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close this bookGuidelines for Training Community Health Workers in Nutrition (WHO, 1986, 128 p.)
View the document(introduction...)
View the documentAcknowledgements
View the documentPreface to first edition
View the documentPreface to second edition
View the documentChapter 1 Introduction
View the documentChapter 2 Teaching for better learning
View the documentChapter 3 Some basic facts about food
close this folderTraining modules
View the documentMODULE 1 GETTING TO KNOW THE E COMMUNITY AND ITS NEEDS
View the documentMODULE 2 MEASURING AND MONITORING THE GROWTH AND NUTRITION OF CHILDREN
View the documentMODULE 3 PROMOTION OF BREAST-FEEDING
View the documentMODULE 4 NUTRITIONAL ADVICE ON THE FEEDING OF INFANTS AND YOUNG
View the documentMODULE 5 NUTRITIONAL CARE OF MOTHERS
View the documentMODULE 6 IDENTIFICATION, MANAGEMENT, AN D PREVENTION OF COMMON NUTRITIONAL DEFICIENCIES
View the documentMODULE 7 NUTRITIONAL CARE DURING DIARRHOEA AND OTHER COMMON INFECTIONS
View the documentMODULE 8 CONVEYING NUTRITION MESSAGES TO THE COMMUNITY
View the documentMODULE 9 SOLVING NUTRITIONAL PROBLEMS IN THE COMMUNITY

MODULE 9 SOLVING NUTRITIONAL PROBLEMS IN THE COMMUNITY

LEARNING OBJECTIVES

After studying this chapter, taking part in the discussions, and doing the exercises, a community health worker should be able to:

· Understand that a number of activities are generally necessary to solve one nutritional problem because nutritional problems often have many causes.

· Identify the major causes of malnutrition in a child, select the causes that she can deal with, and carry out appropriate tasks to remove those causes.

· Convince parents that regular weighing of children is necessary to know what actions are required at different ages so that the child grows well.

A SPECIAL NOTE FOR THE TRAINERS

Each of the 8 previous modules gives all essential details about one particular task, including how it should be done, why it should be done, and how to acquire the skills necessary for doing it. Each of these tasks will considerably improve the nutritional status of members of a community, if these are done well by the community health worker.

In this module, the attention of the trainees is drawn to the fact that in doing actual work in the community, they will have to combine various tasks to solve nutritional problems. For instance, when a community health worker visits a family, she will not only monitor the growth of the child, but on the basis of the child's growth pattern, give advice to the mother about proper feeding practices; if the child is suffering from diarrhoea, she will also have to advise the mother on rehydration and proper feeding during diarrhoea and during the days after the diarrhoea is over so that the child gains back the lost weight.

Thus, to solve a nutritional problem the trainee will have to follow three steps:

· Identify and understand the cause(s) of the problem;
· Select the appropriate task(s) from all the tasks she has learnt;
· Carry out the selected tasks as best as she can.

This module should help trainers to convey the above ideas to the trainees.

TRAINING CONTENT

Tasks to be done to solve nutritional problems

Once a community health worker has studied the preceding modules and has done all the exercises contained in them, she should be adequately trained to carry out specific nutrition-related tasks. However, the ability to do specific nutritional tasks by itself is not enough. The community health worker must also have a broad understanding of the causes of nutritional problems. The example below will illustrate this point.

When a community health worker visits a family and finds a badly nourished child who has not been gaining weight for 2-3 months, she must find out the causes for the child's malnourished state. To do this, she must immediately remember all the important causes of growth failure and should not simply think of defects in feeding. In Module 7 the community health workers learned that diarrhoea and infections can cause malnutrition. It should be noted that these are the commonest causes of malnutrition in the community. If the child being examined has diarrhoea, the community health worker will have to advise the parents about how to prevent dehydration, how to feed the child during diarrhoea, and how to prevent the recurrence of diarrhoea. Also, if the child is not immunized against common childhood infections, the community health worker will have to persuade the parents to have the child immunized.

On the other hand, if the child does not have either diarrhoea or any other infection, the reason for his growth failure may be inadequate care and feeding. In such cases the community health worker should find out why the child is not being properly fed. The reasons can be many. It may be that the mother is pregnant again and feels too tired to look after the child properly. She may herself be malnourished or anaemic. She may also have a number of other children or she may be working outside and may be leaving the child in the care of an older brother or sister.

Thus, in solving nutritional problems, the community health worker has to remember that each nutritional problem has several causes (and not just one as conveniently described in each module). The community health worker, therefore, must first understand the problem and identify the possible causes. Then she must decide what tasks have to be done to solve that problem. In doing so, she must remember the following points:

· The major causes of nutritional problems are often ignorance on the part of mothers, diarrhoea and other infections and inadequate child care as a result of ill health or malnutrition of the mothers.

· The community health worker should carry out all the tasks that seem appropriate in her attempts to solve nutritional problems.

Community health workers will not be able to solve all the nutritional problems in a community. For example, it will be difficult for them to help an orphan child or children of very poor parents. In such cases they are advised to get in touch with community leaders or other workers from different sectors (social workers, nearby charitable organizations, etc.) to see what can be done for such children.

Fig. 37 gives an example of steps to be followed in solving the nutritional problem of a child who has not been gaining weight for 2-3 months.

Tasks to be done when there are no nutritional problems

Regular weighing of all children is essential even when they are gaining weight normally. In the case of children who are growing well, the community health worker should:

· tell mothers that as children grow older they need more food and that by one year of age they should start eating from the family pot;

· teach mothers how to avoid diarrhoea and other infections by washing their hands often, boiling water for children, giving children cooked food, and using clean utensils;

· convince parents to get their children immunized in order to prevent the occurrence of diseases and malnutrition.

Growth monitoring for establishing contact with the community

Look at Fig. 37 again. Note that the main problem of the child in the example is that he is not growing properly. This problem can be identified only by regular weighing. After this is done, several other tasks must follow, as is pointed out in the example in Fig. 37. It is important to remember that weighing a child and using a growth chart are not the only two tasks in growth monitoring. They are the first two tasks in a series of tasks necessary for preventing health and nutritional problems in the community.


Fig. 37. An example of steps to be followed in solving a nutritional problem in the community

Community health workers will need the support and cooperation of the community in their work. This was mentioned in Module 1. The relationship between a community health worker and the people she serves should be such that the people have confidence in her. Once such a relationship is established, the community health worker's task of convincing people about such things as family planning, immunizations, and use of oral rehydration solution will become easier.

A good way to establish a relationship of confidence with people in the community is by growth monitoring. First, regular weighing of children will increase contact between the community health worker and mothers. This will enable the community health worker to establish a friendly relationship with the mothers. Second, by regularly recording weights on growth charts the community health worker will be able to identify malnourished children early. Then by doing all the tasks she has learnt she will be able to help any malnourished children recover quickly. And when parents see that their children are gaining weight again and are growing well, they will have more and more confidence in the advice of the community health worker. Thus, growth monitoring should be the first task of a community health worker, after she has got to know the community.

TRAINING METHODS

1. Lecture: Training content.

2. Community survey: Identification of malnourished children and the major causes of their malnutrition.

3. Group discussion: Findings of the community survey.

EXERCISES

Exercise 1. Identifying malnourished children in the community and determining the causes

The trainees, in small groups, will visit 10 households, and using a weighing balance and growth charts, make a list of all children under five years who are malnourished. For each malnourished child, the possible major causes should be listed. In a group discussion, the tasks which can be undertaken for each major cause will be suggested and their suitability discussed.

Exercise 2. Role-play concerning the use of the growth chart in motivating the mothers to accept other advice

Characters: A mother with a malnourished child A community health worker

The mother regards the reduction in the weight of her baby as something natural that happens to all children. She does not understand how this is related to the need for immunization and other activities. The community health worker tries to convince her that the chart often indicates what needs to be done to keep her child healthy and strong, and that she is there to help the mother do what is necessary.

Other useful WHO training materials

Price* (Sw. fr.)

Nutrition learning packages. 1989

30.-

The community health worker. 1987

22.-

The management and prevention of diarrhoea. Practical guidelines, 3rd ed. 1993

12.-

Education for health. A manual on health education in primary health care. 1988

34.-

The growth chart: a tool for use in infant and child health care. 1986

12.-

Jelliffe, D.B. & Jelliffe, E.F.P. Dietary management of young children with acute diarrhoea. A manual for managers of health programmes. 1991

8.-

Readings on diarrhoea. Student manual. 1992

20.-

Further information on these and other World Health Organization publications can be obtained from Distribution and Sales, World Health Organization, 1211 Geneva 27, Switzerland.

*Prices in developing countries are 7096 of those listed here.