Cover Image
close this book Community Nutrition Action for Child Survival
View the document Table of contents
View the document Introduction
View the document How to use community nutrition action for child survival
close this folder Part I - Community nutrition problems and interventions
close this folder Unit 1 - The nutrition of women and children
View the document Session 1: What is malnutrition?
View the document Session 2: Focus on the nutrition of women and children
View the document Session 2: Focus on women and children
View the document Session 3: Important causes of malnutrition in women and children
View the document Session 4: Community nutrition action for child survival
close this folder Unit 2: Measuring and monitoring growth in young children
View the document Session 1: Measuring growth
View the document Session 2: Arm circumference
View the document Session 3: The road to health chart
View the document Session 4: The thinness chart
View the document Session 6: Counseling, referral and follow-up of malnourished children
close this folder Unit 3: PROMOTING BREASTFEEDING
View the document Session 1: The importance of breastfeeding
View the document Session 2: Helping mothers breastfeed
View the document Session 3: Breastfeeding information for Kenyans
close this folder Unit 4: Introducing weaning practices in the community
View the document Session 1: Changing weaning practices
View the document Session 2: Making improved meaning foods in the home
View the document Session 3: Weaning food practice
View the document Session 4: Case study: Village weaning food projects in Thailand
View the document Session 5: Weaning foods - Village production techniques
close this folder Unit 5: Preventing diarrhea
View the document Session 1: Preventing diarrhea*
View the document Session 2: Diarrhea home management
View the document Session 3: Community activities to prevent diarrhea*
close this folder Unit 6: Immunization
View the document Session: Improving immunization coverage - The community's role
close this folder Unit 7: Family planning and nutrition
View the document Session 1: Family planning and nutrition
View the document Session 2: Providing the facts about family planning
View the document Session 3: Community-based distribution of family planning methods
close this folder Part II - Planning nutrition action projects
close this folder Unit 1: Working with the community to improve nutrition
View the document Session: Simulation exercise
close this folder Unit 2: Finding the causes of malnutrition
View the document Session 1: Conducting a community nutrition mini-survey
View the document Session 2: Analyzing community nutrition information
close this folder Unit 3: Deciding what to do
View the document Session 1: Visits to on-going nutrition projects
View the document Session 2: Case studies/panel discussion
close this folder Unit 4: Planning nutrition action projects
View the document Session 1: Describing the problem
View the document Session 2: Writing project goals and objectives
View the document Session 3: Choosing project activities
View the document Session 4: Developing a project work plan
View the document Session 5: Planning how to evaluate
View the document Session 6: Preparing a budget
close this folder Unit 5 - Session: Writing a project proposal/Mini-Workshop
View the document Session: Writing a project proposal Mini-Workshop
close this folder Part III - Project management systems
close this folder Unit 1: Training community nutrition workers
View the document Session 1: Introduction
View the document Session 2: Assessing training needs/writing objectives
View the document Session 3: Choosing training methods
View the document Session 4: Scheduling training content
close this folder Unit 2: Evaluating progress
View the document Session 1: What do he need to know? How can we find out?
View the document Session 2: Records and reports
View the document Session 3: A prototype record keeping system
View the document Session 4: Evaluating activities with the community
close this folder Unit 3 - Supervising community nutrition activities
View the document Session 1: The role of the supervisor
View the document Session 2: Identifying and solving problems
View the document Session 3: Problem-solving/role play
View the document Session 4: Planning and conducting supervision visits

Session 6: Counseling, referral and follow-up of malnourished children

Purpose:

In this session, trainees practice explaining the significance of children's growth measurements to their parents. Actions that should be taken in cases of severe malnutrition and early growth failure are discussed.

Time: 2 hours

Materials:

- Role Plays - containing growth charts and mother's instructions for three situations (In this exercise, trainees use the Road to Health Chart as the tool for assessing the nutrition status of several children. Arm circumference measures or measures from the Thinness Chart can be substituted.)

- Handout - "Community Action with Malnourished Children" (This should be developed locally. An example is included.)

Steps:

1. Introduce the session with a discussion of the critical role parents play in monitoring and taking action to improve the growth of their children.

2. Divide into work groups of three people. Work groups will conduct three role plays each. The characters in the role plays are a "community nutrition worker," the "mother" of a malnourished child and an "observer." Work group members will rotate the roles so that each member plays all three roles.

3. Give group members different situation sheets and instruct them to remove the " Instructions to the Mother" for their own reference. In each situation, the "mothers brings her child's Road to Health Chart to the Community nutrition worker." The "worker's" job is to:

- explain the Road to Health Chart and the child's growth curve to the "mother";

- discover the causes of growth failure by asking the questions about the health, eating habits, etc., of the child;

- help the "mother" plan what to do to improve the growth of her child.

The "observer" should note how the "worker" uses the Road to Health Chart to explain the child's situation and the need for action.

Allow about five minutes per role play situation.

4. Discuss the role plays by asking trainees to answer the following questions based on their experience in the roles of "mother," and "community nutrition worker" and

"observer."

- How did the "community nutrition worker" use the Road to Health Chart to explain a child's nutrition status? - What questions did you ask to find out why the child had stopped growing?

- Did the "community nutrition workers" tell the "mothers" what they should do, or did they plan together how to improve the child's growth? Which do you think is more effective?

5. Counseling and education of parents are two community interventions to improve the nutrition of children identified during growth monitoring activities. Ask participants: "What other actions can/should be taken in the community with "high risk" children?" Write their responses on the flipchart.

6. Distribute the Handout - "What to Do When Children are Malnourished." Explain that each community nutrition program must decide what the community/clinic or agency will do for the malnourished children identified in growth monitoring activities. This handout gives a basic list of appropriate community interventions. Review them with the trainees and encourage them to add others that they feel would be necessary and feasible.

7. Review the basic steps in measuring growth and taking action to improve the nutrition of "high risk" children:

- Measure and assess the growth of all children under five regularly.

- Counsel the parents of "high risk" children. Visit them at home if possible.

- Refer or treat malnourished and sick children for illness.

- Follow up and evaluate the progress of each child.

ROLE PLAY

Situation #1


Situation #1

Instruction to the Mother:

You brought the baby to the weighing activity because she is sick and has gotten thin.

You stopped breastfeeding her in September, at 4 months, because she "didn't like" your milk.

ROLE PLAY

Situation #2


Situation #2

Instruction to the Mother:

You work on a tea plantation all day and leave this child with your 8-year-old daughter. Your husband left in August to find a job in the city. You are breastfeeding in the morning and at night. During the day the baby eats rice from the morning meal.

ROLE PLAY

Situation #3


Situation #3

Instruction to the Mother:

You stopped breastfeeding this child in August when he was 16 months old because you became pregnant again. He refused to eat much for the next few weeks. Then he got the measles in November. Since then he has had frequent diarrhea.

HANDOUT

COMMUNITY ACTION WITH MALNOURISHED CHILDREN

To the Trainer:

This handout should be developed by each program based on the nutrition assessment instruments they use, their resources and established guidelines for intervention.

Example:

In a CEDPA-supported nutrition program, Community Nutrition Volunteers use arm circumference and weight gain to identify "high risk" children.

If a child has:

The Community Nutrition Volunteer:

Yellow Arm Circumference
(>12.5 cm <13.5 cm)
or
No weight gain for two months

- Counsels the parent(s)
- Teaches the mother to make improved foods for child feeding
- Refers the child to the nearest clinic if he is sick
- Follows up after one month

Red Arm Circumference
(<12.5 cm)
or
No weight gain for three months

- Counsels the parent(s)
- Refers for immediate medical treatment
- Gives food supplement
- Visits home one week later to teach mother how to make improved foods and how to treat diarrhea with ORS
- Follows up monthly until arm circumference is green

All children

- Teaches the mother to prepare improved weaning foods
- Teaches the mother how to make and give ORS to treat diarrhea
- Discusses the importance of and methods for child spacing

 

REFERENCES

American Public Health Association. Growth Monitoring. 1981.

Morley, D. and Woodland, M. See How They Grow Monitoring Child Growth for Appropriate Health Care in Developing Countries. Oxford University Press, New York, 1979.

Nabarro, D., Verney, J. and Wijga, A. The Weight-for-Height Chart Project. Evaluation Report. 1982-1984.

World Health Organization. Guidelines for Training Community

Health Workers in Nutrition. WHO Offset Publication No. 59. Geneva, 1981.