section 6
Prevention and management of diarrhea
1 year
33 meeting
Let’s review:
Once the meeting starts, welcome everyone and ask the participants: • Who can help us remember what we talked about in our last meeting? • Who was able to do the activity at home that we asked you to do at the end of the meeting? How did it go? • Does anyone have questions or concerns after doing the activity?
What are we going to learn?
We are going to learn about the prevention and management of diarrhea, including the use of Oral Rehydration Therapy. LET’S TALK ABOUT IT! We are going to look at some pictures, so we can talk about what we all know about this topic.
What are things you can do when your child has diarrhea?
What do you think causes diarrhea in small children?
What can you do to prevent diarrhea in children?
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Activity:
“The three steps” We are going to practice three basic steps to prevent and treat infant diarrhea.
What we’ll need: • Tables with a flipchart (see below) • Vegetables from the region • Bucket of water
WHAT WE’LL DO: • Prepare three different “stations” in the room where you are meeting - they can be three different tables with a sign over each station, as follows: • The first station is “Prevention.” At this station review and practice hand washing, washing fruits and vegetables, and protecting food and drinking water from insects. • The second station is “Diagnosis.” At this station have a mother volunteer with her one-year old baby to demonstrate how you can look at the baby’s mucous and skin to check for dehydration. • The third station is “Treatment.” At this station you should do a demonstration and discuss how to prepare an oral rehydration solution, how to give it to a child, and at what point you should go to the nearest health clinic for treatment. • Divide the group into three smaller groups. Each station should have a mother as a facilitator (ask these mothers in advance) to explain the station. Every group should spend ten minutes at the station to learn the three steps of prevention, diagnosis and treatment. When each group is done at a station they can rotate to the next station until each group has done each station. • At the end of the discussion, gather the group and talk about preventing diarrhea. It is especially important to talk about the access to running water in the community and how the water sources should be protected. Also talk about the ways that food can be stored, so that it doesn’t “go bad”. OTHER SUGGESTIONS: • If access to water is a problem for the community, the ones who will be most affected are the youngest children. Ask parents to talk to local authorities to discuss what it would take to get enough water for the needs of the families in the community. • This is a good time to explore different options for purifying drinking water. You can make homemade water filters or use solar purifiers - whichever method is easiest to insure that the water the family is drinking is pure.
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Summing up:
What did we learn today? Now, we’ll review what we discussed today. • How do you feel after this meeting? Why? • What are the two most important things you’ve learned today? • What will you do differently based on what you learned during the meeting? • What did you like the most? Are there things you didn’t like? • Do you have any remaining concerns or questions about what we talked about? To finish: what would you recommend to improve today’s meeting when we do it again with another group. (Explain that replying this question will help the meeting be even better in the future for parents with small children.)
To do at home:
• A sk families to make sure they wash their hands and cooking utensils before preparing food. • Ask families to develop the habit of washing and purifying raw fruits and vegetables before eating them, and to protect food from flies and other insects. • Ask families to keep several envelopes of oral rehydration solution at home. • Ask families to make sure they have clean and purified water available to drink at home.
Basic information for the facilitator: Learning more about diarrhea: 1- Signs and symptoms of diarrhea: Diarrhea is caused by germs that are swallowed, especially germs that come from feces. This normally happens when feces are eliminated in an unsafe place, bad hygiene practices, unavailable drinking water or when babies are not breastfed. Babies that are well breastfed during their first six months will have less probability of having diarrhea. A child’s life is in danger if there are several watery stools within an hour or if there is blood in the feces. Immediate help from a trained health worker is needed. Meanwhile, a child in this condition should be rehydrated with Oral Rehydration Salt (ORS) solution and given zinc. If the child passes several watery stools in one or two hours and vomits, there is cause for alarm — these are possible signs of cholera. Cholera can kill children in a matter of hours. Seek medical help immediately and continue to give your child ORS solution and zinc.
section 6 / 1 year • meeting 33
32 Parents should immediately seek help from a trained health worker if the child: • Passes several watery stools in one or two hours • Passes blood in the feces • Vomits frequently • Has a fever • Is extremely thirsty • If the child’s skin does not stretch quickly
• • • •
after stretching. (Hydrated skin is elastic, dehidrated skin looks wrinkled) Does not want to drink Refuses to eat Has sunken eyes Looks weak or is lethargic
• Has had diarrhea for more than one week
2- Prevention of diarrhea and cholera:
There are four steps to prevent the spread of cholera or diarrhea • Eliminate feces (including that of babies and children) in a latrine, toilet bowl, or bury it. • Always wash hands with soap or ash and water after using the bathroom or after contact with feces and before touching food, eating or feeding the baby. • Use safe drinking water. • Wash, peel or cook all foods.
3- Treatment for diarrhea:
milk is the best food and the only liquid that a baby needs when they have diarrhea. It is nutritious • Breast
and clean, and it helps prevent infection and sickness. • Breast milk prevents dehydration and malnutrition and replenishes liquids. Sometimes mothers say that one should stop breastfeeding when the child has diarrhea – THIS IS WRONG. They should breastfeed even more when the baby has diarrhea. • Do not give any type of pill, antibiotic, or other medicine to a baby with diarrhea, unless instructed to do so by a medical professional. • The best treatment for diarrhea is to give lots of liquids and an oral rehydration solution that has been mixed with purified or boiled water, along with a 10-14 day treatment of zinc pills.
4- How to prepare Oral Rehydration Solution :
• Pour the contents of the oral rehydration solution into a clean container. Review the directions and get the amount of clean water that it requires, if you don’t add enough water it can make the diarrhea worse. • Only add water do not use milk, soup, juices or soda. Do not add sugar. • Mix well and give it to the baby in a clean glass. Do not use a bottle.
• If you are not able to find oral rehydration solution, you can treat dehydration with a mixture of four teaspoons of sugar and half a teaspoon of salt in a liter of clean water. Be careful with the mixture, if you add too much sugar it can make the diarrhea worse. Too much salt can also be harmful. If you use too much water it shouldn’t be a problem. • Recommended foods for a baby that is suffering from diarrhea are – cereals, beans, fish, well cooked meat, yogurt and fruit. If possible add one or two spoonfuls of oil into the cereal or fruit. Every meal should be prepared for the moment of feeding and the child should eat five to six times a day. • If you are in a place where there is a vitamin A deficiency, you should take steps to use a supplement. This helps to prevent diarrhea and also aid in recuperating from diarrhea. Foods that have vitamin A are: breast milk, liver, fish, dairy products, fruits and vegetables that are yellow and orange, and vegetables with green leaves (like spinach). • Including the zinc treatment helps reduce the duration and severity of the diarrhea and protects from other episodes of diarrhea for up to two months. Children can take 20 mg of zinc a day for 10-14 days.
Facilitator’s Manual