may differ from their communities, and how they would attempt to resolve such differences.

Trainer Note

This discussion should address the fact that different people in the community have different knowledge, practices and degrees of influence over others. Because it is necessary to recognize these differences in their later work on planning health education projects and deciding with whom to work, it is important to emphasize these differences here. This point will be discussed more in Session 14 (Working with the Community).

Also make certain that participants recognize the difference between knowledge and actual practice. People in their communities and they themselves may know what to do, but may not always do it. Note that people must take into account many things in deciding what actions to take, For example lack of money or social pressures can lead to actions harmful to children's health even though individuals or families "know better".

Step 7 (10 min)

Identifying Nays to Learn More About Local Beliefs and Practices

To close the session, ask participants to briefly discuss their experience of interviewing people about their beliefs and practices - What was easy about the interaction? What was hard? Have them discuss and list in their notebooks other ways to gather and validate information about cultural beliefs and practices in the treatment of diarrhea and how they can use that information to make their health education for CDD, particularly ORT, more effective. Finally, distribute Handout 13D (The Role of Traditional Healing in Diarrheal Diseases Control) for supplementary reading.

Trainer Note

You may want to recommend additional general reading in Community Culture and Care (Traditional and Modern Health Systems) pp. 173-242.)

Handout 13D (The Role of Traditional Healing in Diarrheal Disease Control) discusses a number of Brazilian cultural beliefs and practices related to diarrhea. Because there are many similarities in traditions associated with diarrhea cross-culturally, much of the information may be directly applicable to your local culture.