Cover Image
close this bookOral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 pages)
View the document(introductory text...)
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
View the documentTrainer Attachment 4C: Answers for exercises
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
View the documentTrainer Attachment 9B: Case studies
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
View the documentTrainer Attachment 11A: Discussion guidelines on collaboration
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
View the documentTrainer Attachment 14B: Examples of problem situations
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
View the documentTrainer Attachment 17C: Examples of a teaching situations
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

Trainer Attachment 5C: Suggestions for a lecturette on the hows and whys of ORS

RESOURCES

- Oral Rehydration Therapy (ORT) For ChIIdhood Diarrhea (ORT Resource Packet. pp. 43-44.
- Trainer Attachment 5 (The Scientific Basis for Oral Rehydration Therapy)

IMPORTANT INFORMATION:

1. Diarrhea upsets the body's chemical balance and its' ability to process and absorb eater and nutrients.

When the child is healthy, the lining of his or her intestines transforms food into a tore that can be absorbed and transported by the blood stream to all parts of the body. These nutrients provide energy and enable growth. The blood stream is also the source of the minerals and water needed by the intestine to transform the food into a useable form. The intestine "borrows" and returns water and minerals as it processes food. This chemical balance is upset during diarrhea.

Diarrheal diseases affect the functions of the intestines. During diarrhea, the small intestine loses its ability to absorb water and essential minerals called electrolytes (sodium chloride, potassium, and bicarbonate). Minerals and water needed to process food leave the body in the child's stools, depleting the body's store of these vital elements and the nutrients they help process.

2. Water and electrolye loss cause the physical signs and symptoms recorded on the WHO Treatment Chart.

Fluid and mineral loss of greater than five percent, but less than ten percent of body weight generally causes a weak rapid pulse, loss of skin elasticity, low blood pressure, severe thirst, and other signs noted in Column B of the WHO Diarrhea Treatment Chart.

A loss of more than ten percent of the body weight results in shock, stupor, disrupted kidney function, acids build up in the blood (acidosis), peripheral blood vessels collapse, and death follows (see Treatment Plan C on the WHO chart.

3. Infants and small children are nor- susceptible to dehydration from diarrhea.

Infants and young children are particularly susceptable to dehydration from diarrhea, because of their small body weight For example, it a child who weighs ten kilograms loses one kilogram of water, ho or she has lost ten percent of the body weight and is severely dehydrated.

4. Oral Rehydration Salts (ORS) restore the body's chemical balance, and replaces the water lost.

Oral Rehydration with ORS (Oral Rehydration Salts) replaces the blood's electrolytes nearly as quickly as they are lost in the stool. This is due in large measure to the special ability of glucose to increase the absorption rate of sodium through the intestinal lining.

ORS includes all the essential electrolytes. Sugar and salt solution only has one of the three. This is why it is necessary to give ORS to a mildly dehydrated child.

Summarized below is the formula for the new trisodium citrate ORS. The ingredients for the other solutions are stated in The Treatment of Diarrhoea, p.17 and 42.

ORAL REHYDRATION SALTS (ORS) FORMULATION CONTAINING TRISODIUM CITRATE

1. In 1982-1983 the WHO Diarrhoeal Diseases Control (CDD) Programme supported laboratory studies to identify a more stable ORS composition, particularly for use in tropical countries, where ORS has to be packed and stored under climatic conditions of high humidity and temperature. The results of these studies demonstrated that ORS containing 2.9 grams of trisodium citrate dihydrate in place of 2.5 grams of sodium bicarbonate (sodium hydrogen carbonate) was the best of the formulations evaluated1. The formulae of the standard ORS (ORS-bicarbonate) and ORS containing trisodium citrate dihydrate (ORS-citrate) are shown below:

ORS-bicarbonate

grams/litre

ORS-citrate

grams/litre

Sodium chloride

3.5

Sodium chloride

3.5

Sodium bicarbonate (sodium hydrogen carbonate)

2.5

Trisodium citrate dihydrate

2.9

Potassium chloride

1.5

Potassium chloride

1.5

Glucose anhydrous

20.0

Glucose anhydrous

20.0

SUMMARIZE by stating that Oral Rehydration Therapy is used to:

· Replace fluids
· Restore the chemical balance of the body.

ANALOGIES THAT HELP LEARNERS UNDERSTAND THESE CONCEPTS:

To give participants a more concrete sense of what it means to lose chemical balance, ask someone to stand on one foot and hold objects of equal weight in each hand. Then ask them to remain on one foot but hold both objects in one hand. Ask thee to tell the others hoe that feels to go from a balanced to an unbalanced situation. How well can they function in this states This can provide the basis for discussion.

To convey the idea that children are particularly vulnerable to dehydration from diarrhea, put the sane amount of water in a large cup and in a small cup. Ask participants to compare the cups. Use this as a basis for discussion.