1. Introduction (20 minutes)
Ask participants to read pages 1-5 to themselves. Then repeat the main points as follows:
2. Basic Skill: Remember the three rules (30 minutes)
Ask participants to read “Basic skill: Remember the rules of case management in the home”, and to write down the three rules of home case management. If it is available, an Information Summary Sheet may be inserted in this section with more specific, adapted information (this may have been completed by the national programme manager). Stress the following:
Note: Special emphasis should be placed on continued feeding during diarrhoea, and increased feeding for two weeks after the episode.
3. Basic Skill: Use simple language (20-35 minutes)
Ask participants to read “Basic skill: Use simple language”, and the example preceding the short-answer exercise. They should then do the exercise, and compare their answers with those on page 10. Review by mentioning the key points below. If time allows, a group discussion may follow.
4. Basic Skill: Ask questions (10 minutes)
Ask someone from the group to read aloud “Basic skill: Ask Questions”, from mid-page 10 to mid-page 11. Summarize the main points (below). Participants should then do the exercise, and compare their answers with those found on page 12.
5. Step 1 (20 minutes)
Ask participants to read to themselves “Step 1: Ask the questions” (pages 12-13), and complete the exercise on page 14. Ask several participants to read their answers aloud and compare them with those on page 15. Stress the key points below.
6. Step 2 (25 minutes)
Ask someone to read aloud “Step 2: Praise and Encourage helpful behaviours” (page 16). Discuss briefly with the group the importance of including praise and encouragement when advising a mother. Ask the participants to do the exercise. When they have all finished, discuss each of the situations and possible answers. (Suggested answers can be found at the end of this facilitator’s guide).
7. Step 3 (50 minutes)
Ask participants to read “Step 3: Advise the mother what else to do” (page 18), and stress the key points below. For the exercise, divide the participants into pairs to work. Each pair should write answers for all four situations. Then ask each pair to present one situation to the group, and discuss their solutions. Some possible answers are suggested in this facilitator’s guide. If the participants have previous experience treating diarrhoea cases and advising mothers, they may wish to suggest specific examples of behaviours they need to praise, encourage, or advise against in their areas.
8. Advising about danger signs
Ask the participants to read the section, “Advising about danger signs” (page 21). Stress that different countries may have various ways of expressing these signs, in ways that mothers can easily identify and remember. In addition, there may be signs that are well-known and for which mothers commonly become concerned (for example, “The child becomes weak”). These adaptations and additional signs should be included in the list.
9. Step 4 (20 minutes)
Ask the participants to read “Step 4: Check the mother’s understanding” (page 21), and to read the exercise. This exercise should be carried out in the form of a short drill: the facilitator reads the first checking question aloud, and then the “Mother’s response”. One participant suggests a follow-on checking question; another participant suggests an additional follow-on checking question, and so forth. There should be at least two or three suggested follow-on questions after each “Mother’s response”. After completing the drill, stress the following key points:
10. Review of information using the Mother’s Card (30-60 minutes)
Ask the participants to read the top half of page 24. Then ask one participant to read aloud the techniques of using the Mother’s Card, while you demonstrate the techniques one by one. Distribute a Mother’s Card to each participant, and review the contents of the card/pamphlet if necessary. Divide the group into pairs to work together. Each pair should sit together, as a health worker and a mother might sit at a health facility. One member of the pair uses the Mother’s Card to explain and review home case management to the other; when one participant has finished, partners should switch roles and practise again. Circulate among them as they practise, and observe participants to make sure that they are able to use the techniques described earlier.
When the participants have completed the exercise, stress the key points below:
Remember - A pictorial aid is only useful if it is used well.
The six recommended techniques for using the Mother’s Card may seem too simple. However, they have been selected based on the mistakes that health workers make most often, i.e., holding the card so that the health worker can see it but the mother cannot; talking without pointing to the pictures; and not asking the mother to explain what she will do at home.
11. Review of the steps (5 minutes)
Ask the participants to read to themselves “Review of the steps” (page 29) and to complete the outline. Check the participants’ answers individually.
12. Summing-up exercise (20 minutes)
Ask the participants to read the sample conversation (page 31) to themselves, and to answer the questions at the end. Discuss the answers to each question with the group. (There are suggested answers at the end of this guide).
13. “APAC” role-play (60 minutes)
If the participants are sufficiently at ease in the group, you can ask one pair of participants to perform the “APAC” role-play in front of the group. Limit each role-play to 10 minutes, with an additional 10 minutes of discussion. (If the members of the group are shy, the role-play should be performed with the participants in pairs, as they were when using the Mother’s Card). Point out that this is not a complete consultation, but rather the “treatment” part of plan A. The health worker has already assessed the child, and must now advise the mother. After conducting the role-play, participants should evaluate themselves, noting whether they were able to follow the “APAC” procedure, what went well, what was difficult, and what improvements they feel they could make in their method of advising mothers.
Hint: If you ask the participants to perform the role-play in front of the group, it may be useful if you provide each pair with a written situation. In this case, you need to prepare these situations in advance. Some sample situations are included at the end of these guidelines.
14. Practice in a real situation
Note: If these exercises are carried out as part of clinical management training, practice in a real situation should take place during regular clinical practice sessions.
If the exercises are carried out separately, at least one-half day will be needed for practice. Arrange for the participants to spend several hours at a nearby health facility, where they can advise mothers with sick children. It can be either an outpatient or inpatient facility, provided that there are children with diarrhoea whose mothers can be advised. It is best to have cases without dehydration. After the practice session, hold a discussion with participants to allow them to evaluate themselves as they did after the role-play.
15. Optional section: Refer the mother to a small group session (can be carried out concurrently with the practice (above), if there are too few patients for all participants to be practising at once, and if there is a room near where the practice will be carried out).
Ask the participants to read to themselves “Refer the mother to a small group session if necessary” (pages 36-37). Discuss how to decide which mothers to refer to small group sessions, and how these sessions are (or could be in the future) organized in local health facilities.
Each small group session should cover only one subject, for instance ORS preparation, or home fluid preparation; questions and discussion should be encouraged. The following section gives an idea of how to conduct a session on ORS preparation.
16. Leading a demonstration. (This can also be done concurrently with the practice. Allow 20 minutes per demonstration - 10 minutes for demonstration and 10 minutes for discussion.)
This session requires some preparation. Before you begin, have on hand everything you will need for an ORS demonstration: ORS packets (at least one per participant); local containers for measuring water; large bowl and spoon for mixing; small cups and spoons for tasting and/or for giving ORS to children; scissors for opening ORS packets; soap, towel, and basin for washing hands; clean water. Seat the participants in a semicircle.
Ask participants to read “Leading a demonstration”. Read aloud the listed qualities of a good demonstration. Ask the participants if there are other qualities that they think should be added to the list.
Conduct a demonstration of ORS preparation as though you were the health worker, and the participants mothers in an ORT corner. Ask the participants to evaluate your demonstration, in accordance with the listed qualities of a good demonstration. As many participants as possible in the time available should then practise conducting a demonstration.
[Ukrainian] [English] [Russian]