| Community Nutrition Action for Child Survival |
|Part I - Community nutrition problems and interventions|
|Unit 5: Preventing diarrhea|
In this session trainees will learn how to assess a community's current practices with regard to diarrhea, how to use assessment information to, prioritize specific preventive practices to emphasize in their particular area using the WHO recommended step-by-step approach and discuss ways that health workers can support selected preventive practices at the community level.
Time: 3 hours
- Handout - "About Prevention of Diarrhea"
- Flipchart and marking pens
1. Write on the flipchart:
* The best ways to prevent diarrhea are:
Improved Weaning Practices
Use of Plenty of Clean Water
Use of Latrines Proper Disposal of Babies' Stools
* Much of the format and material used to compile this session were adapted from the WHO Programme for Control of Diarrhoeal Diseases Supervisory Skills Course: Module on Prevention of Diarrhoea, and Community Involvement, revised ed.
Briefly review the methods for preventing diarrhea which have already been treated in some detail in Session 1 of the module. Make the point that each one of these methods represents an area which can be addressed through community action in a comprehensive program to control diarrhea! diseases.
2. Assessing Community Practices
The first step in designing community interventions to address diarrhea! diseases is to learn about the community's current practices regarding diarrhea and the reasons for them. This information will provide guidance to further actions by helping you to select which interventions are most needed and which are most likely to be successful in a particular setting.
Trainer: Take a few minutes to solicit suggestions from the group about various ways that this type of information can be obtained and write them on newsprint. The finished list should include:
Five types of information on community practices should be obtained about each of the seven ways to prevent diarrhea listed above.
Write on newsprint:
- The extent to which the community engages in the preventive practice
- What community members do instead of or in addition to the preventive practices
- Reasons community members continue their current practices, as well as barriers and constraints to change
- Latrines: their number, type and cleanliness
- Water sources: their quality, convenience and quantity of supply
3. Selecting Preventive Emphasis
Once information has been obtained regarding the community's current practices, the next step is to select one or more preventive practices to emphasize in your particular area. The WHO recommends a step-by-step approach to selecting preventive emphasis.
Write on each newsprint:
Step 1: List the practices that need to be improved in your area
Point out that this includes:
- People who are not doing the preventive practices
- People doing other practices that are harmful
Step 2: Select the more important practices to improve
Trainer: Brainstorm with the large group a list of ways to prioritize practices as feasible. The list should include:
- Whether or not the government already considers the practice a priority
- What the expected effect of the change will be on the diarrhea rates
- How many people, particularly young children, will be affected
Make the point that overall, the most important practices are those which, if changed, would result in the greatest health improvement for the community.
Step 3: From the more important practices, identify some that will be more feasible to change
Trainer: Brainstorm with the large group a list of ways to prioritize practices as feasible. This list should include:
- Will community members understand and believe the benefits of the new practice or the harm in continuing the current practices?
- Do community members have the necessary resources, or can they be obtained?
- Will community members be willing to do the practice, and not feel that it is against tradition, too difficult, too expensive, or too time consuming?
- Can health workers correctly teach the new practice with little or no training themselves?
Point out that if the answer to all of these questions is yes, the change is more likely to be feasible. If the answer to any questions is no, it is unlikely that an effort to change the practice or introduce a new one will be successful, especially without a large commitment of resources.
Step 4: Select preventive practices to emphasize in your area
Having discussed each practice on both the aspect of importance (i.e. government plans, expected effect on disease rate and number of people affected) and feasibility (i.e. community interest, resource availability and health manpower capability), select one or two practices to emphasize in your area.
4. Undertaking Specific Activities
Health and extension workers can play important roles in bringing about improvements in community health. In the prevention and control of diarrhea! disease the following activities are recommended:
(Write each activity on newsprint)
1. Health and extension workers can use food counseling techniques.
Point out that messages should be brief and clearly relevant to the person or group being addressed. Only a few messages should be given at a time. If too many messages are given, none are likely to be remembered, but the right message at the right time will make an impression.
2. Health and extension workers can -at good examples
What a person does always sends a more powerful message than what a person says.
3. Health and extension workers can participate in community projects to improve preventive practices.
Trainer: Brainstorm with the large group to solicit ideas for community projects that could improve preventive practices and that could be accomplished with limited community resources. Some examples are:
- Buying soap cooperatively
- Improving water sources
- Designating and supporting a tradesman to build family latrines
- Having a breastfeeding support group
- Gardening for improved weaning foods
4. Health and extension workers can support breastfeeding
Opportunities to support breastfeeding can be found particularly when the health worker attends births, prescribes drugs or when mothers are having difficulties with breastfeeding and seek out the health worker for advice.
5. Health and extension workers can build and maintain latrines where they work
A clean, functioning latrine can be an example to others in the community. It should be properly maintained so that people can see how a latrine works.
6. Health and extension workers can advise community members of the cleaner water sources and ways to improve water sources
When the assessments of community practices were done, the cleaner water sources were identified so it should be possible to advise community members about the best water sources. Probably, some water sources can be improved by taking simple measures.
Trainer: Brainstorm with the large group to develop a list of simple improvements that can be made to existing water sources. Include:
- Build a fence or wall around the water source to keep animals away
- Dig drainage ditches from an open well to prevent storm water from flowing into it
- Do not allow washing in the water source
- Do not allow children to play in or around the water source
- Do not locate the latrines uphill or within 10 meters of the water source
- Do not defecate within 10 meters of the water source
- Install a simple pulley device and bucket to make it easier to raise from a well
Summary: Distribute the Handout "About Prevention of Diarrhea". Review the Handout reinforcing the main points and answering any remaining questions.
ABOUT PREVENTION OF DIARRHEA*
* From WHO Supervisory Skills Course: Module on Prevention of Diarrhea.
- The best ways to prevent diarrhea are:
Improved Weaning Practices
Use of Plenty of Clean Water
Use of Latrines
Proper Disposal of Babies' Stools
- It is important to assess a community's current practices related to diarrhea and the reasons for them to know what preventive interventions are needed.
- Use of step-by-step approach to select the specific preventive practices to emphasize in a health area. Briefly, the steps include:
- List the practices that need to be improved in the area.
- Select the more important practices to improve.
- Identify the practices that will be more feasible to change.
- Select one or two preventive practices to emphasize.
- Health services should play an important role in bringing about improvements in a community's practices. Some activities that health workers can do to support selected preventive practices include:
- Use of good counseling techniques
- Set a good example
- Participate in community projects to improve preventive practices
- Support breastfeeding
- Build and maintain a latrine at the health facility
- Advise community members of the cleaner water sources and ways to improve water sources
Chen, LC, and Scrimshaw, NS, eds. Diarrhea and Malnutrition: Interactions, Mechanisms and Interventions. The United Nations University. New York, New York, 1983.
"Dialogue on Diarrhoea". Issues 1-31, AHRTAG. 85 Maryleborne High Street, London WIM3DE.
Esrey SA, and Bently ME. Nutrition and Diarrhea: Draft Guidelines for PRITECH II Country Work Plan. Division of Human Nutrition, Department of International Health, Johns Hopkins University. Baltimore, Maryland, 1987.
Favin M, and McMurtry. Oral Rehydration Therapy. World Health Federation of Public Health Associations. Washington, D.C., 1983.
"Salubritas". Oral Rehydration in the Village. Vol. 3, No. 1, January 1979.
Werner, D. Helping Health Workers Learn: A Book of Methods, Aids and Ideas for Instructors at the Village Level. Hisperian Foundation. Palo Alto, Ca., 1983.
Werner, D. Where There Is No Doctor: A Village Health Care Handbook. Hisperian Foundation. Palo Alto, Cal, 1977.
World Health Organization. Programme for Control of Diarrhoeal Diseases Supervisory Skills Course: Modules on Prevention and Treatment of Diarrhoea, revised ed. Geneva, Switzerland, 1987.
World Health Organization. A Decision Process for Establishing Policy on Fluids for Home Therapy of Diarrhoea. WHO/CDD/SER/87.10. Geneva, Switzerland, 1987.
There are two newsletters which contain current information on diarrhea and other related topics that are available to Third World subscribers:
"Dialogue on Diarrhoea", AHRTAG, 85 Marylebone High Street, London, WIM3DE, United Kingdom.
"Mothers and Children". American Public Health Association, Clearinghouse on Infant Feeding and Maternal Nutrition, 1015 Fifteenth Street, Washington, D.C., 20005.