ari trainer's guide - CORE Group

ARI TRAINER'S GUIDE FOR COMMUNITY LEVEL HEALTH WORKERS Manual prepared by In cooperation with Kim Allen CDD/ARI Section
Kumar Lamichhane Child Health Division
Dr. Penny Dawson Department of Health Services
JSI/Nepal Ministry of Health, HMG/N TABLE OF CONTENTS
1. Training Methodology
2. Community Health Worker Job Description for ARI Case Management
3. Overall Training Objectives for CHW ARI Training Day One (Lesson Plan)
4. Session 1. Registration and Introduction
5. Session 2. Introduction to ARI, Cough and Cold and Pneumonia
6. Session 3. Fast Breathing and Chest Indrawing
7. Session 4. Danger Signs Day Two (Lesson Plan)
8. Session 5. Review of Day One
9. Session 6. Classification of Illness for the less than 2 month old
child
10. Session 7. Classification of Illness for the 2 month to 5 year old
child
11. Session 8. Ask, Look and Feel
12. Session 9. Practical Session Day Three (Lesson Plan)
13. Session 12. Home Therapy
14. Session 11. Treatment for 2 month to 5 year old children with
pneumonia
15. Session 12. Follow-up
16. Session 13. Prevention
17. Session 14. Use of Referral, Treatment and Case Tally Record Forms TRAINING METHODOLOGY This Trainer's Guide was developed to be used with the ARI MANUAL FOR
COMMUNITY LEVEL HEALTH WORKERS. The Community Health Worker (CHW) training
is intended for Female Community Health Volunteers (FCHVs). The following
three pages, "COMMUNITY HEALTH WORKER JOB DESCRIPTION FOR ARI CASE
MANAGEMENT" and "OVERALL TRAINING OBJECTIVES FOR CHW ARI TRAINING", are
provided to summarize for the trainer what the role of the CHW is and what
the training should ultimately accomplish. The training is designed to be participatory with lots of activities and
discussion, not lecture method only. In order to teach the required
skills, role plays, demonstrations, showing of videos and actual practice
on real cases should be done. Also, many of the participants of the
training may be illiterate so the manual is very pictorial with little
text. It is important that the trainers take advantage of the pictures
when teaching. If the pictures and their meaning is well explained, when
the trainees refer back to those pictures they should be reminded of the
health messages taught to them. Throughout the training, the following
steps should be taken: - Ask CHWs about the pictures and their meaning during the presentation
of each session. - At the end of each session have CHWs teach the meaning of the
pictures or series of pictures to each other in groups to demonstrate
their knowledge and understanding. - If any correction is needed, trainer should make the necessary
corrections immediately. The following pages should provide you with the step by step instructions
on how to teach the manual. Each session is divided into the following
sections: - OBJECTIVES: This section is to remind the trainer what should be
covered and understood by the end of each session. - MATERIALS: This section is to remind the trainer what he or she
needs to prepare or bring to the session. - PROCEDURE: This section describes in detail what information the
trainer must cover, including what activities (i.e. role plays,
demonstrations, games, etc.) should be conducted. Where ever a black dot (?) is present before a sentence or paragraph, the
trainer should explain this information to the group. The black dot (?)
signals important information which should be taught to the CHWs. The
information in italics describes what the trainer should do. Evaluation of the CHWs' skills and knowledge should be continuous
throughout the training. Many of the sessions contain questions and
exercises to evaluate knowledge and skills. It is also recommended that
the trainer use the objectives as a guide to measure knowledge and skills.
Trainers should not move on to new sessions until most of the CHWs are able
to perform the specific skills of the session. Trainers should encourage
the brighter CHWs to assist the CHWs who are less bright during the
training. Trainers should attempt to conduct the sessions in the local
language and take advantage of those CHWs who can explain the materials in
the local language to other CHWs.
COMMUNITY HEALTH WORKER JOB DESCRIPTION
FOR ARI CASE MANAGEMENT
The Community Health Workers (CHWs) duties and responsibilities will
include the following: . Assessment of children under 5 years of age for pneumonia using a timer
and recognizing danger signs. . Management of pneumonia for children 2 months to 5 years using
cotrimoxazole pediatric tablets. . Referral of all children 0-2 months with fast breathing or danger signs
to a health facility using a referral form.
. Referral of all children 2 months to 5 years with severe pneumonia and
very severe disease to a health facility using a referral form. . Follow-up of treated and referred cases.
. Advising mothers about danger signs to look for, home care during
illness, and prevention of ARI developing into pneumonia . . Record services provided.
OVERALL TRAINING OBJECTIVES
FOR CHW ARI TRAINING
By the end of the training, CHWs will be able to: . Tell the definition of ARI, cough and cold, and pneumonia.
. Tell the dangers of pneumonia if not treated.
. Recognize the danger signs for young infants (0-2 months):
- Fast breathing
- Severe chest indrawing
- Stopped feeding well
- Abnormally sleepy or difficult to wake
- Fever
- Low body temperature . Recognize the danger signs for children (2 months to 5 years):
- Chest indrawing
- Not able to drink
- Abnormally sleepy or difficult to wake
- Severe undernutrition . Count the respiration rates correctly. The cutoff rates are as follows:
- 0-2 months 60 or more respirations/minute
- 2 months to 5 years 50 or more respirations/minute . Classify the illness of the young infant (0-2 months) into two groups:
- Those to be given home therapy only
- Those to be referred to a health facility . Classify the illness of the child (2 months to 5 years) into three
groups:
- Those to be given home therapy only
- Those to be treated by the CHW
- Those to be referred to a health facility . Assess the young infant or child's illness by asking the following:
- How old is the child?
- Is the child coughing?
- Is the child (2 months to 5 years) able to drink?
- Has the young infant (0-2 months) stopped feeding well?
- Is the child difficult to wake?
. Count young infant and child's respirations using an electronic timer.
. Look and feel for danger signs:
- Chest indrawing
- Severe undernutrition (2 months to 5 years)
- Fever or low body temperature (0-2 months) . Advise mother/caretaker about home therapy:
- Watch child for fast breathing and chest indrawing
- Keep child warm
- Breast feed more often
- Increase food
- Increase fluids
- Keep nose clean and clear . Decide correct treatment for children (2 months to 5 years) for pneumonia
(50 or more respirations/min.) with cotrimoxazole pediatric tablets: - 2 months to 1 year 2 tabs morning and evening for
5 days
- 1 year to 5 years 3 tabs morning and evening for
5 days . Provide correct number of tablets to mother.
. Demonstrate to mother how to crush, mix and feed tablets to child.
. Advise correct medicine dosage, dose frequency and duration.
. Advise the mother about prevention of ARI developing into pneumonia:
- Exclusive breast feeding until 5 months
- Feed nutritious weaning foods
- Immunization
- Avoid smoke, dust and dampness . Follow-up and reassess pneumonia on 3rd day to see if mother is feeding
medicine, teach home therapy, and refer if condition is same or getting
worse. . Follow-up of referred cases to see if mother/caretaker took child to
health facility. . Correct recording of services provided. DAY ONE
Session 1. Registration and Introduction (30 min) Session 2. Introduction to ARI, Cough and Cold and Pneumonia (1 hour) Session 3. Fast Breathing and Chest Indrawing (2 hours 30 min) Session 4. Danger Signs (30 min) Session 1. Registration and Introduction
Time: 30 min OBJECTIVES: By the end of the session the trainer should: 1. Deal with the administrative issues such as:
- Registration
- Introductions
- Distribution of Materials
2. Go over the Training Purpose
3. Go over Methodology
4. Explain the times when the course starts and finishes each
day and when breaks will occur. Ask the CHWs to make sure
that they are ready to start each session on time. MATERIALS: Manuals, pens, copies PROCEDURE: Training Purpose Explain to the CHWs: . The purpose of the training is to reduce deaths due to pneumonia by
providing knowledge and skills in stand