for Community Health Workers - FHI 360

Fact Sheetsfor Community Health Workers in APHIAplus Nuru ya Bonde

Ministry of Health

Fact Sheets for Community Health Workers <

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This publication is funded by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-623-A-11-00007.

The contents are the responsibility of Family Health International (FHI 360) APHIAplus Nuru ya Bonde project and do not necessarily reect the views of the US Government.

The content may be freely reviewed, quoted, reproduced, or translated provided it is not for commercial gain. Partial of adaptive use of this work is also welcome, provided permission is first obtained from FHI 360. FHI 360, USAID and APHIAplus Nuru ya Bonde must be prominently acknowledged in any publication and two copies must be submitted to APHIAplus Nuru ya Bonde.

Contact: [email protected]

©2012 Family Health International

> Fact Sheets for Community Health Workers

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Contents

Forward Page ivAcknowledgements Page v

Introduction Page 1

1. Fact Sheet on Antenatal Care Prevention Page 3Role of CHW Page 4Pregnancy Danger Signs Page 4

2. Fact Sheet on Newborn Care Page 11Prevention Page 11Role of CHW Page 11Newborn Danger Signs Page 12

3. Fact Sheet on Child Health Page 15

4. Fact Sheet on Growth Monitoring Page 19Role of CHW Page 19

5. Fact Sheet on Breastfeeding Page 22Role of CHW Page 23CHWs can support breastfeeding mothers Page 23

6. Fact Sheet on Immunisation Page 27Prevention Page 27Home Care Page 27Role of CHW Page 28Immunisation Page 22Vitamin A Page 29Deworming Page 30

7. Fact Sheet on Weaning Page 31Role of CHW Page 31

8. Fact Sheet on Feeding the Young Child Page 33Role of CHW Page 33

9. Fact Sheet on Hygiene Page 35Prevention Page 35Home Care Page 35Role of CHW Page 35Tippy Taps Page 38

10. Fact Sheet on Family Planning Page 39Role of CHW Page 39


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11. Fact Sheet on Diarrhoea 4Prevention Page 44Home Care Page 44Role of CHW Page 45Danger Signs Page 45

12. Fact Sheet on Malaria Page 48Prevention Page 48Home Care Page 48Role of CHW Page 49Danger Signs Page 50

13. Fact Sheet on Cough Page 52Prevention Page 52Home Care Page 52Role of CHW Page 52Danger Signs Page 53

14. Fact Sheet on HIV and AIDS Page 55Prevention Page 55Role of CHW Page 55

15. Fact Sheet on Community Action Plan Page 60Role of CHW Page 60

16. Fact Sheet on Mapping Page 63

17. Fact Sheet on Children with Special Needs Page 65Role of CHW Page 65Home Care Page 65

18. Factsheet on Adolescent Growth and Development Page 68

19. Fact Sheet on Care for the Elderly Page 77

20. Fact Sheet on First Aid Page 85Prevention Page 85Role of CHW Page 85First Aid Page 86Poisoning Page 86Animal Bites Page 87Burns Page 88Convulsions Page 88

20. References Page 89


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It is now widely accepted that Community Health Workers make an important contribution towards ensuring equitable healthcare access and improving the lives of individuals and communities, especially in the rural areas.

In Kenya, the Government has recognised the important role of CHWs. This crucial role is well articulated in the Health Sector Strategic Plan and Community Health Strategy. The strategy creates a structure conducive to the work of CHWs. For example, the Community Health Unit is given a prime place in interventions to address health issues at the community level and ensure linkages to various services.

The USAID-funded APHIAplus Nuru ya Bonde project is working in collaboration with the Ministry of Public Health and Sanitation to strengthen Community Units in six Rift Valley counties. We are working together to ensure these key structures are well-positioned to effectively contribute to the Ministry’s efforts towards achieving national health sector strategic objectives, attainment of the Millennium Development Goals (MDGs) and meeting the goals of Vision 2030.

It is important to note that the Government has made impressive gains in rolling out the Community Strategy nationally. This document is intended to complement what the Government is doing through the Division of Community Health Services. This resource is meant to augment other documents used to implement the Community Strategy, including the CHW Curriculum and Training Modules.

Although primarily designed as a reference for community health workers, we are sure other service providers and trainers find the information useful. Indeed, this publication will help fill an information gap in materials for community health workers.

These factsheets were developed through a highly consultative process by a team that included community health workers and other service providers, representatives of the Ministry of Public Health and sanitation, APHIAplus Nuru ya Bonde staff. I wish to thank all those who contributed to make this publication a reality, including the Ministry of Public Health and Sanitation and USAID which provided the funding.

Ruth Odhiambo, Project Director,APHIAplus Nuru ya Bonde

Forward


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This publication is the result of the collaboration of many institutions and individuals. The initial draft of the fact sheets was developed by APHIAplus Nuru ya Bonde Associate Directors Richard Odindo (Health Communication), Charity Muturi-Njeru, Program Management) and the project’s Community Strategy Team, led by Acting Senior Technical Advisor, Duncan Ager. Many colleagues from the project and partners contributed to the process of refining the content.

We especially acknowledge the support from the Ministry of Health who provided technical direction, especially the Provincial Director of Public Health and Sanitation, Rift Valley, Dr. Ejersa Waqo, the Provincial Public Health Officer, Mr. Isaac Ruto, the Provincial Community Strategy Focal Person, Mr. Daniel Mwangi and the Provincial Public Nurse, Mr. Chris Lengusuranga.

We also thank all those who helped to review and pretest the fact sheets among Community Health Workers in Laikipia and Loitoktok. The team included the following: Richard Odindo, Kennedy Odera, George Oele, Humphrey Munene, Benson Mbuthia, Hesbon Simba, John Ndiritu, Benjamin Cheboi, Purity Njogu, Benard Odhiambo, Duncan Ager, Judy Akinyi, David Wetisia, Ronald Chirichir and Oliver Furechi (all of APHIAplus Nuru ya Bonde); Christopher Lengusiranga, Daniel Sironka, Daniel Mwangi, Margaret Mugo, Eunice Maina, Charles Kariuki and Florence Nyokabi Githenya (Ministry of Health).

Richard Odindo provided technical oversight in the process to develop this publication and George Nyairo Obanyi (Information Officer, APHIAplus Nuru ya Bonde) editorial support. Proofreading by Nicole McMahon. Rachael Manyeki (Program Officer) helped to coordinate the various teams.

Graphic Design by Sunburst Communications Ltd.Illustrations by Ben Nyangoma.

Special thanks to the APHIAplus Project Director, Ruth Odhiambo, for her support and encouragement to the teams in the publication process.

This publication is funded by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-623-A-11-00007.

The contents are the responsibility of Family Health International (FHI 360) APHIAplus Nuru ya Bonde project and do not necessarily reflect the views of the US Government.The content may be freely reviewed, quoted, reproduced, or translated provided it is not for commercial gain. Partial of adaptive use of this work is also welcome, provided permission is first obtained from FHI 360. FHI 360, USAID and APHIAplus Nuru ya Bonde must be prominently acknowledged in any publication and two copies must be submitted to APHIAplus Nuru ya Bonde. Contact: [email protected]

©2012 Family Health International

Acknowledgements


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Fact Sheets

forCommunity Health Workers

in APHIAplus Nuru ya Bonde


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Introduction

In countries where formal health workers are too few, Community Health Workers (CHWs), frontline volunteers, have an important role to play in providing services to the poorest and most vulnerable communities. As members of the communities within which they work, CHWs know and understand the health needs of those around them. Moreover, they can be trained and deployed quickly, and are unlikely to emigrate.

CHWs include the most generic type of community based workers such as village health workers (VHWs) or community resource persons (CORPs). In addition to generalist CHWs there are more specialised cadres such as community rehabilitation facilitators (CRFs), community-based directly observed therapy short-course (DOTS) supporters, HIV/AIDS communicators (HACS), home based care (HBC) workers and first aid workers.

All these types of CHWs carry out one or more functions related to health care

delivery. They are trained in the context of anintervention but usually have no formal professional or paraprofessional education.

The use of CHWs has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries. The World Health Organization (WHO) now recognizes CHWs as important in task-shifting the process of delegation whereby tasks are moved, where appropriate, to less specialised health workers.

CHWs are now taking on more roles in primary health care. However, for CHWs to effectively play their role there is need for simple, standard approaches and tools to inform their work. These fact sheets are intended to contribute to addressing this need by providing easy-to-understand information and standard messages on common health challenges.

To reflect real needs on the healthcare frontline, this publication was designed

through participatory process involving diverse stakeholders, including the CHWs themselves. It started with an APHIAplus Nuru ya Bonde team reviewing various reports documenting gaps in information among CHWs and interviews with trainers and program managers. The rapid needs assessment together with the scope of work for CHWs in APHIAplus Nuru ya Bonde informed selection of topics for the fact sheets. A team led by APHIAplus Nuru ya Bonde staff then compiled the first draft, which was subjected to a technical review by the team and representatives of the Ministry of Health. The revised copy was pretested among CHWs in the field and their feedback incorporated in the final draft.

Intended use of this publication

These fact sheets are in no way exhaustive. They cover topics that were identified as most important for CHWs inthe project area, Kenya’s Rift Valley region. The


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fact sheets are primarily intended to provide a reference point where CHWs and other frontline health workers can find standard information and messages to support their work in the community. However, trainers could also find the information contained in the fact sheets useful in training community health workers and community leaders. The facts sheets can also serve as a primary source for production of various job aids such as flipcharts and flyers for use in the community.

Types of informationThe fact sheets contain different types of information as to assist in:

Procedures: The fact sheets remind workers of the steps or actions to take while performing a particular task. These job aids contain a set of instructions, simply stated and usually illustrated, but with enough detail so workers can take the necessary actions.

Information: The fact sheets contains facts that a worker may need to have in order to perform a specific task. They usually answer the following questions:Who? What? When? Which? Where?

Decision-support: The fact sheets faciliate decision making, problem solving, and self-evaluation. They answer the following questions: Why? Which way? Which one?


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1.Key Messages• Attendanantenatalclinicfourtimes

during each pregnancy.• Eatabalanceddietandgetmorerestthan

usual during pregnancy.•WomenandtheirpartnersshouldseekHIV

counselling before having a baby.• Obtaintwodosesoftetanusimmunisation.• Seekhelpimmediatelyfromthehealthcentre

for a pregnant woman with danger signs.• Swollenfaceandhandsaresignsofa

dangerous condition associated with high blood pressure in the mother that can also harm her baby.

• Fitscancausethedeathofthemotherand her baby.

•Whenyouhaveswollenfaceandhands,goimmediately to the nearest health facility to receive care.

• Takeapregnantwomanwhoishavingfitstothe nearest health facility.

Fact Sheet on on Antenatal Care

Prevention

All pregnant women should do the following:•Attendantenatalclinicatleastfourtimesbefore

delivery during each pregnancy.• Visitantenatalclinicassoonasyoumissthree

menstrual periods.• Eatabalanceddietandgetmorerestthanusual

during pregnancy.• Obtaintwodosesoftetanusimmunisation.


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• Sleepunderabednetwhenpregnant.• Takeironpillsduringpregnancy.• Encouragepregnantmotherstodeliveratthehealth

facility.

Role of CHW• Encourageyourcommunitytosupportpregnant

women.• Visitpregnantwomeneachmonth.• Encouragepregnantwomentoattendantenatalclinic.• Discussbreastfeedingandnutritionwithpregnant

women.• Referapregnantwomanwithdangersignstothe

health centre immediately.• Encouragepregnantwomentoprepareforbirth

(birth plans).• Involvehusbandorpartnerinthebirthplan.

Pregnancy Danger Signs• Vaginalbleeding.•Waterbreaksbeforetimeofdelivery.• Convulsionsorfits.• Prolongedlabourover12hours.• Severeabdominalpainbeforedelivery.• Highfever.• Feelingthebabymovinglessornotatall.• Swellingoffaceandhands.• Severeorcontinuousheadacheformorethan12

hours.• Severeorcontinuousvomiting.

CHW


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The care of a newborn begins with good care for the mother during pregnancy and delivery. Mothers need to prepare for delivery at a health centre or with the help of a skilled birth attendant at home. They should be encouraged to have a Personalised Birth Plan. The pregnant woman should prepare a clean tie, rubber gloves, a dry blanket, a clean blade and some clothes for the baby. This is part of the plan.

A good plan will ensure the woman delivers at a health centre.

If the woman fails to make it to the health centre and delivers at home, cut the umbilical cord with a new, clean blade. Tie the cord with clean tie. Keep newborns warm. Wrap the new born in a clean, dry blanket. Newborns can be warmed by placing them skin to skin with the chest or abdomen of their mother and covering them.

Rural women work hard and long hours, from early in the morning until late at night. Women clean,


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collect water, work on the farm and cook. A pregnant woman may not be able to do all this work. She needs extra rest, a balanced diet, and effective care before pregnancy.

Remember: A pregnant women is looking after two people, herself and her baby.

Pregnant mothers need to eat well. A balanced diet helps the baby grow stronger and helps to prevent illness. Mothers who are weak produce low weight babies. A good diet includes a lot of fruit, vegetables and animal foods, especially meat and fish. Pregnant women should use iodised salt and drink plenty of water.

Encourage pregnant women to eat additional small meals each day such as bananas and groundnuts. Women need to take one iron pill a day during pregnancy.


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A pregnant woman needs to attend antenatal clinic at least four times during each pregnancy. She should start attending antenatal clinic after she has missed three menstrual periods. At the antenatal clinic, health workers check the woman’s weight and blood pressure. Women are also immunised against tetanus to protect them and the unborn baby. Women are advised on how to care for themselves and prepare for child birth.

• Pregnantwomenaremoreatriskfrommalariaandshould sleep under a bednet. If a woman gets malaria or a fever when pregnant, she must seek treatment immediately.

• Pregnantwomenshoulddolessworkifpossible.


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• Allpregnantwomenshouldseekcounsellingfromthe health centre about HIV and AIDS before delivery. Drugs can be given to protect a newborn from HIV. Women are advised to seek HIV and AIDS counselling with every pregnancy.

CHWs can help make motherhood safer by learning to recognise pregnancy danger signs. Danger signs in pregnancy include bleeding, premature labour and breaking water early. A woman who is relaxed, knows what to expect and has prepared for birth is more likely to have a successful delivery.

To make motherhood safer, everone in the community needs to learn about pregnancy and child birth. This includes boys, girls, men and women of all ages. When danger signs in pregnancy appear, a woman may not be able to take action or make decisions by herself. She needs other people to ensure she gets the treatment she needs.

Quick action can save the life of the mother and baby. Avoid delays.

The first delay comes in deciding there is an emergency. It can take time for people to agree to take action. After the decision is made, there is often more delay in referring the woman to a health centre.

CHWs can educate community members about pregnancy danger signs. When pregnancy danger signs arise the woman must be taken to the health center immediately. If a community is prepared, both money and transport can be made more readily available for an emergency. A transport plan can make the difference between life and death.

Men often make the decisions about transportation and health care. Men should be involved in discussions about pregnancy, childbirth and the need for women


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to be taken to hospital when they see danger signs. The loss of a woman in pregnancy affects not only the baby she carries but all her children, her husband and the whole community. Discussion about a mother’s death can make the community aware of how important it is to avoid deaths due to pregnancy. Drama, dance and song about aspects of safe motherhood are a good way to spread these ideas in the community.

What a woman can do to protect herself and her baby during her pregnancy• Getvaccinatedagainsttetanus.• Protectherselfandthebabyfrommalariabysleeping

under insecticide-treated bednets and taking the recommended doses of medicine for malaria.

• Taketherecommendeddosesofironandfolatetoavoid anemia.

• Eatfoodsofhighnutritionalvaluesuchasmilk,cheese, eggs, meat, fish, oils, nuts such as peanuts, seeds, cereals, beans, vegetables and fruit. Such foods are especially important during the last months of pregnancy. Among these nutritious foods, women can give priority to those that are more readily available and affordable.

• Useiodisedsaltwhencookingtopreventmiscarriagesand damage to the baby’s brain.

• GettestedforHIVtoreceivecareandprotectyourbaby.• Getscreenedforsexuallytransmittedinfections

(STIs), including syphilis and other reproductive health infections or diseases that can affect your health and that of the baby.

Prepare for birth and make plans in case of complicationsAlthough giving birth is usually a normal process, it is important to plan for the delivery and to be prepared in case of any complications or emergencies to protect the health of the woman and baby. Preparing for the delivery allows you to plan for the best available care. Here are some things to consider for the plan:


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• Identifytheplaceofyourdeliverywithyourhealthworker and birth partner.

• Discusswiththenurseormidwifewhenyoushouldgofor antenatal visits, when to reach the centre for the delivery and what to take with you.

• Preparethenecessarymaterialsforyourselfandforyour baby.

• Saveenoughmoneyforgoingtothehealthcentreforthe delivery and complications, other medical expenses and for the transport.

• Identifythetransporttobeusedtothehealthfacility.• Planwhowillgowithyouforsupportduringdelivery

and who will help at home while you are away.

Giving birth in a facility is recommended because:• Complicationscandevelopatanytimeduringdelivery

without warning.• Ahealthfacilityhasstaff,equipment,suppliesanddrugs

available to provide the best care.

Important points to Note:1. Immunisation of antenatal women provides immunity

against infectious diseases which cause problems such as tetanus in newborns.

2. Pregnant women should visit the clinic at least four times during each pregnancy for antenatal care. They will be immunised, weighed, receive iron pills and counselling.

3. Abnormal bleeding, convulsions (fits), severe pain, rupture of membrane and prolonged labour are danger signs in pregnancy which require a pregnant woman be taken to the health centre.

4. Under-nourished mothers are at risk of giving birth to unhealthy babies who do not thrive following delivery.

5. During pregnancy, women are more at risk of malaria which can kill. They should sleep at night under insecticide-treated nets.


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2.Key Messages• Encouragemotherstodeliverinahealth

facility or under the care of a skilled birth attendant at home.

• Breastfeedinghelpsinfantstogrowandstay healthy.

• Keepnewbornbabieswarm.• Newbornsmayshowdifferentsignsof

illness.

Fact Sheet on Newborn Care

Prevention• Immunisepregnantwomenatleasttwotimesfor

tetanus.• Useacleantieandnewbladeforthecordatdelivery.• Keepnewbornswarmanddry.• Ensureanewbornisweighedandimmunisedbefore

one week of age.• Refersicknewbornstothehealthcentreearly.• Deliveryinahealthfacility.

Role of CHW• Encouragepregnantwomentoprepareforchildbirth.• Visitnewmotherswithinthefirstweektosupportand

educate them on how to care for the newborn.• Ifamotherdeliversathome,encourageherto

visit a health centre immediately for the baby to be immunised.

• Supportmotherswithsmall,earlyorsickbabies.• Encouragemotherstostartbreastfeedingearlyand

keep babies warm.

CHW


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Newborn Danger Signs•Poorbreastfeeding•Fever•Fastbreathing•Verysleepy•Convulsionsandfits

The care of a newborn begins with good care for the mother during pregnancy and delivery. Mothers need to prepare for delivery at the health centre or with a trained birth attendant at home. Prepare a clean tie, rubber gloves, a dry blanket, a clean blade and some clothes.

In case a women does not make it to the health centre and delivers at home, cut the umbilical cord with a new, clean blade. Tie the cord with a clean tie.

Keep newborns warm. Wrap the newborn in a clean, dry blanket. Newborns can be warmed by placing them skin to skin on the chest or abdomen of their mother and covering them.


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The best food for a baby is breast milk. Start breastfeeding within one hour of birth. Give only breast milk until the baby is six months of age. DO NOT give cow’s milk, water or other liquids. Breastfeed a newborn baby eight times every 24 hours.

Newborn babies need special care in the first month of life. A CHW and a skilled birth attendant can help the mother prepare for and care for her newborn.

Newborn babies account for many deaths among children under five years. Newborn babies may suffer from prematurity (effects of being born too early), low birth weight, problems with breastfeeding, infection and birth trauma. Out of every 20 children born in Africa, one dies before they are one month of age.

Take the child to the health centre within the first week for immunisation and weighing.

Take a child with danger signs to the health centreimmediately


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A community health worker can help a new mother care for a newborn at home. A CHW can help the mother decide when a newborn should be taken to the health centre for immunisation or treatment.

A mother who has recently delivered may not be able to walk a long way with a sick baby. A CHW can help a mother to take a sick newborn to the health centre. Encourage men to help mothers with young babies.

Danger signs• Newborndangersignsdifferfromthose

of older children.• Asleepynewbornwhofeedspoorlyis

sick.• Anewbornwithanyfeverissick.• Anewbornwhoiswellatbirthbutstops

feeding in the first or second week of life is sick.

•Watchnewbornsforpoorfeeding,fever,skin sores, eye discharge and a cord which is red or has pus.

• Takeanewbornwithdangersignstothehealth centre immediately.


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3.Fact Sheet on Child Health

It takes a whole village to raise one childAfrican Proverb

Key Messages• Childrenneedlove,careandattention

in the first years of life to grow and thrive.

• Involvethewholecommunityinchild health activities.

• Encouragepeoplebyexample.

In a ‘Child-Friendly Society’ everychild would have: •Alovingfamily •Enoughtoeat •Aqualityeducation •Adequatehealthandmedicalcare •Acomfortablehome •Respectanddignity •Safetyandprotectionintimesofneed •Accesstocleanwaterandadequatesanitation

Community volunteers such as CHWs and Community Owned Resource Persons spend much of their time in activities that prevent and reduce illnesses that affect children. They also encourage the growth and development of children. They do this by supporting parents and caregivers to provide nutrition and stimulation to children, especially in the first five years of life.

A child needs enough to eat, a good education, a home and loving family, safety, access to health care, dignity and a suitable environment. A child needs to receive love


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and attention. Every child needs to be hugged and held. A child needs protection from neglect and the safety so they can have a chance to explore and learn.

Many people other than a mother can provide care for a child. Fathers are important to children and need to spend time with them. Children respond to encouragement and appreciation from their fathers.

Grandparents, older siblings and other adults such as neighbours and friends also play a role.

Child development is the process by which a child gradually learns more complicated levels of moving, thinking, speaking, feeling and relating to others. The first three to five years of a child’s life are especially important for creating a strong and resilient child, who becomes able to overcome later difficulties in life. While all children go through the same steps as they grow, the rate of development may differ.

It is women who mostly care for children but men also have an important role to play. Men often control

A child is theadornment of the homeAfrican Proverb


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the money and make the major decisions that affect children such as when and where they should go to schol. When men appreciate the importance of child care activities, they are more likely to support them.

For example, a woman who is supported by her husband in breastfeeding is more likely to succeed and continue doing it for two years. When men appreciate the importance of women visiting the clinic for antenatal care during pregnancy, they can help organise health services and transport that can save the lives of women.

A CHW can still improve the health of children in her community by involving the whole community. Everyone has a role to play – men, women, teachers, local leaders and older children. Older children often care for younger ones and can learn to do so safely.

A child without both parents is vulnerable and faces many dangers. If parents neglect a child or a child is orphaned, a CHW can help by involving other adults in the community to support the child. Adults can help by taking an interest in children in need of help. They can make the children feel comfortable and include them in family and community activities. A child with at least one caring adult in his or her life can survive a difficult upbringing.

The whole community can encourage parents with a disabled child to help the child to reach his or her full potential. Diasabled children and those with special needs and from poor families can benefit if a CHW shows interest in their wellbeing.

Treat all children as valuable individuals. Encourage and praise them. Children copy what they see done around them. Much of what makes a difference for the health of a child happens at home.


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CHWs should encourage good child care practices. These include preparing and feeding a child healthy food, good hygiene, showing love, playing with and valuing every child as he or she is. Communities can help by making safe places for children to play. Support provided by men can make a big difference in creating healthy communities.

The United Nations Convention of the Rights of Children

Children have the right to:• Protection

– From injury and from physical and emotional harm

• Survival– Includes food, shelter, safety and

health care• Development

– The right to grow, develop and play• Participation

– To share in the life of their family, school, community and nation

Adopted in 1989 by all countries

Show every child love and stimulate their growth by playing with them.


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4. Fact Sheet on Growth Monitoring

Role of CHW• Identifymotherswhoarenotgainingweightduring

pregnancy and discuss this with them.•Weighchildrenwhentheyareimmunised.• Identifychildrenwhoarenotgrowingwellandtake

action.• Promotegoodnutritionandgrowthofchildrenwith

the whole community.• Discussgrowthofchildrenwithmothers.• CheckthatallchildreninthevillagehaveaChild

Health Card.• Ensurethatchildrenunderoneyearoldareweighed

when they are immunised.• Makefollow-upvisitstohomesofunderweight

children.• Discussprogressofanunderweightchildwiththe

mother or caretaker each month.

Malnutrition and growth monitoring• Childrenbecomemalnourishedwhentheydonot

receive enough nutritious food. Malnutrition is serious in children.

Key Messages•Weighandimmunisenewbornsbefore

they are one week old.•Weighchildrenwhentheyareimmunised.• Supportmotherswhohavechildrenwho

are not growing well.• Providesomepracticalcounsellingto

mothers of underweight children at each visit.

CHW


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• Malnourishedchildrenareillmoreoftenthanhealthychildren.

• Feedingchildrenwellprotectsthemagainstillness.• Malnutritionismostcommonbetweensixtotwelve

months of life.• Malnutritionoccursmorefrequentlyaroundthetime

of weaning a child from breast milk to table food. • Mostchildrenwhohavebeenundergoodnutrition

grow well within the first year of life. A child who does not grow well is more prone to disease.

• Growthmonitoringneedstobeginearly.•Weighingchildrenlessthanoneyearofageisthe

first priority. They should be weighed every month and during immunisation. Children who are growing well after one year of age can be weighed every six months when they receive Vitamin A drops and deworming treatment.

• Childrenwhoarenotgrowingwellbetweenoneandthree years need to be weighed frequently until their weight improves.

• Growthmonitoringhelpsustofindchildrenwhoareunderweight.

Effective GrowthMonitoring

• Start early• Involve mothers• Understand local

beliefs• Follow up

underweight children

• Promote growth


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Counsel mothers of underweight children and follow-up• Explainthemeaningofthechild’sweighttothe

mother or caretaker every time the child is weighed.• Mostmotherssoonlearntounderstandgrowth

charts.• Ifgrowthofachildispoor,trytounderstandwhy.• Discusspracticalwaystoimprovethechild’sgrowth

with the mother and family.• Followupchildrenwhoareunderweight.• TheCHWandstaffatthehealthcentreneedto

work together to identify and assist children at risk of malnutrition. The CHW can help to explain good nutrition to the family. The CHW can help families stake action. The CHW can also involve community leaders and others who can assist the family to improve the diet of a child.

• Growthfailureofachildcanstartduringpregnancy.Mothers should gain about 10 kilos during pregnancy or about one kilo every month. Weighing pregnant women, especially during the last six months of pregnancy, can identify mothers who need to improve their diet. Well-fed mothers give birth to well-nourished babies.

• Some malnourished children may be very thin and small.

• Some malnourished children may have swelling of the stomach, legs and hands.

• In times of drought and insecurity, most children may be under nourished.

• Growth monitoring needs to be actively followed up by nutrition counselling and monthly follow-up.


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5. Fact Sheet on Breastfeeding

Key Messages• Beginbreastfeedingwithinthefirsthour

of birth.• Breastfeedbabiesexclusively(without

giving water or anything) up to six months.• Givebreastmilk,extrafluidsandfoodtoa

sick infant.• Breastfeedinghelpsababykeephealthy

and grow well.• Breastfeedingofferssomeprotectionfrom

disease.

NOTE TO MOTHERS: Correct way to breastfeed• Tobreastfeedyourbaby,makesurethatyouare

seated or lying down comfortably. A correct posture will keep you from getting tired too quickly or stopping breastfeeding before the baby is satisfied.

• Toallowyourbabytogetenoughmilknecessaryforgrowth from each feeding, make sure he/she is in a good position:- The baby’s whole body is fully supported, the baby

is held close, at the level of the breast, and turned toward the mother.

- The baby’s mouth and chin are close to the breast.

• Toavoidpaininthenipplesandtomakethebabysuckeasily, make sure that your baby’s mouth is attached properly to the breast. You can check by making sure:- The baby’s chin touches or is very close to the

breast.


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- The mouth is wide open.- The area around the nipple is more visible above

the baby’s mouth than under it.- The lower lip is turned out.

Role of CHW• Educatefamiliesabouttheimportanceof

breastfeeding.• Supportbreastfeedingmothers.• Encouragemotherstobreastfeedimmediatelyafter

birth.

Breastfeeding helps a baby to grow and protects a baby from disease. Begin breastfeeding within one hour after birth.

Colostrum is the first, watery milk which comes after birth. Colostrum is good because it protects a baby from sickness.

CHW should advise mothers:• Tobreastfeedatleasteighttimeseverydayincluding

at night.• NOTtogivebabiesotherfood,waterorliquidsinthe

first six months of life.• Tocontinuebreastfeedinganinfantuntiltwoyears

of age. Pregnant mothers can still breastfeed. • Mothersoftwinscanbreastfeed.

Mothers who are HIV positive can breastfeed their newborns for the first three months from birth if they ONLY use breastmilk. Some mothers may choose to use milk formula. Breast milk gives the best start for a child.

CHWs can support breastfeeding mothers:• Newmotherswhoarebreastfeedingforthefirst

time can learn from mothers with experience.

CHW


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• Checktoensurenewmothersarenothavingproblems and help them solve problems they may face.

• Encouragemotherstoeatagooddiet,drinkplentyof fluids, and rest to ensure a good milk supply.

• Continuetogivebreastmilk,extrafluidsandfoodto a sick child over six months. Go to health centre if you have problems that make breastfeeding hard.

What CHWs should tell mothers and families• Breastmilkisthebestfoodforbabies.• Breastmilkprotectsagainstinfections,whichare

common causes of illnesses and deaths in newborns.• Breastfeedthebabywithinthefirsthourafterbirth

to promote milk production and to give the baby the benefits of colostrum. Colostrum is the first milk that comes out soon after birth.

• Colostrumprotectsthebabyfromillnesses.Giveitto your newborn baby.


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• Immediatebreastfeedinghelpswithdeliveryoftheplacenta and reduces bleeding in the mother.

•Whilebreastfeeding,waituntilthebabyletsgoofthenipple on their own before giving to the other breast. In this way, the baby will receive the fat-rich milk that comes out near the end of a feed as the breast gets emptied.

• Breastfeeddayandnightwheneverthebabywantsmilk. This will promote milk production. It will also prevent breast becoming too full and painful.

• Exclusivebreastfeedingisessentialduringthefirstsix months. This means giving only breast milk. DO NOT give water, tea, herbs, other liquids or foods. During this period, breast milk is a complete food and contains all the water a baby needs, even in hot climates.

• Exclusivebreastfeedingondemandduringthefirstsix months can also prevent pregnancy if a woman’s menstrual periods have not returned. After this time, another method needs to be used to avoid pregnancy.

Remember to advise the woman on the need for HIV testing if her HIV status is unknown. If she is HIV-positive, encourage her to go to a health facility for appropriate counselling.

Breast CareWomen may have breast problems that interfere with breastfeeding. One common problem is a cracked nipple which hurts the mother when the baby feeds.

Ointment may help if it is available. Some mothers with very sore nipples may have to give up breastfeeding for a few days. She can begin to breastfeed again when the nipple heals. If the child stops sucking the nipple, the mother needs to continue to express her breast milk by hand and give it to the baby.


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Women who are breastfeeding can develop an infection in their breast. An infection makes the breast hot and swollen and painful. Often a lump can be felt. Pressing the area with a cloth dipped in hot water can help to reduce the pain. Antibiotics are needed to treat breast infection.

A woman with hot swelling needs to go to the health unit. A woman can breastfeed from the healthy breast and express breast milk by hand from the affected breast until it is better.

How to manage problems during breastfeeding

• Positioning: Wrong positioning can lead to cracked nipples and mastitis.

• Mastitis is burning (inflation and infection) felt in the breast as a result of not breastfeeding long enough or frequently enough. Breastfeed one breast at a time until the baby empties it.

• Cracked nipples. Causes by pulling the child from the breast. Tickle the child on the check for them to release the breast.

• Pus: Caused by not emptying breasts. This should be treated in hospital.


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6. Fact Sheet on Immunisation

Key Messages• Ensureeverychildisfullyimmunised

(6 times) before one year of age.• Immunisationprotectsagainsteight

killer diseases.• Immunisationissafe.• GivechildrenVitaminAonceeverysix

months, starting at six months of age.• Dewormchildreneverysimonths

starting at one year old.• Itisimportantthatchildrencomplete

all immunisations.• Childrenwhohavenotbeen

immunised should be referred to a health facility.

Prevention• Ensureeverychildisimmunisedsixtimesbeforethey

reach one year of age.• Childrenagedoneyearandaboveshouldbe

dewormed every six months.• EnsureachildisgivenVitaminAonceeverysix

months, starting at six months old.

Home Care• Ifpainorrednessonthearmorlegdevelopsafter

immunisation, DO NOT rub.• Givethechildparacetamol.Ifpainandredness

persists, refer the child to the health centre.• Takeachildwhopasseswormsfordeworming

treatment.


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Role of CHW• Remindfamiliestotakechildrenforimmunisation.• Educateaboutimmunisation,VitaminAand

deworming for keeping children healthy.• Traceallchildrenwhohavedefaultedfrom

immunisation and refer them to the health facility.• MobiliseyourvillageforChildHealthandNational

Immunisation Days.• RemindparentstobringChildHealthCardsfor

immunisations and Child Health Days (even if they have been immunised before).

• Encourageparentstodewormachildeverysixmonths.

•Watchforchildrenwhohavebigbellies,whopassworms or who are weak.

• Encourageparentstotakechildrentothehealthcentre to be dewormed.

Every child should be immunised six times from the time they are born until one year of age

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ImmunisationImmunisation is safe and protects a child from six diseases that kill. Even sick children may be immunised. Every child needs to be taken for immunisation six times before they are one year of age. When all children in a community are immunised diseases spread less.

Immunisation at birthThe first time to immunise a child is at birth. Every child should be immunised for tuberculosis and polio before one week of age.

Immunisation at six weeks, 10 weeks and 14 weeksThe next three immunisations start at six weeks of age. These immunisations provide protection for eight diseases. These disease are: polio, diphtheria, pertussis, tetanus, hepatitis B (HepB), hemophilus influenza B (Hib), measles and pneumonia. These three immunisations are given four weeks apart. They can be given at six weeks, 10 weeks and 14 weeks of age.

Measles immunisationThe last immunisation is for measles. It can be given at nine months of age. Most vaccines are given by injection to the arm or leg. Polio vaccine is given by drops in the mouth. Some babies get mild fever or swelling after an immunisation. This is normal. It means the baby is building defences against the disease.

Advantages of Vitamin A• Makeschildrenstrongandhealthy.• Keepseyeshealthy.• Helpspreventsicknesslikemeasles,diarrhoeaand

chest infections.

Children should receive Vitamin A drops every six months starting at six months old. School children also need to receive Vitamin A drops twice a year.

Foods that contain Vitamin A include orange and yellow fruits and vegetables such as mangoes, pawpaw, pumpkin, carrots, maize, yellow sweet potatoes, red palm


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oil and bananas. Vitamin A is also found in dark green and medium green leaves such as spinach, kale (sukuma), the leaves of cassava, cowpeas, sweet potatoes and beans.

Remember: Older children and adults also need foods that are rich in Vitamins.

DewormingWorms cause sickness and make a child weak. Worms can grow inside a child. Give all children deworming tablets every six months starting at one year old. Deworming tablets are safe for children. Deworming tablets kill any worms inside the child. School children should be dewormed every three months.

Children with worms may have anemia (low blood count), big bellies and may pass worms in their faeces or vomit. If you observe a child pass worms or if you think a child has worms, do not wait. Seek treatment for the worms at the health centre.

More information on immunisation

1. At birth: BCG, oral polio.2. At 6 weeks: First Penta, First Polio, First

pneumococcal.3. At 10 weeks: Second Penta, Second Polio, Second pneumococcal.4. At 14 weeks: Third Penta, Third Polio, Third

pneumococcal.5. At 6 months: Vitamin A 100,000 International

Units (IU).6. At 6 months: Measles.• If a child has not received any of the above

immunisations, they can start, provided they are under five years. If you find a child who has not been immunised, refer the child to a health facility.

• During special campaigns, ensure children are immunised again, even if they have received the vaccine before.


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7. Fact Sheet on Weaning

Key Messages• Atsixmonthsofage,feedachildusing

their own plate.• Localweaningfoods,suchasmillet

porridge are good for babies.• Introducenewweaningfoodsslowly,one

at a time.•Washyourhandsbeforepreparing

weaning foods.

Role of CHW• Educatefamiliesaboutweaningfoodsandtheir

preparation.• Encouragefamiliestohavehomegardens.

A baby needs the important nutrients in breast milk until the age of two years. After six months of age, a baby is growing so fast he needs extra food as well as breast milk. At this stage, weaning the baby should start.

Weaning is a gradual process by which an infant becomes used to food other than breast milk. Weaning foods do not take the place of breast milk but add to it. When the baby is six months of age, other foods should be given in addition to breast milk. Mothers should still give breast milk as often as the child wants. They should continue breastfeeding until the child is two years old.

Weaning foods must be prepared carefully. If weaning food is not prepared in a clean way, a baby can become

sick. Mothers should wash their hands before preparing food and when feeding the child. If the

baby touches the food, his or her hands also need to be washed. Infection can be avoided by keeping food and hands clean.

Babies should be fed with a clean cup and spoon.

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Advice for mothers:• Startweaningwhenthebabyissixmonthsold.Start

with thick porridge made from freshly prepared soft foods such as millet, maize, soybean flour or cassava. Millet porridge is one of the best weaning foods for babies. Make the porridge thick and don’t put too much water. This will nourish a baby.

• Mixmilk,sugarandfatintoporridgetomakeitricher

and easy to swallow. Give porridge at least three times a day if the baby is still breastfeeding. Give porridge five times a day if baby is not breastfed.

• Onceachildtakesporridgewell,addothermashedfoods. To make a balanced diet, include food from all of the four food groups. Weaning foods can also be made from rice, yam, Irish potato, sweet potato, breadfruit and banana.

• Aftertheinfanthaseatenporridgeandmashedfood for two weeks, add some fruit, vegetable, oil, fish, eggs or meat to the baby’s meals. Continue breastfeeding. Babies can eat food from the family pot. Take the food for the baby out of the pot before spices and salt are added. Mash the food. It is good to add some oil, dark leafy vegetables and egg.

•Encouragethebabywhenheorshestartstoeatfamily foods. Be patient with the baby. At first babies are messy. They spit food out as they learn to chew. Spitting means the baby is getting used to the food.

•Startweaningwithoneortwospoonfulsofmashedfood just before breastfeeding the baby. Slowly increase the amount of mashed food and the number of meals. Let the baby get used to one new food before another is introduced.

By eight months of age, the baby needs four meals each day as well as breast milk. By one year of age, an infant can eat all types of family food. Some food may need to be mashed for a one-year-old child. At one year of age, a child needs about half the daily amount of food that the mother eats.


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8.Fact Sheet on Feeding the Young Child

Key Messages• Healthyfoodkeepsachildhealthy,strong

and smart.• Healthyeatingprotectsachildfromillness.• Feedachildabalanceddietwithprotective,

body-building, fat and energy foods.• Feedachildfoodfourtimesadayplus

breast milk.• Feedachildwhodoesnotbreastfeed

three meals and two snacks a day.• Promotegoodeatinghabits.

Role of CHW• Educatemothersabouthealthychildfeedingand

nutrition.• Encouragehomegardens.• Adviseparentstocontinuefeedingasickchild.• Educatemothersaboutthefourfoodgroups.

Food is important to make a child healthy. A balanced diet for children over six months of age includes protective foods, body-building foods and energy food at every meal. A spoon of fat or oil in each plate of food for a child adds energy. A child needs food from all of the food groups.

Give adequate servings of food. After weaning, continue to breastfeed a child as often as he or she wants until two years of age.

Feed a child using their own plate. A small child eats slowly. Let them touch and pick up food by themselves. Praise and encourage them as they learn to eat. Feed a young child food four times a day and continue to give them breast milk. Give the child nutritious snacks like egg or banana.

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Give children their own bowl or plate. A child may not get enough food if others share the bowl or plate. It is also hygienic for a child to use their own bowl. By one year of age a child should be able to use a spoon. Children will be messy at first. Love, patience and encouragement will help them learn. Mothers bond with their child when they watch them eat.

Feed a child food that is rich in Vitamin A and iron. Vitamin A, iron and iodine help the body to grow and prevent illness. Iron is found in leafy green vegetable and millet. Vitamin A is found in leafy greens and fruits such as pawpaws, carrots, banana and mango. Iodine is found in treated salt.

Types of food Category Benefits Minerals/Vitamins

Beans, ground nuts, simsim, peas, milk, eggs, yoghurt, soybeans, liver, millet, fish, eggs, meat, chicken and grasshoppers and locusts.

Body building, make us grow, rich in proteins, vitamins and minerals

Enhance growth

Vitamin A, B, D, E, K and calcium

Cassava, bananas, Irish potatoes, maize, sweet potatoes, yellow bananas, millet, rice, pasta, bread, maize (ugali), oil, butter, margarine and sugar.

Energy foods Provides energy to our bodies. Add fibres

Potassium iodine

Carrots, pumpkin, onion, pineapple, passion fruit, mango, tomato, paw-paw and dark green leaves. Protective foods

Protects the body against diseases

Vitamin A, B, D, E, K and zinc


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Fact Sheet on Hygiene

Key Messages• Bathingregularlypreventsdisease.• Disposeofhumanfaecesinalatrine.• Sundrydishesonaraisedrack.• Keepthecompoundandlatrinecleanand

free of brush.•Washyourhandsatthefourcriticaltimes.

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Prevention• Batheregularlytopreventskinandeyedisease.• Coverfoodtokeepfliesaway.• Afterwashingdishes,drytheminthesunonaraisedrack.• Disposeoffaeces,eventhoseofchildren,inapitlatrine

or bury them.

Home Care• Cleanskininfectionsandapplyrecommendedmedicine

to areas with redness, pus and ring worm.• Ifarashisitchyanddoesnotgoawayafterafew

days, ask a health worker if you should be treated for scabies.

• Ifonechildhasscabies,washallthefamilybeddingandclothes and treat the child and all family members to avoid the disease spreading.

Role of CHW• Supporteffortstoincreasecleanliness.• Identifychildrenwithskinproblemsthatcanbe

treated.• Provideanexampleofgoodhygienebydoing.• Encourageschoolstoprovidetippytaps(leakytins)for

pupils to wash their hands.

9.


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For many rural women, carrying enough water just for drinking is a big job. Woman may need to work on the farm, look after the children and make them meals. Sometimes a woman may not have the time and energy to make several trips to get water for washing.

Our first response when we find an unclean home should be sympathy for the mother. A CHW needs to find out about a situation before making suggestions. Listen to the mother. Find out why she has trouble keeping the home clean. Find something she is doing well and praise her for it.

The whole family benefits if we are patient and able to help the mother keep the home clean.

Let water boil for a minute to make it safe.

A CHW can help by discussing what the mother can do as the first step. People can make changes when they feel hopeful. Being told we are not clean is hurtful. Such messages make us feel bad and are unlikely to motivate us to improve.


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Washing is a very important health practice. Bathing regularly can prevent skin diseases such as ring worms, scabies, pinworm and infected eczema.

Skin disease is common in children.

Skin disease is one of the most common diseases. It causes itching and often the skin gets infected. If you think a child has scabies or other skin disease take the child to see a health worker.

Skin diseases cause discomfort to a child. Skin disease can cause a child to feel isolated. Children with skin infection should not share clothes.

Skin disease does not mean one has syphilis.

Washing the face regularly can prevent eye infections such as trachoma.

A tippy tap (leaky tin) can be made from a plastic container. Tipping the spout allows a small amount of water out each time, enough for a child to wash their face and eyes. Bathing regularly can be done using small amounts of water. One small container can allow a whole classroom of children to wash each day.

Keep cuts and wounds clean using soap and water.

A tidy compound is easier to keep clean. Clearing rubbish and bushes in and around the compound helps to limit mosquitoes. Faeces attract flies and spread disease. All faeces, even those of small children, need to be disposed of in a latrine. A latrine needs to be kept clean so people will use it. Everyone should was their hands after using the toilet. Washing the hands after the toilet and before eating can prevent diarrhoea.

Cleanliness is important during food preparation and eating. Wash hands before preparing food. The whole family needs to wash their hands before eating.

Diarrhoea is common in children when they are being weaned. Diarrhoea is caused by infection from germs


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that can be passed on in food or in water. Drinking water needs to be safe water. Heat water and after it has boiled, let it continue boiling for one minute to make it safe for drinking.

Tippy tapsIn places where water is far away, people are unable to wash regularly. One way to use less water is a tippy tap, which is also called a leaky tin. A tippy tap can be made for school using a plastic container or bottle.

Each morning one child fills the tippy tap. The tippy tap saves water. Each child get a small handful of water, enough to wash their face, hands and eyes. Tippy Taps can also save water at home.

Assist school to have tippy taps.

Wash hands with soap before eating.


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10. Fact Sheet on Family Planning

Key Messages• Familiescanchoosewhentohavechildren

and how many children to have.• Planningtheirfamilymayhelpparents

ensure they can provide food, clothes, housing and school fees for all their children.

• Youcangetfamilyplanninginformationand services at health centres.

• Spacingchildrenisgoodforthemother’shealth.

Role of CHW• Providefactualinformationoffamilyplanning.• Todiscussthebenefitsofspacingchildrenwith

couples.• Tosuggestwherecouplescanreceivefamilyplanning

services.• Provideshort-termfamilyplanningmethodsafter

training.

Family planning means choosing when to have children and how many children to have. Family planning is not about limiting the number of children in a family. A couple can have as many children as they want using family planning.

By planning to have children at least two years apart, a mother can regain her strength. She can build up her energy, her blood and her bones so she is healthy before she has another baby.

A strong and healthy mother can have a healthier pregnancy and a healthier baby. Spacing children allows each child the best possible start in life.

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Mothers who space their children improve their muscle tone. The chance of a mother’s death during pregnancy is also reduced.

Fathers and mothers are better able to improve their economic status if they plan their family. They are better able to feed, clothe, educate and provide health care for the family.

When births are spaced at least two years apart, each baby can be breastfed for two years. Breastfeeding is the best and safest way to feed a baby until two years of age. Spacing children also means that mothers and fathers have more time and energy to spend with each child in their early years. The first years of life are important preparation for the rest of life.

When we talk to people about family planning, we need to be sensitive. Family planning involves people’s private lives. We need to have the right information and good counselling skills. Encourage both husband and wife to talk about family planning and make decisions together.

Remember that men like to talk about family planning with other men. So encourage men to discuss family


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planning among themseleves and with their spouses.As a CHW your role is to let people know where they can get family planning. Sometimes you can also help answer questions they may have. You will need to learn something about the different methods of family planning to assist people of their choices.

Many families agree that spacing their family is wise. The first step in family planning is getting good information. A couple can decide on the method which works best for them. Family planning works best when the man and woman make the decision together.

A CHW needs to know what family planning services are available to couples locally. Most health centres have family planning clinics on specific days. Talk with the health staff at the local health centre to find out when and what services are available. Knowing this information will allow you to assist women in your community.

Many women are unable to access the family planning services they need. A CHW can help educate families about family planning.


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• Tellpeopleaboutfamilyplanningserviceswhicharelocally available.

• Assistpeopletogetinformationaboutfamilyplanning.

• Rememberpeolearefreetodecidedonwhetherornot to use family planning methods.

• Youdonotneedtoconvincepeopletousefamily planning methods.

There are many different methods of family planning available. People should be given information on the available methods so that they can choose. When choosing a family planning method, people need to ask a few questions such as: How well does the method prevent pregnancy?. How much will it cost? How easy is it to use? Where can I get it? What problems might the method cause? Trained health workers can answer these questions.

There are also permanent methods for preventing pregnancies, such as tubal ligation (TL) for women and vasectomy for men. Permanent methods are only for people who are sure they do not want any more children.

Family planning methodsType Method

Hormonal Pills, Injection, implants

Non Hormonal Intrauterine device (coils)

Barrier method Male and female condom

Permanent Tubal ligation, vasectomy

Natural Calendar (rhythm method), exclusive breastfeeding


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Tell people about family planning services available and let them choose.


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11. Fact Sheet on Diarrhoea

Key Messages• Disposeofchildandadultfaecesina

latrine.•Washhandswithsoapandrunningwater

after using the toilet, before preparing meals, before feeding a baby or eating and after cleaning the baby’s bottom.

• Givechildrenwithdiarrhoeaextrafluidssuch as porridge and soup.

• PrepareOralRehydrationSolution (ORS) following the instructions at the end of this fact sheet or the ORS packet.

• Ifnotaddresseddiarrhoeacanleadtodehydration and death.

Prevention• Disposeofchildandadultfaecesinalatrine.•Washhandswithsoapafterdefecation,before

preparing meals and before feeding children.• Boilwaterbeforedrinking.• Preparefoodinacleanplaceusingcleanpotsand

utensils.• PrepareORSfollowingtheinstructionsinthis

factsheet or on the ORS packet.

Home Care• Continuetofeedachildwhohasdiarrhoea.• Continuebreastfeedinginfantswhohavediarrhoea.• Ifachildisnotbreastfeeding,givehimorherORS.• Giveachildextrafluidsandfeedthechildmore

frequently until diarhoea stops.


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Role of CHW• Encouragehandwashingwithsoapafterusingthe

toilet, before preparing meals, before feeding children or eating and after cleaning the baby’s bottom.

• Educatefamiliesaboutboilingwaterfordrinkingorusing other recommended water treatment methods.

• Motivatepeopletobuildanduselatrines.• DemonstratehowtomixandgiveORStoachildwith

diarrhoea.• KeepextraORSpacketsathome.• Recogniseachildwithdehydration.

Danger Signs• Bloodinstool• Notdrinkingorbreastfeeding• Verysleepy,notresponding• Vomitseverything

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Diarrhoea is caused by germs that can be passed from one person to another. Washing hands with soap and running water removes germs, leaving hands clean. Wash hands after using the toilet, before preparing food, before feeding a baby or eating and after cleaning a baby’s bottom.

Faeces contain germs that can cause illness. Even faeces of small children can cause illness. Dispose of all faeces, including child faeces, in a latrine. Using a latrine will keep the compound free from germs.

Diarrhoea usually gets better on its own without medicine. A child who has diarrhoea loses water in the faeces. A child who does not get enough fluids to replace what is lost in diarrhoea, can die of dehydration. To prevent dehydration, a child with diarrhoea needs to receive extra fluids in small and frequent feeds. A breastfeeding child with diarrhoea needs to breastfeed more times in a day.

• Giveachildwithdiarrhoeaextrafluidsandfeedmorefrequently until diarrhoea stops.

• ORSisgoodforachildwithdiarrhoeabecauseitmoves from the stomach into the rest of the body quickly.

• FeedORSorotherfluidsoftentoachildwithdiarrhoea. Feed small sips from a cup or spoon. Give small amounts of liquids every few minutes.

•Whenachildisverydehydrated,heorshemaynotwant to drink and will be sleepy. Sit with the child and offer small sips of oral rehydration fluid from a cup every few minutes to make sure the child gets enough liquid.

• ContinuetofeedthechildwithORSinsmall,frequent amounts until diarrhoea stops.

A child with dehydration has a dry mouth, sunken eyes, dry skin and passes dark yellow urine. To check if the skin of a child is dry, gently pinch to gather the child’s skin on the abdomen. The wrinkle in the child’s skin will


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stay for a few seconds if the skin is dry. This can be seen on the back of an adult’s hand where the skin is dry. A child’s skin should not be dry.

Give any child with dehydration ORS or breastmilk immediately. Watch for danger signs of sleepiness, vomiting, not drinking or blood in the stool (faeces). Take a child with danger signs to the health centre immediately.

Note: • Continuefeedingthechildduringdiarrhoea.If

diarrhoea persist after two days or the child shows signs of dehydration take the child to the nearest health facility.

• Alotoftheinformationaboveisalsousefulinprevention and management of diarhhoea in older children and adults.

Instructions: How to make Oral Rehydration Solution

• Pour 200ml of previously boiled and cooled water in a jug or other container.

• Empty a pack of ORS into jug or container.• Stir well to disolve completely.• Solution is ready for drinking.• For infants on mothers milk, mothers should

continue to breastfeed more frequently as there is more demand for fluids.

• Patient should continue to drink ORS as much as body demands.

Dosage:• INFANTS: One litre over a period of 24 hours• CHILDREN: One litre over 24 hours,

according to age• ADULTS: Drink frequently as required

or as directed as physician, use only in recommended dilution.


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12. Fact Sheet on Malaria

Key Messages• Malaria is spread by mosquito bites.• Everyone should sleep under an

insecticide-treated net. This is especially important for children and pregnant women.

A child with high fever should be given extra fluids and medical care immediately.

Malaria can kill children and adults if not treated.

DO NOT give medicine for malaria at home. Ensure a child or adult you think has

malaria is taken for tests at the health centre.

Take a child with fever to the health centreimmediately

Prevention• Childrenunderfiveandpregnantwomenshould

sleep under an insecticide-treated net.• Closewindowsanddoorsbeforedarktokeepout

mosquitoes.• Clearbushyareasandstandingwateraroundthe

home.

Home Care• Seekmedicalcareimmediatelyforachildwithfever.• Breastfeedachildwithfevermoreoften.• Feedachildwithfevermorefluidslikesoup,fresh

juice, rice water (whitish liquid drained from boiling rice), yoghurt and drinking water. Fluids make the body work well.

• Removeachild’sclothesandspongehimwithwaterwhen he has fever. Use a towel dipped in warm water to pat the body.


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Role of CHW• Recogniseachildwithdangersignswhomighthave

malaria.• Referanewbornwithfevertothehealthcentre

immediately.• Teachparentsthatachildwithfeverneedsearly

treatment.• Teachparentstocareforchildrenwithfever.• Encouragechildrenandpregnantwomentosleep

under insecticide-treated nets.• Encourageyourcommunitytoclearbushesand

remove standing water near homes.• Referchildrenoradultswhohavefevertothehealth

centre to be tested for malaria.

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Danger Signs• Fits• Childnotdrinkingorbreastfeeding• Childverysleepyornotresponsive(notactive)• Stiffneck• Feverformorethantwodays• Anynewbornwithafever

Malaria is passed from one person to another by mosquito bites.

Malaria kills many children. It also causes serious problems for children and pregnant women. Mosquitoes usually bite at night.

Children and pregnant women should sleep under insecticide-treated nets. Even if they sleep on the floor, children and pregnant women should sleep under nets.

Women who are not pregnant and men may also get malaria but they usually recover.

• Netsaresafeforchildren.Themany,tinyholesletairin so a child can breathe easily.

• Closethedoorsandwindowsbeforedarktokeepmosquitoes out of the house.

• Keeptheareaaroundahomefreeofbushesandstanding water to stop mosquitoes from increasing.

•Wearlongsleevesatnighttoavoidbeingbitten.

Children have fevers for many reasons. All high fever in children should be treated as malaria because malaria is common and malaria can kill children. However, children should be taken to a health centre for malaria tests before medicine is given. DO NOT give any malaria medicine at home before a test for malaria is done at the health centre.


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Note:A child with malaria may also have fever, headache, general weakness, joint and bodypains, loss of appetite, diarrhoea and vomiting.

Give a child with fever as much fluid or breastmilk as he or she will take. Cool the child by removing his or her clothes and sponging his or her body with a towel dipped in warm water.

The danger signs for a child with fever are convulsions, not drinking or breastfeeding well, being very sleepy or not active, a stiff neck and fever lasting more than two days after treatment is given. Take any child with a danger sign to the health centre immediately.


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Fact Sheet on Cough

Key Messages• Childrenhavecoughsandrunnynosesthat

are not serious.• Takeachildwithfastordifficultbreathing

to the health center immediately.• Achildwithahighfeverandcoughfor

more than two days may require treatment at the health center.

Prevention• EnsureeverychildisgiveVitaminAdropseverysix

months to help prevent chest infection. Start when the child is six months old.

• Ensureeachchildisimmunised.Startimmunisationat birth.

(See Immunisation calendar in fact sheet on immunisation and deworming)

Home Care• Continuefeedingachildwithacough.• Continuebreastfeedinganinfantwithacough.• Givemorefluidstoachildwithacough.• Givethecoughingchildnatural,freshjuicesqueezed

from passion fruit, orange juice, pineapple and lemon (with water). Also give them soup, yoghurt, water, honey, and mashed avocado seed in a little water.

Role of CHW• Educateparentsaboutcoughanditsdangersigns.• EnsurechildreninyourcommunityreceiveVitaminA

every six months.• Referachildwithacoughtothehealthcentre

immediately if they have a danger sign.

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Danger Signs• Fastbreathing• Difficultbreathing• Notabletodrink• Verysleepy,notresponding• Highfeverformorethantwodays

Coughs are common in children. • Acough,coldandrunningnoseoftencometogether.• Continuetobreastfeedababywithacough.• Givefluidstoanolderchildwithacough.• DONOTgivecoughmedicinetoachild.

Treatment of a cough can be done at home by giving the child drinks that soothe the throat and reduce coughing. Passion fruit juice, orange juice, soup, water with lemon, water with honey, water with mashed avocado seed and yoghurt can all help a child with a sore throat or cough.


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Give a child with a cough and running nose fresh fruit juices.

Some coughs become chest infections which are called pneumonia.• Achildwithpneumoniaoftenwillnoteatordrink.• Achildwithpneumoniahasfastbreathingand

fever and is very sick.• Fastanddifficultbreathingaredangersignsin

children. Take children with danger signs to the health centre immediately.

A child with a cough and fever for more than two days may be getting pneumonia. Take the child to the health centre.

If a cough in a child lasts for more than two weeks, he or she may have tuberculosis (TB). Take the child to the health centre for test and treatment.

Vitamin A helps to prevent chest infections and pneumonia. Make sure all children receive vitamin A drops every six months.

Give children foods that contain vitamin A such as liver, carrots, paw paw, pumpkin and green leafy vegetables.

Take a child with a danger sign to the health centreimmediately


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Fact Sheet on HIV and AIDS

Key Messages•WomenandtheirpartnersshouldseekHIV

counselling before having a baby.• ChildrenwithHIVhavethesamerightsas

other children and should be supported.• HIVispreventable.• HIVandAIDScanbemanaged.

Prevention• PreventHIVinchildrenbypreventingitsspreadin

adults.• Allpregnantmothersshouldattendantenalclinics

(ANC) for counselling on HIV and AIDS. •WomenwhoareHIV-positivecanbehelpedto

protect their unborn child from getting HIV.

Role of CHW• SupportchildrenandfamilieswithHIVandAIDSin

your community.• Encouragethecommunitytosupportchildrenwho

have been orphaned for any reason.• Becomefamiliarwithservicesavailabletohelp

families affected by HIV and AIDS.• ProvideinformationandeducationaboutHIVand

AIDS to pregnant women.

CHW

14.


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PMTCT stands for “prevention of mother to child’ transmission of HIV”.

HIV can be prevented by safe sex. Safe sex means being faithful to your partner. HIV can be passed from a woman to her newborn during delivery. Only some babies born to mothers with HIV will be infected with HIV. Treatment can be given to pregnant women and their babies to prevent HIV passing on to the unborn child. Women and their partners should seek HIV counselling before having a baby.

• ApregnantwomanwithHIVneedstoreceivecounselling at the health centre to prevent her baby from getting HIV.

• AwomanwithHIVneedstoreceivesupportsothatshe can breastfeed her baby.

• AwomanwithHIVneedssupportforherownhealth.

HIV weakens the body and its defences against disease. Children with HIV need special care to prevent infections that take advantage of the weakened protection. Children with HIV have the same rights as other children. Provide love, care, education, food and immunisation to children with HIV. Seek early treatment at the health centre for children with HIV when they are sick.


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One of the ways to raise awareness about HIV in the community is through teaching school children. Tell parents about the HIV and AIDS messages that their children will be taught before teaching the children.

School children can help spread information about HIV and AIDS when they take the lessons and discussion home.

Encourage activities that give children the opportunity to talk about and learn about HIV and AIDS.

How do ARVs work?HIV is a virus that infects cells of the body’s ability (immunity) to fight diseases. HIV does this by destroying CD4 cells that offer protection against diseases. Anti-retroviral drugs (ARVs) prevent the HIV from multiplying inside a person and destroying the body’s defences. If this growth stops, the the body’s ability to protect itself against diseases improves. This is why people with HIV now live longer if they take ARVs.

Facts on treatmentARVs do not cure HIV infection but they prevent the development of AIDS. They can stop the HIV being made in the body. This stops the virus from damaging the body’s defences against disease. ARVs cannot completely remove HIV from the body. People with HIV need to continuously take ARVs. The use of ARVs has improved the quality of life for people with HIV and prevented them from dying early.

Prevent HIV: Practise ABC

• Abstinence• Be faithful • Use Condoms


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What is treatment adherence and why is it important?HIV makes many copies of itself that then damages the body’s immune cells (CD4 cells). It is also a very clever virus that tries to change itself so that these medicines no longer work. However, taking at least three medicines at the same time makes it harder for the virus to change and resist the medicines. Taking ARVs every day at the right time and in the right way keeps the right levels of the medicines in the body to work against HIV. Missing your medication can give the HIV a chance to become resistant to the ARV medicine.

What other kinds of care do people living with HIV need?Even when ART is available, people living with HIV need other forms of care. In addition to access to HIV treatment, good nutrition, safe water and basic hygiene are important to maintain a high quality of life for a person living with HIV.


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Often people with HIV need social, emotional and spiritual support as well as regular counseling. Before ART is needed, people usually are asked to start on cotrimoxazole (for example septrin) or may need to take isoniazid to prevent TB.

What is “PEP”?The term “post-exposure prophylaxis for HIV” (PEP) refers to a set of actions taken to prevent infection in a person who may have been exposed to the HIV infection. It includes first aid care, counselling and risk assessment and HIV testing. Sometimes a person may be given ARVs for a short period. Medication given quickly after possible HIV infection can help prevent HIV infection.

However, PEP treatment has not been shown to prevent the transmission of HIV.

PEP should be available as soon as possible and no later than 72 hours after exposure, and be given for 28 days without interruption.

Note:Victims of sexual rape should be advise to visit a health centre for help because they could have been exposed to HIV.


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Fact Sheet on Community Action Plan

Key Messages• ACommunityActionPlanhelpsavillageor

community to plan for the future.• ACommunityActionPlanfocusesona

few activities that are possible.• ACommunityActionPlanneedstobe

reviewed every year.

CHW Role of CHW• AssistthecommunitytodevelopaCommunity

Action Plan for child health.• Assistthecommunitytoreachtheirgoals.• Reviewprogresswiththecommunity.

When we start a journey, it is important to have an idea of where we are going. If we don’t know where we are headed, we may not know when we arrive.

Important points to note about a community action plan:•Wefirstneedtoreviewourcurrentsituation.We

need to discuss what we like in our community and what we want to improve or change.

• Mappingexercisescanhelpshowwhereweare.These exercises encourage people to think about what they know and have in their community. For example, an exercise such as Three Card Sort can help a community decide on their most important needs.

15.


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• Toimprovethecurrentsituation,weneedtoworktogether. We also need to have a goal. From time to time, we may change our goal.

• A community action plan helps people in a community agree on what they want to achieve and to set goals together.

• Acommunityactionplansetsoutsomespecificgoals.

• Acommunityplanhelpsustostartwheretheyare.It also assists us to start with one or two important issues or needs.

Goal settingIn community work, there is often so much to do that people easily become discouraged. For this reason, we need to select goals that we can achieve. The goals should be important for our community.

Maps help communities identify their resources and how to best use them.


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When we reach our goals, it gives us hope in our ability to achieve things that are important to us. When we have hope, we can deal with and improve our world around us.

• Includeeveryoneinthecommunityactionplan.

•Whenpeoplehavediscussedandanalysedthesituation, start with one or two simple goals.

•Whenthereisagreementonthegoals,findwaystoinvolve the whole community in achieving the goals.

Once we set a goal, we should agree on what different members of the community can do to achieve it. We should ask ourselves questions such as: What can teachers do? What can children do? What can the women do? What can the men do? What can religious and cultural leaders do?

For example, if cleanliness is the goal, teachers can organise for the children to wash their faces at school each day using a tippy tap (leaky tin). Children can organise to clear rubbish from public places. Mothers can remove rubbish from the compound and fathers can work together to clear bushes around homes and build pit latrines.

It is important that people:•discusstheirsituation,•agreeonwheretostart,•agreewhattheywanttoachieve,and•agreeonhowtoinvolveeveryoneinthesolution.

By working together on matters that are important to them and within their control, people believe in themselves and are able to solve even larger problems.

A communityaction plan helps people to agree on their most important needs


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16. Fact Sheet on Mapping

Why do we make maps?

• To appreciate how much information people have about the community

• To identify what is important about their community for people

• To make a visual representation of the area

We use maps to find directions to where we are going and to identify physical features in our world.

Maps drawn by communities show us how people see their world. The maps provide information about physical features as well as people’s attitudes.

Maps can be used as tools for showing and evaluating achievements of community activities. Maps made before and after a project can be used to record changes made during the project.

Maps made by youth or women may differ from those made by men. Such maps provide information about different things and issues in the community and show that people have a lot of information about their community.

You can work with community members to draw maps of their areas. The map should show places that are important to everyone such as homes, health centres, schools, mosques and markets. They should include things that are important to health such as sanitation and water sources.

Maps can be drawn on the ground with stones, nuts and twigs. Maps can also be drawn on paper.

Allow people to ask questions about the map. When a map drawn on the ground is finished, it can be copied to paper.


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Encourage people to discuss the mapping exercise. In small groups have them discuss the following:• CanmappinghelpourvillagetodecidewhataCHW

does?•WhataresomerolesforaCHWinavillage?•WhataretheskillsaCHWneeds?•WhatarethechallengesofbeingaCHW?

Have each group report on one of the questions to the bigger group. Allow open discussion, questions and additions from other groups.

Some Questions for CommunityDiscussion•Whatwouldweliketoseehappenin

our community?• Howcanwemakeourcommunity

better for the children?


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Fact Sheet on Children with Special Needs

Key Messages• Showextraloveandcareforchildrenwith

special needs and their families.• Provideimmunisation,healthyfood,toys,

clothes and insecticide-treated nets for special children.

• Encouragespecialchildrentositandplayoutside like other children.

• Buildsocialnetworkstohelpfamiliestocare for a special child.

• Helpreducestigmabyunderstandingchronic illness and by giving practical assistance.

• Assistspecialchildrentoattendschoolwhen possible.

CHW Role of CHW• Identifychildrenwithspecialneedssuchasorphans,

disabled children and those who have chronic (long-term) illness.

• Supportfamiliesofchildrenwithspecialneedsbyvisiting them regularly.

• Encouragethefamilyandcommunitytoincludechildrenwith special needs in family and community activities.

• Ensurechildrenwithspecialneedsareweighed,immunised, fed and receive health care.

Home Care• Supportthefamilyofachildwithspecialneeds.• Immuniseaspecialchildandprovideinsecticide-treated

nets.• Takeaspecialchildtothehealthcentrewhensick.

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• Stimulateadisabledchildorchronicallyillchildbytalking, playing and using home-made toys.

Special children include those with disabilities, with chronic illnesses and those who are orphans due to HIV. Children with special needs require extra care and love.

The way a condition affects a child depends partly on how the family and community view the child’s condition. People may think the child or family attracts bad luck or has been affected by witchcraft. Children with special needs may be hidden and neglected to protect the family from shame. Sometimes a child is protected too much. In some families, stigma is attached to chronic illness or disability.

Children with special needs may miss school, lose their appetite and fail to grow and develop. Worries about the child may cause sadness or guilt in the family. If one child requires much help, other children in the family may feel neglected. With support from the community and access to care many special children can grow up well.

Because disabled children often do not get to play with other children, they need toys to stimulate them to develop and grow. Special children need to be integrated into the community.

DisabilityDisability may be mental or physical. Children with disabilities may not be able to walk, talk, hear, see, or learn well. A child with disability may be weak, small and often sick. A disabled child may be difficult to move, feed or take to the latrine. The family of a disabled child needs help and encouragement.

Help to link the family of a disabled child with support groups and services, such as the deaf society or blind society. A CHW can help the family and community to understand that the family is not to blame. Most causes of disability are not known. Families should not be blamed or isolated because their child is disabled.


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Play is important for disabled children. Encourage others to play with them.

OrphansOrphans have special needs. Ensure children who are orphans have a safe and loving place to live. Ensure orphaned children receive food, shelter, immunisation and health care. Orphans need to be able to play and attend school like other children. All children need to be loved.

SicknessSome sickness can last for a long time. Some sickness can stop and then start over. Asthma, epilepsy, sickle cell anemia, diabetes, cancer and HIV can affect children. Sickness may affect the mental and physical well-being of a child as well as their relationships in the family and community.

Malnourished children are ill. A malnourished child may be irritable, cry easily and be difficult to feed. Children with sickness and malnutrition need special help from the CHW, the community and the family.


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18.Fact Sheet on Adolescent Growth and Development

Key Messages• Adolescenceisatimeofphysical,

intellectual, emotional and social development.

• Adolescentsneedthesupportofadultsto understand the changes they are going through.

• Behaviorpatternsthatareestablishedduring adolescence can have long-lasting positive and negative effects on future health and well-being.

• Adultscanhelpguidethemtomakehealthy choices.

• Adolescentshavetherighttobetreatedwith respect. Listen to their concerns and give them accurate, up-to-date information about health matters that affect them.

• Adolescentsfindithardertoaccesshealthservices than adults. Help them get these services.

• Goodcommunicationskillsandempathyare important in dealing with young people.

Adolescence is a time of physical, intellectual, emotional and social development. Adolescent development occurs between ages 10 to 19 years. Adolescence starts at different times and lasts for different periods among the individuals.

Adolescence is a phase in life during which major physical, psychological and social changes occur. As they encounter these changes, adolescents have many


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questions and concerns about what is happening to their bodies.

In many places, adolescents are unable to share their questions and concerns, and to seek answers from competent and caring adults.

While adolescence is generally considered as a healthy time of life. It is also a period when many behaviours that negatively affect health both during adolescence and later in life occur.

Many adolescents die every year – mostly from unintentional injuries (for example, road accidents), intentional injuries (suicide and interpersonal violence) and pregnancy related causes.

Health workers can help those adolescents who are well to stay well, and those adolescents who develop health problems get back to good health.

This guide includes information about physical and psychological development during adolescence. This information is useful for health professionals, parents and adolescents.

Physical changes during adolescenceDuring adolescence, young people go through many changes as they move from childhood into adulthood. Both boys and girls experience a sudden increase in physical growth. Other physical changes include the following: • Boysandgirlsgrowhairaroundtheirprivateparts

and armpits. Boys also start growing hair on the face (beard).

• Inbothboysandgirls,theskingetsoilyandacne(pimples) may occur.

• Girlsbecometallerandheavier.Theirhipsgrow.The fat in their abdominal, buttock and thigh areas increases.


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• Girlsbegintodevelopbreastsandtomenstruate(havemonthly periods).

• Boysalsogrowtaller,heavierandstronger.Theirshoulders broaden. Their sexual organs become bigger. They experience frequent erections and often have “wet dreams”. Boys also break their voice.

Mental and emotional changes • Thesuddenandrapidphysicalgrowthinadolescents

makes them self-conscious, sensitive and worried about their own body changes.

• Girlsbecomeanxiousiftheyarenotreadyfortheirmenstrual periods.

• Adolescentspullawayfromtheirparentsandestablishtheir own identity. Conflict can result from adolescents’ rebellion as their parents try to keep control.

• Bothboysandgirlsdevelopthecapacitytoreasonaswell as the skills to carry out adult relationships and roles.

Health risks Many adolescents face pressures to use alcohol, cigarettes, or other drugs and to initiate sexual relationships at earlier ages, putting themselves at high risk for injuries, unintended pregnancies, and infection from sexually transmitted infections (STIs), including HIV. Many also experience a wide range of mental health problems. • AsaCHWyoucanhelpyoungpeopletounderstandthe

changes they are going through. You can also listen to their problems and give them advice.

• Youcanalsogivetheminformationonthehealthrisksthey face and help them access correct information. Encourage them to seek treatment if they are unwell.

Unintended pregnancy• Manygirlsagedbetween15and19givebirtheveryyear.


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This is because adolescents are very fertile and can easily get pregnant if they don’t abstain from sexual relations.

• Thereishigherriskofdyingfrompregnancyamongtheadolescents. The younger the girl the higher the risk.

• Adolescentslackaccesstohealthinformationandservices.

Sexually transmitted infections (STIs)Adolescents may think they are too young or too sexually inexperienced to acquire STIs. They may also not think they are at risk because they incorrectly believe that STIs only occur in people who are “promiscuous” or who engage in bad behaviours.

The fact is that young people face a high risk of getting STIs, including HIV because of the following reasons:• TheylackinformationonhowtopreventSTIs.• Theycaneasilybeinfluencedbypeerpressureoradults

to engage into risky sexual relations.• Youngpeopleneedtoknowhowtoprotectthemselves

and have the means to do so.• Theyarelesslikelytoseekproperinformationor

treatment due to fear, ignorance, or inexperience. • Betteraccesstotestingandcounsellingwillinform

young people about their status so that can protect themselves against HIV, or seek help if they are infected.

• ScreeningforSTIsshouldbeencouraged.

Poor nutrition• Manyboysandgirlsareundernourished.Thismakes

their bodies weak and more likely to be attacked by diseases.

• However,manyyoungpeoplearealsoobeseoroverweight. This also makes them prone to disease, including depression.

•Propernutritionandphysicalexerciseduringadolescenceare foundations for good health in adulthood.


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Mental health• Manyadolescentsexperiencementalillness,

particularly depression and anxiety. Violence, humiliation and poverty increase the risk of mental illness.

• Buildinglifeskillsandprovidingpsychosocialsupportto adolescents promotes their mental health.

Alcohol and drugs abuse• Adolescentsmayeasilybetemptedtoexperimentwith

alcohol, tobacco and drugs.

• Tobaccoandalcoholuseamongadolescentsisabig problem. CHWs should advise them not to start smoking and help those in these habits to stop. CHWs also need to create awareness in the community on the dangers of tobacco smoking and alcohol abuse.

• Excessivedrinkingofalcoholisalarminginmanyofourcommunities. Alcohol use starts at a young age and


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can develop into a habit that is difficult to break in adulthood.

• Alcoholabusereducesself-controlandincreaseschances of engaging in risky behavior.

CHWs should educate the community on the dangers of excessive alcohol consumption and counsel those already abusing alcohol to stop.

Violence• Violenceisaleadingcauseofdeathamongyoung

people.• Promotinggoodrelationshipsbetweenparentsand

children early in life, providing training in life skills and reducing alcohol use helps to reduce violence.

• Careforadolescentvictimsofviolenceandsupportcan help deal with both the physical and the psychological consequences of violence.

Common diseases and conditions affecting adolescents

• Injuries.• Breast enlargement and tenderness in boys.• Tired teenager: fatigue is a common

symptom during adolescence.• Anemia (low blood counts), especially

among girls who diet to stay trim and fail to replace the iron they lose during menstruation.

• Acne. • Depression.• Eating disorders due to the quest to achiev

an ideal figure and peer influence.• Moodiness.• Sexually transmitted infections (STIs).• Obesity, mainly caused by sugary

beverages, junk food, low physical activity.


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Social issues affect adolescentsThe conditions in which young people grow can affect their health. These conditions or circumstances are shaped by peers, family, school, work and communities.

• Peer pressure: Peers influence the adolescent’s way of life, including the way they talk to what they wear. Positive peer influence reduces the chances of getting into unhealthy habits. On the other hand negative peer pressure can lead to young people having multiple sexual partners.

• Media Influence: Adolescents spend time using the media, including Internet, television and magazines. The media may influence the behavior of adolescents.

• Exclusion and isolation: Adolescents who grow up in families where they feel loved and are listened to are less likely to start smoking or use alcohol and other drugs than those who lack family and community support. They are also less likely to engage in early sexual intercourse or attempt to commit suicide.

• Accidents: Young people are prone to accidents, especially if they consume alcohol.

• Sexuality: As adolescents’ sexual characteristics mature during puberty, they look to the outside world for guidance to understand what is happening to their bodies, brains and emotions.

• Relationships: Adolescents usually start dating between ages 14-16 years. Adults should counsel them to healthy relationships by showing how boys and girls can be friends and help each other grow.

• Risk taking behavior: Adolescents can be tempted to engage in sexual relations early. Alcohol use increases the likelihood of teenage sex. Youth should be given life skills to enable them to understand their bodies and make responsible decisions about sex.


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CHWs should encourage young people to turn to trusted adults for advice, join organised youth groups or visit a youth-friendly centre for advice.

What adolescents can do to live healthy• Getatleasteighthoursofsleepeveryday.• Eatwell.Abalanceddietkeepsyoungpeoplehealthy,

helping them to grow and develop properly. Eating well gives them the energy to participate in school and physical activities.

•Delaysexualrelationsuntilyou’rematureenoughtotake responsibility for sexual relations.


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• Avoidriskybehaviorssuchassmokingandalcoholuse.

• Seekpromptmedicalattention.• Maintainphysicalandoralhygiene.• Followtheadviceofparents,teachers,religious

leaders and other trusted adults.• Engageinsocialactivitiesandphysicalexercise.• Spendtimewithfriendstoboostself-confidenceand

learn new things.

Points for CHW to note:• Encourageparentstomaintainopencommunication

with young people.• Talkwithadolescentsaboutthedangersofdrugs,

drinking, smoking and risky sexual behaviours.• Discusswiththemontheimportanceofchoosing

friends who do not act in dangerous or unhealthy ways.

• Adviseadolescentstoreportallincidentsofsexualabuse and exploitation to authorities; report sexual harassment and abuse to law enforcers.

• Identifyresponsibleyoungpeoplewhocanserveasgood examples and encourage them to advise their peers.

As a CHW, you can help community leaders and members understand the needs of adolescents, and the importance of working together to respond to these needs.


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Fact Sheet on Care for the Elderly

Key Messages• Aspeoplegetolder,ourbodieschangeas

a natural part of ageing.• Bodilychangescanoccurinalmostevery

organ and can affect an elderly person’s health and lifestyle.

• Somediseasesandconditionsbecomemore prominent in the elderly.

• Socialissuesaffectthephysicalandmental health of older adults.

• Abalanceddietandregularexerciseareimportant for the health of the elderly.

• Thereareanumberofscreeningtestsandpreventive measures recommended for the elderly.

• Importantpreventivemeasuresathomecan improve the safety and health of the elderly.

• Elderlyneedregularmedicalcheck-ups.• InKenya,theMinistryofHealthclassifies

the elderly as anyone over 60 years.

What changes occur in the body as we age?Our bodies and minds change in many ways as we age. The changes can differ from one person to the next and can start at different times. Such changes are not necessarily indicative of disease but they can be worrying to the individual.

Ageing cannot be stopped. But if we know the changes that take place as we grow older, we can change our lifestyles to reduce the effect of these changes on our health.

19.


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Expected bodily changes of ageing include change in:1) Skin: With ageing, skin becomes less flexible, thinner and easily broken. Bruising is easily noticeable. Wrinkles, age spots and skin tags are more visible. Skin can also become more dry and itchy because it produces less natural skin oil.

2) Bones, joints, and muscles: Bones lose density and become smaller. They can break (fracture) more easily. Muscles also shrink and become weaker. Joints are less flexible and can become painful.

3) Movement and balance: Balance and movement are affected by bone, joint and muscle problems. As a result, the elderly can easily fall due to loss of balance and get bruises or fractures. It is important to protect the elderly from falls by removing things that could hinder their movement or trip them.

4) Body shape: As the bones age, the body stature can become shorter and the back curved. Muscles become smaller. The body finds it harder to use up fat. Undigested fat is deposited in the abdomen and buttocks. Maintaining an ideal body weight becomes more difficult with age.

5) Face: Ageing changes also take place in the face. Other than wrinkles and age spots, the overall facial shape can change. Bones that make up the face shrink. Loss of volume from bones that make up the face and fat can result in less tightness of the skin and sagging. The face becomes droopier and bottom heavy.

6) Teeth and gums: Teeth can become weaker, brittle and dry. Salivary glands produce less saliva. Gums can also recede (pull back) from the teeth. These changes may result in dry mouth, tooth decay, infections, bad breath, and tooth loss and gum disease.

7) Hair and nail: Hair can become thinner and weaker as a person ages. Dry hair may lead to itching and discomfort.


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Nails may become brittle and unshapely. Nails can also get dry and form vertical ridges. Toe nail thickening (ram’s horn shape) is common. Nail fungal infections may occur frequently.

8) Chemical changes: The body produces substances that control the way it works. Because of these changes, the elderly commonly suffer from diabetes (low blood sugar), low sexual urge, poor digestion (constipation) and loss of memory. Some elderly people have difficulty controlling urine.

9) Protection from disease: The body’s ability to fight off disease weakens with age.

10) Hearing: Hearing is reduced. Some sounds are harder to hear.

11) Vision: Eyes can become drier and see less clearly. Glasses or contact lenses can help correct these problems.

12) Taste and smell: Sense of smell and taste may fade leading to poor appetite and weight loss.

13) Sleep: Duration and quality of sleep can change with age. It is common for elderly people to wake up at night.

Note! • Ageingisnotadisease.Itis,actually,aseriesof

processes that begin with life and continue throughout the life cycle.

• Changesthatcomewithagearedifferentineveryindividual. Some people may experience more changes in a particular area compared to others.

Some diseases common in the elderly• Heartdiseasesuchasheartattacksandhighblood

pressure• Thesediseasescanaffectthekidneys


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• Breathingproblemsbecausethelungstakeinlessair• Skindiseases• Cancers:Prostate,colon,lung,breast,skin,bladder,

ovary, brain, pancreas and others• Anemia(lowbloodcount)• Stomachulcersandconstipation• Difficultyincontrollingurine• Gumdisease,drymouth,lossofteeth• Pneumonia• Depression,anxiety,difficultysleeping

The elderly also feel tired more frequently. Their appetite reduces and weight decreases.


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Key Messages for elderly peoplei. Moderate exercise for at least 30

minutes every day strengthens bones and muscles. A good exercise is one which would increase the heart rate slightly.

ii. Eat more fruits, vegetables, whole grains and drink at least eight glasses of water a day to prevent constipation and maintain good health.

iii. Reduce fat, sugar and salt intake to avoid diseases.

iv. Avoid tobacco use and excessive alcohol drinking. Both are harmful to your health.

v. Go for regular medical check-up to detect illnesses such as diabetes, hypertension and cancers.

Note:If a person feels chest pains or tightness, shortness of breath, fainting or dizziness during or after exercising, it is important for the person to stop the exercise and see a health worker.

I. Social issues that affect the life and health of the elderly

Social issues can have a significant impact on the life of the elderly. These issues includei. Loneliness from losing a spouse and friendsii. Inability to independently manage regular activities of

livingiii. Difficulty coping and accepting physical changes of

ageing


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iv. Frustration with ongoing medical problems and increasing number of medications

v. Social isolation as adult children are engaged in their own lives

vi. Feeling inadequate from inability to continue to work

vii. Boredom from retirement and lack of routine activities

viii. Financial stresses from the loss of regular income

These factors can have a negative impact on overall health of an older individual. As a CHW you can work with elderly people, their family and the community to address these problems.

II. Lifestyle changes to lead a healthy lifeA balanced diet and regular exercise to maintain a healthy life for people of all ages.

Many diseases in elderly may be prevented or slowed down by adopting simple lifestyle changes. These changes include: i. Limiting alcohol intake to one drink dailyii. Stopping smoking iii. Using skin oils and sun protectioniv. Brushing teeth once or twice a dayv. Taking steps to prevent disease and seeking prompt

treatment when unwellvi. Following instructions for health screening,

preventive tests, and vaccinationsvii. Visiting a dentist every one or two yearsviii. Following up with eye doctor and foot doctor,

especially for people with diabetesix. Being aware of the side effects of medicines on the

bodyx. Adhering to routine sleep timetablexi. Engaging in social activities


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iii. Benefits of exercisei. Maintaining weight and burning excess calories.ii. Improving the ratio of good cholesterol to bad

cholesterol.iii. Building up physical endurance.iv. Maintaining health of the heart and lungs.v. Better delivery of oxygen and nutrients to body

tissues.vi. Maintaining bone and muscle health.vii. Reducing fall risks and arthritis.viii. Mood improvement.ix. Better sleep quality and duration.

Common medical tests for the elderlyBelow are some of the important preventive and screening measures for elderly.•Coloncancerscreeningforadultsbetweenages50

A balanced diet is important to keep elderly persons health.


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and 75 (younger starting age in high risk groups)• Breastcancerscreeningwithyearlymammogramfor

females between 40 and 75 (younger starting age for high risk groups)

• Prostatecancerscreeningwithannualrectalexamand PSA (prostate sensitive antigen) in males above age 50

• Lipiddisorderscreeningyearlyformenabove35andwomen above 45

• Diabetesscreeninginpeoplewithhighbloodpressure, high cholesterol, obesity, or previous high blood sugar levels with or without symptoms of diabetes

• Bloodpressurescreeningatleastonceayear• Smokingcessationcounselling

Other screening tests that doctors may recommend are:• Visionandhearingexams• Skincancerscreening• Cardiacstresstests• Thyroidfunctiontests• Mentalstatusexam• Peripheralvasculardiseasescreening

V. Important safety measures for the elderly• Usingcanesorwalkersandshowerseatstoprevent

falls.• Ifpossible,replacehardfloorswithcarpetingfor

injury reduction in case of a fall.• Usinghearingaidsandwearingglasses.• Usepillboxestomanagemedications.• Hiringcaregiversoracceptingassistancefromfamily

members if activities of daily living become difficult.• Regularsleepandwaketimestoimprovethequality

of sleep.• Takepartinsocialactivities.• Preparingawillandotherinstructionsinpreparation

for the time a person may become incapable of making sound decisions.


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CHW

20. Fact Sheet on First Aid

Key Messages• Makehomesandcompoundscleanand

safe to prevent injuries like burns, cuts and poisoning.

• Usefirstaidathomethentakeinjuredchildren to the health centre for help.

• Cleanlinessisimportantithelpswoundstoheal.

• Donotletsmallchildrenplaynearfire.

Prevention• Keepchildrenawayfromfire,charcoalcookers,hot

pots, lamps and matches.• Keeppoisonsoutofreachofchildren.Useonly

clearly marked containers.• Donotstorekerosene,orotherpoisonsinsoftdrink

bottles which children may try to drink.• Preventcutsbyremovingsharpobjectsfromthe

compound. Keep sharp objects like knives out of reach of young children.

Role of CHW• Educatecommunitiesaboutpreventionofburns,

cuts, poisoning and other injuries.• Helpprovidefirstaidandfirstaideducationto

community members.


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Keep medicine away from children.

First Aid

Poisoning• Ifachildtakesapoisonthatisnotparaffinandnot

acid, make them vomit. Give them a large drink of water then put your finger down the middle of the child’s throat to make the child vomit. Take them to the health centre immediately.

• Ifachilddrinkskeroseneorparaffin,takethechildimmediately to the health centre.

• Ifachilddrinksacid,givethechildlotofwaterormilk and then take him or her to the health centre.

• Carrythepoisoncontainertothehealthcentretohelp identify the poison.


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Animal Bites•Washareaquicklywithsoapandwater.Coverthe

area with a clean cloth. Take the child immediately to the health centre.

• Animalbitesarelikelytobecomeinfected.Donotclose the wound. Wash carefully. Tetanus injection is needed.

Cuts• Presshardonthebleedingpartwithyourhand

and a cloth. Hold the wound as high as possible. When bleeding stops, uncover and wash with soap and water. Cover with a clean cloth. If bleeding continues, keep pressing on the wound and take the child immediately to the health centre

• DONOTputanimalfaecesormudonawound.


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• Coverlargercutswithacleanclothandseekmedicalattention immediately. DO NOT tie the cloth too tight. If the wound is painful, hot and or red seek help from a health centre.

Burns• Puttheburnedpartofthebodyintocool,clean

water.• Giveplentyoffluids.• DONOTbreakblisters.• Keepburnsascleanaspossible.Coverburnsfrom

dirt, dust and flies with a clean cloth. Do not put grease or other things on burns. Covering a burn with honey can help to control infection and speed up healing. Gently wash off honey. Apply a new layer of honey at least twice a day.

• Takethechildtothehealthcentre.

Convulsions or fits• Becalm.Fitscanbeveryfrighteningtoonlookers.• Laythechildonthefloor.Cleartheareaofobjects

that can injure the child.• Turnthechildonhissidetoaidbreathingduringafit.• Cleartheareaofarticlesthatcaninjurethechild.• Donotputyourfingeroranyobjectinachild’s

mouth during a fit.


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References

1. One Million Community Health Workers: Technical Task Force Report, The Earth Institute, University of Columbia

2. USAID/BASICS and POPPHI, Guide for Training Community Health Workers/Volunteers to Provide Maternal and Newborn Health Messages, September 2009

3. Kay Wotton and Jenn Brenner, Health Child Uganda Trainers Manual for Community Owned Resource People Published by Healthy Child Uganda,University of Mbarara, Box 1410, Mbarara,Uganda.

4. Adolescent Job Aid. World Health Organization (WHO), 2010.

APHIAplus Nuru ya Bonde (Rift Valley) is five-year project funded by USAID that aims to improve access to health services in five of the 14 counties in Rift Valley region.

The objectives of APHIAplus Nuru ya Bonde include supporting health facilities to deliver quality services and enabling communities to play a bigger role in identifying and solving health problems. APHIAplus Nuru ya Bonde work within government priorities to support public and private health facili-ties to deliver quality services.

APHIAPlus Nuru ya Bonde is a partnership compris-ing FHI 360 and its core partners African Medical and Research Foundation (AMREF), Liverpool VCT, Care and Treatment (LVCT), Catholic Relief Services (CRS), the National Organization for Peer Educators (NOPE) and Gold Star Kenya.

The project also works with other local implementing partners that include government ministries, non-governmental, faith-based and community organi-zations.

APHIAplus- Nuru ya Bonde, Nakumatt West Side Mall,Kenyatta Avenue, P.O Box 13208 -20-100 Nakuru, Kenya. Tel:+254(051)0710150767

for Community Health Workers - FHI 360

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