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Parasites (Malaria and Worms)Leader Mother Flipchart

Module 4 of 6

Picture A: REPEAT (half or all of) Picture 2.2 C of parents and children sleeping under a mosquito net.

Picture B: REPEAT Picture 5.3C [Hardship] and his sister sitting on a mat wearing shoes.

Picture C: REPEAT (half or most of) Picture 4.2D (parasites)Picture D: Repeat

Picture 1.2 B (Anopheles Mosquito)

Picture E: Repeat Picture 6.2A. (Pregnant woman taking pill at 4 months)

Picture F: Repeat image from Module 3, Picture 3.4D of Hardship receiving a deworming pill.

Insert FH and USAID and other logos here.

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Parasites (Malaria and Worms) Table of Contents:

Lesson 1: Malaria Transmission and Impact on Health and Food Security.........4Lesson 2: Malaria Prevention (ITNs, IPTs and Indoor Spraying)......................12Lesson 3: Malaria Recognition, Care and Treatment with ACT........................20Lesson 4: Parasites Defined and Impact on Health and Food Security.............28Lesson 5: Parasite Transmission and Prevention with EHA.............................36Lesson 6: Regular Treatment of Parasites.....................................................44Lesson 7: Maintaining the Care Group..........................................................52References for the Illustrator:......................................................................60

Health mangers: please review all text in GREEN and make changes as necessary before translating or giving to the illustrator. Use the same local names and images for the main characters ([Mother A] and [Mother B]) as used in Module 1, 2 and 3. Once changes have been made, delete all text in green (Notes for the Health Manager). You may use the illustrations I have inserted for ASPIRE and the other activities, or substitute with your own images. Please ask the illustrator to complete any of the illustrations that are missing, or contain the text, “do not copy.” Yellow font indicates the instructions for the illustrator. After the illustrations are complete, remove all yellow descriptions and insert the images. Flipchart pages are formatted for a Top-of-page BOUND FLIPCHART. This means that the details come before each picture page. This allows the facilitator to read the back of the chart for the details while the audience views the corresponding picture. If you are not using a bound flipchart, pages may need to be rearranged. Adapt as necessary.

Lessons, stories, and activities in the Parasites (Malaria and Worms) Lesson Plan are meant to complement the information provided in Parasites (Malaria and Worms) Leader Mother Flipchart.

AcknowledgementsMany thanks to the illustrators including your local illustrator’s name, Ocatvio Gonzales and Petra Röhr-Rouendaal. Carolyn D. Wetzel and Julie A. Hettinger are greatly appreciated for reviewing and editing the materials. Several lessons and activities were adapted from the work of Brooker and Decoster. Games used in the lessons are available through the HIV/AIDS Alliance. See below for full details.

Brooker, Rachel and DeCoster, Mary. (2009) Freedom from Malaria: Let’s Make Malaria History! Washington DC. Food for the Hungry (FH), made possible through the USAID Child Survival Cooperative Agreement GHS-A-00-05-0014-00.International HIV/AIDS Alliance. (2002). 100 ways to energize groups: games to use in workshops, meetings and the community. Available at www.aidsalliance.org.Rohr-Roendaal, Petra (1997) Where There is No Artist. Development drawings and how to use them. London, UK: Intermediate Technology Publications.

Suggested Citation: Hanold, Mitzi J. (2009) Parasites (Malaria and Worms) Leader Mother Flipchart. Washington DC. Food for the Hungry (FH), made possible through support provided by the Office of Food for Peace, Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S. Agency for International Development under the terms [insert Award Number here1]. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the U.S. Agency for International Development.

1 Please adapt the MYAP Award No and add relevant logos as described in your country’s USAID branding document (Award No DRC = FFP-A-00-08-00072; Award No ETH = FFP-A-00-08-00082-00; Award No Moz = FFP-A-00-08-00086). Delete this note after you have added the appropriate logos and information.

2

http://www.aidsalliance.org/

Lesson 1: Malaria Transmission and Impact on Health and Food SecurityThis is the text for the back of page 3 with (Picture 1.1) Notes for the Health Manager: Adapt the words from the Danger Sign Song below. (See the Activity for Module 3, Lesson 5.) Insert the lines which refer to fever and going to the clinic.

Materials for Lesson 1:1. Attendance Registers 2. (Optional) Paper and pencil*

1. Game: The Two Mosquitoes

2. Attendance and Troubleshooting

3. Story: [Hardship] Has a Fever (Picture 1.1)[Hardship] is not feeling well. [Mother B] uses the back of her hand to compare the warmth of [Hardship]’s forehead to her own. His skin is very hot. Is fever serious? [Mother B] can’t remember. She sings the Danger Sign Song. “… His body is hot with fever… Take your child to the clinic, don’t wait another minute. The child’s life is in danger!” [Father B] and [Mother B] go quickly to the clinic.

4. Ask? What causes fever?? Is fever a serious disease/sickness for

children? Why?

Let’s compare your thoughts with the messages on the following pages.

Story: [Hardship] Has a Fever (Picture 1.1)

* Materials with an asterisk should be organized by the Activity Leader.

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[HARDSHIP] AND [OF GREAT WORTH] ARE 18 MONTHS OLD (SAME AS MODULE 3) IN ALL IMAGES IN THIS ALBUM. Please instruct the illustrator accordingly.

Picture A. [Hardship] is in bed. There are heat waves coming off his body (see below). [Mother B] has the back of her hand against the forehead of the child. The back of her other hand is against her own forehead. [Mother B]’s mouth and eyes are open wide in surprise. The child is very hot.

Caption Pictures A: [Hardship] is not feeling well. His skin is very hot. Is fever serious? [Mother B] can’t remember.

Picture B. A close picture of [Mother B]’s head and upper body. Her mouth is open wide and there are music notes coming out of her mouth (see below). She is holding [Hardship] 18 months in her arms. He still has heat waves coming off his body.

Picture C. [Father B] is carrying [Hardship – 18 months] and walking with [Mother B] towards the clinic which can be seen in the background.

Caption Picture B: [Mother B] sings the Danger Sign song… “His body is hot with fever… don’t wait another minute…”

Caption Picture C: [Father B] and [Mother B] quickly go quickly to the clinic.

Malaria Defined and Transmission (Picture 1.2)

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This is the text for the back of page 5.

5. Show

? What do you see in these pictures?

6. Explain

Fever is the most common sign of malaria. o Fever is not a sickness, but a sign that there is

sickness in the body. o In our region, fever is usually caused by malaria.

Mosquitoes carry the sickness of malaria. o Mosquitoes that carry malaria are active when the

sun is low in the sky and at night. When the mosquito bites a person who already has malaria,

he picks up the illness. He carries it with him. The mosquito gives malaria to each

person that he bites. o Mosquitoes do not become sick with malaria. o They only carry the illness to others.o If one person in our community has malaria, all of us

are at risk of being bitten by a mosquito carrying the sickness.

Malaria Defined and Transmission (Picture 1.2)

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Notes for the Health Manager: See Module 3, Lesson 5 for an illustration of the Neighbor and her child. In Module 3 Lesson 5 the neighbor’s child has malaria. Use the same child for this illustration.

Picture A. The child of [Mother B]’s Neighbor] is in bed with fever. There are heat waves coming off his body. There is a large red mosquito bite on his arm. He is next to a window. The sun is setting (6pm); it is beginning to get dark.

Picture B. Use a curved arrow beginning with the mosquito bite in Picture A and pointing to Picture B. A large mosquito with the back legs in the air. Use a curved arrow starting at the mosquito in Picture B and pointing to Picture D.

Caption Picture A: Fever is the most common sign of malaria.

Caption Picture B: Mosquitoes carry the sickness of malaria.

Picture C. Repeat picture 1.1A of [Mother B] feeling the forehead of [Hardship]. There is a curved arrow connecting Picture D to [Hardship].

Picture D. [Hardship – 18 months] is walking by the neighbor’s window (see picture A). He is smiling and looks healthy. He has a red mark on his arm where a mosquito has bitten him. The sun is setting at 6pm.

Caption Picture C-D: When the mosquito bites a person who already has malaria, he picks up the illness. He carries it with him. The mosquito gives it to each person that he bites.

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Impact of Malaria on Pregnant Women and Children (Picture 1.3)

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This is the text for the back of page 7. Notes for the Health Manager: If “anemia” is not well understood, you may substitute “weak blood” for all anemia references. Follow the example that was used in Module 1, Lesson 4.

7. Show


8. Explain

Untreated malaria can kill a child in 1 or 2 days. o Many children die from malaria.

Malaria causes anemia. It prevents children from growing well.

o Weak blood makes them tired, drowsy and weak. o Malaria prevents children from doing well in school.o Children with weak blood are often sick with other

illnesses. Anemia in pregnancy may cause the baby to be born too

early, too small, or dead. o In the womb, infants get nutrients from the mother’s

blood. o If her blood is too weak, the infant will not grow well.

Anemia in pregnancy increases the risk of the mother dying in childbirth.

o Anemia makes the blood and the mother very weak.o If she loses too much blood during birth, she will not

survive.

Impact of Malaria on Pregnant Women and Children (Picture 1.3)

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Picture D.The sun is at 8 am. A child (8 months old) has fever and is crying. An arrow points to picture B.

Picture E.Repeat the child from picture A crying with fever. Above him is a moon. An arrow points to picture C.

Picture F. The sun is at 8 am; the father is digging a grave. The dead child is on the ground next to the hole the father is digging. The child is wrapped in a piece of fabric with just his head showing.

Caption Pictures A-C: Untreated malaria can kill a child in 1 or 2 days.

Picture G. Copy Picture 3B from Lesson 6 of Module 2 (see sample below.)

Caption Picture D: Malaria causes anemia. It prevents children from growing well.

Picture H. A tiny infant is being held in two cupped hands. The infant is malnourished, skinny, and small. The baby’s mouth is open and he is struggling to breathe (see example).

Picture I. Show a father and three children crying next to two coffins (one adult coffin and on child sized coffin.

Caption Picture E-F: Anemia in pregnancy may cause the baby to be born too early, too small or dead. It increases the risk of the mother dying. Impact of Malaria on Food Security (Picture 1.4)

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9. Show


10. Explain

Workers with malaria have little energy. They are not able to work long hours.

o Anemia (weak blood) makes them weak and tired.o Malaria reduces a worker’s productivity.

Frequent malaria makes life difficult. Caregivers must pay for travel to the clinic and medicine.

o Malaria puts a financial burden on families. When children have malaria, caregivers are not able to work

long hours.o Malaria reduces the time families can work.

? Do you believe that malaria can be overcome? What can we do to reduce malaria sickness and death?

11. Activity: The Cost of Malaria

14. Practice and Coaching12. Probe 13. Inform 15. Request 16. Examine

Impact of Malaria on Food Security (Picture 1.4)

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Picture A. A close up of [Father B] resting against a tree in front of his field. He is wiping the sweat from his brow. His body is dirty and sweaty from working. There are many weeds in the field (he has not done much work).

Notes for the Health Manager: If women spend more time working in the field, use an image of [Mother B]’s female neighbor. (See picture 5.1 in Module 3)

Caption Picture A: Workers with malaria have little energy. They are not able to work long hours.Picture B. [Mother B] is riding in a taxi or

bus. The clinic is seen in the background.

Notes for the Health Manager: Adapt based on local transport. If most people walk to the clinic, then you can adapt the text to say, “caring for the sick takes time and money.” The image can include taking local transport (in the morning) and walking out of the clinic as the sun sets.

Picture C. [Mother B] is paying a pharmacist for medication.

If medication is purchased at the clinic, show [Mother B] purchasing from the doctor. Adapt as needed.

Caption Picture B-C: Frequent malaria makes life difficult. Caregivers must go often to the clinic and pay for medicine.

Picture D. [Mother B] is sitting on her daughter’s bed. She is looking out the window. On the table next to her daughter’s bed is the malaria medication from Picture C and a glass of water. The child has heat coming off his body. [Mother B]’s work tools are sitting on the floor.

Caption Picture D: When children have malaria, caregivers are not able to work long hours.

Lesson 2: Malaria Prevention (ITNs, IPTs and Indoor Spraying)

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Materials:1. Attendance Registers2. Leaves, pebbles, a small bucket of sand or other small items for the game.3. Two different types of malaria nets; bring one example of each.*4. A home where the group can practice hanging mosquito nets *

1. Game: The Mosquito Game


3. Story: No Money for a Net (Picture 2.1)

[Mother B] goes to visit [Mother A]. [Mother B] tells her about [Hardship]’s visit to the clinic. “Is he sleeping under a mosquito net each night?” [Mother A] asks. “No,” says [Mother B]. “We don’t have enough money for a mosquito net. Besides, [Hardship] is taking malaria medication. Why does he need to sleep under a net?”

4. Ask? Why should [Hardship] sleep under a net? ? Do you and your children sleep under a net

each night?


Story: No Money for a Net (Picture 2.1)

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Picture A. [Mother B] is sitting with [Mother A]. [Mother B] is breastfeeding [Hardship- 18 months]. [Mother B] is holding the malaria treatment packet in her hand. There are two pills left.

Notes for the Health Manager: Give information to the illustrator as to what ACT packets look like.

Caption Picture A: [Mother B] goes to visit [Mother A]. [Mother B] tells her about [Hardship]’s visit to the clinic.

Picture B. [Mother A] and [Mother B] are standing next to a bed with a mosquito net (in Mother A’s house). The net is loosely tied in a knot so that it does not drape onto the bed or ground (or it is draped over the hook on the wall so that it does not drape on the bed or on the ground). [Mother A] is pointing at the net as she speaks with [Mother B]. [Hardship] is still breastfeeding.

Caption Picture B: “Is he sleeping under a mosquito net each night?” [Mother A] asks.

Picture C. [Father B] is holding a few bills in one hand and pointing to the mosquito net. The salesman has his arms crossed and is shaking his head no.

Caption Picture C-D: “No,” says [Mother B]. “We cannot afford a mosquito net! Besides, [Hardship] is taking malaria medication. Why does he need to sleep under a net? Prevent Malaria with Insecticide Treated Nets (Picture 2.2)

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5. Show


6. Explain

Those with malaria should sleep under a net to prevent mosquitoes from carrying the sickness to others.

o Malaria is transmitted through mosquito bites.o If mosquitoes can’t bite a sick person, they can’t

spread malaria. An ITN2 prevents bites. It kills mosquitoes that land on the

net. o Hanging a net reduces the number mosquitoes in

your house. Fathers, mothers, pregnant women and children should all

sleep under a bed net to prevent malaria. o If you only have one net, children under age five and

pregnant women should sleep under the net together.

o Save money to purchase more nets so that everyone can be protected.

? [Mother B] said that she was too poor to have a net. How could buying a net SAVE money for the future?

o If the family has less sickness, they will work more and earn more money. Children will be sick less and need less medication.

2 Only an insecticide treated net kills mosquitoes. An old net, or one that has been washed many times, no longer contains the chemicals to kill mosquitoes. However, it still protects from bites at night. Both nets are effective for prevention of bites.

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Prevent Malaria with Insecticide Treated Nets (Picture 2.2)

Picture A. Copy Picture 1.2A only this time the child is under a mosquito net. There are several mosquitoes flying around the outside of the net. The child does not have a mosquito bite on his arm. There are heat waves coming off his body.

Caption Picture A: Those with malaria should sleep under a net to prevent mosquitoes from carrying the sickness to others.

Picture B. [Mother A] is sweeping off the top of the mosquito net. There are many dead mosquitoes there. (Use the same net and bed as in Picture 2.1 D)

Caption Picture B: An ITN prevents bites. It kills mosquitoes that land on the net.

Picture C. There are two beds (or mats in the room. All the children are sleeping together under one net (Boy 8 years old, girl 4 years old and [Of Great Worth – 18 months old]. [Mother A] and [Father A] are sleeping under a net. Use one of the same nets as in Picture 2.1 B)

Caption Picture C: Fathers, mothers and children should all sleep under mosquito nets to prevent malaria.

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Intermittent Preventative Treatment for Pregnant Women (Picture 2.3)This is the text for the back of page 15. Notes for the Health Manager: IPT is recommended for stable epidemics (where malaria is constant all year round). Make sure that IPT is available and supported by the MOH before printing this page. Adapt text and illustration based on local recommendations. Some countries recommend two doses, others three.

7. Show


8. Explain

To prevent illness and death, pregnant women should take malaria pills.

o The pills reduce the malaria sickness in your body. This keeps your blood and your baby healthy.

Visit the health worker at the first sign of pregnancy. He will tell you when to return.

o The first malaria treatment should be taken in the fourth month of pregnancy.

o At four months of pregnancy, the belly begins to extend and the mother begins to feel movement inside the belly.

o The second treatment is taken in the seventh month of pregnancy.

? How can malaria pills help the family to be healthier and happier?

o Mother and infant will need less care and medication.o Mother will be healthier during pregnancy. o Fewer infants will die before birth.

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Intermittent Preventative Treatment for Pregnant Women (Picture 2.3)

Picture A. Repeat image 1.3D. Put a large X over the picture.

Picture B. Two pictures of a pregnant woman. In each image she is taking a pill from a health worker. In the first image her belly is very small (4 months of pregnancy). In the second image (2 months before birth) her belly is much larger.

Caption Picture A-B: To prevent illness and death, pregnant women should take two malaria treatments.

Picture C. A health worker is talking standing with the pregnant woman from picture A. She has a small bump on her stomach (just beginning to show - 4 months pregnant). On the wall behind them is a long horizontal poster. On the poster are 9 moons in a row followed by a mother with a newborn on her chest. The fourth and seventh moons are circled. The health worker is pointing to the seventh moon on the poster. Adapt according to guidance by MOH.

Caption Picture C: Visit the health worker at the first sign of pregnancy. He will tell you when to return.

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Prevent Malaria with Indoor Spraying (Picture 2.4)This is the text for the back of page 17. If indoor spraying is not widely practiced in your country, consider adding an alternative flipchart page for this lesson. Both pages can be printed, but only four of the five pages should be used for teaching. See “Reduce Breeding Sites” at the end of this document.

9. Show


10. Explain

Reduce mosquitoes by taking part in community spraying programs. o The government arranges for men to come and spray all

the homes in regions where malaria is high.o The spray contains a long lasting insecticide. It kills all the

mosquitoes that hide inside the house. Everything and everyone moves outside when the walls are

sprayed.o Remove furniture, clothes, and the sick who normally stay

in bed.o The men wear masks and long clothing to protect their skin

from the insecticide. o Let the insecticide dry on the walls for one hour.

After one hour, sweep out the dead insects. Move everything back inside.

? Do you believe that we CAN stop malaria? Why?o Many countries have already eliminated malaria. We can

too. We have been given dominion over mosquitoes. We can make it happen!

11. Activity: Hanging a Mosquito Net


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Prevent Malaria with Indoor spraying (Picture 2.4)

Picture A. A village leader is standing with the two men in green suits who are holding spraying containers (see the next picture). They are standing in front of a large crowd of community members (men, women and children) who are listening to the village leader. The village leader is pointing to a large image of a mosquito (Picture 1.2B) while he speaks. The mosquito has a large X on it.

Picture B. This picture can be used or it can be redrawn to match other illustrations.

Caption Picture A: Reduce mosquitoes by taking part in a community spraying program.

Caption Picture B: Everything and everyone moves outside when the walls are sprayed.

Picture C. This picture can be used or it can be redrawn to match other illustrations.

Picture D. This picture can be used or it can be redrawn to match other illustrations.

Caption Picture C: After 1 hour, sweep out the dead insects.

Caption Picture D: Move everything back inside.

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Lesson 3: Malaria Recognition, Care and Treatment with ACT This is the text for the back of page 19.

Materials1. Attendance Registers

1. Game: Mosquito Count


3. Story: Advantages of the Mosquito Net (Picture 3.1)

[Mother B] listened to the words of [Mother A]. She and her husband saved money each week to purchase a net. The children love to sleep under the net each night. “It keeps off the flies,” [Hardship] says. “I don’t wake up itching,” says the daughter. “It makes us feel like we have our own room,” says the boy.” Yes,” says [Father B]. “And we are happy because you are safe from malaria.”

4. Ask

? What are some of the advantages that you have seen using a net?

? How can you encourage others to sleep under a net?


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Story: Advantages of the Mosquito Net (Picture 3.1)

Picture A. These pictures will be similar to 2.1 C.

[Father B] is giving money to a salesman with one hand while holding the new mosquito net in the other hand. They are all smiling.

Picture B. All of [Mother B]’s children are sleeping under a net. We see [Hardship], his older sister (4 years old) and the eldest (boy 8 years). The net is tucked in around the mat or mattress.

Caption Picture A: [Mother B] and [Father B] saved enough money to purchase a net.

Caption Picture B: The children love to sleep under the net each night.

Picture C. The three children are sitting together inside the mosquito net. [Hardship] is pointing at a fly that is flying on the outside of the net. [The daughter] is pointing to her arm (no mosquito bites) and smiling. The boy has large eyes and his two arms are stretched out towards the sides of the mosquito net. (See caption below for more details.)

Caption Picture C: “It keeps out the flies.” says [Hardship]. “I don’t have any mosquito bites,” says the girl. It makes us feel like we have our own room, said the boy.

Picture D. [Mother B] and [Father B] are standing together smiling. They are looking at the mosquito net with the three children sitting inside.

Caption Picture D: “Yes!” said [Father B]. “And we are happy because you are safe from malaria.”

Signs of Malaria Infection (Picture 3.2) This is the text for the back of page 21.

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5. Show


6. Explain:

Fever is the most common sign of malaria. o Use the back of the hand placed lightly on your

child's skin to test for fever. o If the skin feels hotter than your own skin, take the

child to the clinic. Chills, sweating and headache are signs of malaria. Vomiting and convulsions are signs of malaria. Some children refuse to eat or drink. If you see any of these signs, take the child to the clinic

immediately. o Take the child on the same day that you see the sign.o If caregivers, pregnant women or others in the family

have fever, take them to the clinic for treatment right away.

o Treatment shortens the days of sickness. Treatment helps the body recover.

o Treatment prevents malaria death.

? Do you know children in the community who have died from malaria? How can you prevent this from happening to your children?

o Remember the signs of malaria.o Take the child to the clinic at the first sign of fever.o Make sure the child sleeps under a net each night.

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Signs of Malaria Infection (Picture 3.2)Notes to the Health Manger: You can use the illustration below from Mozambique. Please site the author in the credits. If your illustrator redraws the image, show [Mother B] and [Hardship].

A close-up of [Hardship]’s face and shoulders. He has heat waves coming off his body. His mouth is downturned (sad).

Picture E. A close up of [Hardship]’s face and shoulders. Large drops of sweat are falling off his face and shoulders. His hand is against the side of his head (headache). He is frowning with eyes downturned.

Picture F. [Hardship] is in bed under a blanket. His entire body is shaking (chills).

Caption Picture A: Fever is the most common sign of malaria.

Caption Picture B-C: Chills, sweating, and headache are signs of malaria.

Picture G. [Hardship] is vomiting. Picture H. [Hardship] has a convulsion. Arms are stiff and he is shaking all over uncontrollably. Eyes are open wide.

Caption Picture D-E: Vomiting and convulsions are signs of malaria.

Picture I. Repeat 1.1C [Father B] taking [Hardship] to the clinic.

Caption Picture F: Some children refuse to eat or drink.

Caption Picture G: If you see any of these signs, take the child to the clinic immediately.

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Malaria Treatment with ACT (Picture 3.3) This is the text for the back of page 23. Confirm ACT dosage with the MOH. IF ACT is NOT given in your country, emphasize the following the doctor’s recommendations. Please verify with the MOH the recommended time which the woman should return to the health clinic if the fever persists (24 or 48 hours). Adapt as needed.

7. Show


8. Explain

At the clinic the health worker will give ACT malaria pills.o There are several types of malaria treatment on the

market. o The best malaria medication is ACT.3

Even if the child is feeling better, give all the pills as directed by the health worker.

o If you only give half of the medicine the malaria will return much stronger than before.

o The child will need a second treatment. o ACT pills are given for XXX days.

Return quickly to the clinic if the fever does not go away within one day.

o ACT acts very quickly.o The child may have more than one infection requiring

special care.

3 ACT stands for Artemisinin-based Combination Therapies.

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Malaria Treatment with ACT (Picture 3.3)

Notes for the Health Manager: Describe the ACT pill container for the illustrator. If pills are purchased at the pharmacy or corner store, then show a salesman selling [Mother B] ACT pills. Change the caption to match the procedure for obtaining pills and the number of days that the pills are required,

Picture A. The health worker is handing [Mother B] ACT pills. She is holding up her fingers that represent the number of days of treatment with ACT. [Hardship] is strapped onto [Mother B]’s back. Heat waves are coming off his body.

Caption Picture A: At the clinic the health worker will give ACT malaria pills.

Picture B. [Hardship is sitting on [Mother B]’s lap. He is laughing and has no fever. [Mother B] is holding a pill in one hand and a cup of water in the other hand for [Hardship].

Picture C. Repeat Image 1.1C In the corner of the picture show one sun and moon to emphasize that one day has passed.

Notes for the Health Manager: Use the same symbols used in Module 1 and 2 to represent one day.

Caption Picture B: Even if the child feels better, give all the pills as directed by the health worker.

Caption Picture C: Return quickly to the clinic if the fever does not go away within one day.

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Caring for Children with Fever (Picture 3.4)This is the text for the back of page 25.

9. Show


10. Explain If fever stays too long, the child may have convulsions. Keep the child cool by wrapping them in a wet cloth.

o Keeping the body cool prevents convulsions.o Wrap the child in a wet cloth to keep them cool on

the way to the clinic.o It helps to lower the body temperature.o Pour cool water on a towel placed around their head.

Chase the illness far away. Offer extra foods and fluids each day during the illness.

o Fever and sweating cause a child to lose a lot of water.

o Breastfeed a child more often during sickness. Offer extra foods and fluids each day for two weeks after the

child has recovered. o Strengthen the child’s body to prevent illness from

returning.

11. Activity: Making an Emergency Plan


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Caring for Children with Fever (Picture 3.4)

Picture A. Repeat picture 3.2A of [Hardship] with fever.

Picture B. [Hardship] is having convulsions. Arms are stiff. He is shaking all over uncontrollably. Eyes are open wide.

Caption Picture A-B: If the fever stays too long, the child may have convulsions.

Picture C. Copy illustration using [Mother B] wrapping [Hardship in a dripping cloth – or draping it over his body lying on a mat on the ground.

Caption Picture C: Keep the child cool by wrapping them in a wet cloth.

Picture D. Repeat picture 5.3 B from Module 3 of [Mother B] breastfeeding [Hardship].

Picture E. Repeat picture 5.3 D from Module 3.

Caption Picture D: Chase the illness far away. Offer extra foods and fluids each day.

Caption Picture E: Offer extra foods and fluids each day for two weeks after the child has recovered.

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Lesson 4: Parasites Defined and Impact on Health and Food Security This is the text for the back of page 27

Materials1. Attendance Registers 2. Two women and two children who are prepared for the Parasite Skit.

1. Game: Simon Says


3. Story: Poor Appetite (Picture 4.1)

[Mother B] has noticed that her children are not eating well. Why aren’t you eating? She asks. “My stomach is already full” her son says. “I’m just not hungry” say the girl. This continues for many days. [Father B] encourages them to eat every day. They still eat very little.

4. Ask? What do you think is wrong with the

children?? What do you do when your children

lose their appetite?


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Story: Poor Appetite (Picture 4.1)

Picture F. [Mother B]’s son is holding his belly – it is extended and round although his arms and legs are very thin. He is talking.

Picture G. [Mother B]’s daughter is talking. She is pushing away a bowl of cut fruit.

Caption Picture A: “My stomach is already full,” her son says.

Caption Picture B: “I’m not hungry” says the girl.

Notes to the Health Manager: Adapt the illustration according to local eating customs.

Picture H. [Father B] is sitting with [Hardship] (on a mat or at a table). He is holding food in his hand to feed [Hardship], but the child is looking away. The oldest boy (8 years) and the girl (4 years) are also sitting with them. They have a bowl of food in front of them. They have eaten less than half of the food in the bowl. The boy is staring at his fingers. The girl is yawning.

Caption Picture C: This continues for many days. [Father B] encourages them to eat every day. They still eat very little.

29

Parasites Defined (Picture 4.2)This is the text for the back of page 29.

5. Show


6. Explain

Many people have parasites that live in their bodies. Most of them don’t know they have a parasite.

o In this picture, everyone wearing red has a parasite inside their body.

A parasite is a small worm that lives in the body. o Parasites live in animals and humans.

Parasites feed on blood and food in the body.o Some parasites eat the food in the stomach.o Some feed on blood making the blood weak.o Some parasites attach to the liver and intestine and

suck out bits of food. Some parasites are too small to see. Others can be several

meters long inside the body.

? Can you think of a parasite that is carried by mosquitoes and feeds on blood?

o Malaria! Mosquitoes carry the malaria parasite. o The malaria parasite feeds on blood making the

blood weak.

30

Parasites Defined (Picture 4.2)

Picture A. Show [Mother B] and her family with a neighbor’s family. [Mother B]’s family include [Father B], [Hardship] (18 months), a daughter (4 years) and a son (8 years). [Father B] and the three children are wearing red pieces of clothing. The neighbor and her husband have three children. The father and one child are wearing a red piece of clothing.

Caption Picture A: Many people have parasites in their bodies. Most of them don’t know they have a parasite.Picture B. Show many (5-10) pinworms

(each 1cm long and white) living inside a stomach seen with a child’s body.

Picture C. A close up of a boy putting food in his mouth. Show the boy’s upper body and the stomach. In the stomach are two large worms (with large heads and teeth). They are sitting in the bottom of the empty stomach with their mouths open. There are balls of food falling into the worms’ mouths. Another worm is chewing on the side of the stomach; the stomach is bloody where the worm is chewing.

Caption Picture B: A parasite is a small worm that lives in the body.

Caption Picture C: Parasites feed on blood and food in the body.

Picture D. Draw three tiny pinworms (white 1 cm long), three tiny hookworms (red 1 cm long), one tapeworm that is looped back and forth across the page (white, 1 meter long) and a roundworm (pink 10 cm long). See reference guide for the names of each worm. Draw them as close to TRUE size as possible.

Caption Picture D: Some parasites are too small to see. Others can be several meter long inside the body.

Impact of Parasites on Pregnant Women and Children (Picture 4.3)


31

7. Show


8. Explain

Parasites in pregnancy cause anemia and malnutrition. o Anemia is caused by parasites that feed on blood. o When parasites steal food from our stomach, our

bodies become malnourished. Anemia increases death in childbirth. Babies are born too

early, too small or dead. Children with parasites don’t eat well and become

malnourished. o When a child has parasites, it causes anemia. o Anemia reduces a child’s ability to grow.o Anemia reduces a child’s ability to overcome illness.o Anemia reduces a child’s ability to do well in school.

32

Impact of Parasites on Pregnant Mothers and Children (Picture 4.3)

Notes for the Health Manager: If the dead are not buried in coffins, adapt picture D to reflect local customs. The coffins might be replaced with a bed with two bodies (an adult and an infant) covered entirely with a white sheet.

Picture A. A pregnant woman (8 months along) is leaning on her husband. They are walking to the clinic. (Should be the same people as seen in image 1.3 E).

Picture B. Repeat picture 1.3 E of father crying over two coffins.

Caption Picture A: Parasites in pregnancy cause anemia and malnutrition.

Caption Picture B: Anemia increases death in childbirth. Babies are born too early, too small or dead.

Picture C. Repeat last two images from Module 2, picture 2.5 on Malnutrition. Child refusing food and child becoming malnourished.

Picture D. Copy image from Module 3, Picture 3.4 C of [Mother B]’s son sitting in school.

Caption Picture C: Children with parasites don’t eat well and are malnourished.

Caption Picture D: Anemia prevents children from growing tall and doing well in school.

Impact of Parasites on livestock and food security (Picture 4.4) This is the text for the back of page 33.

33

9. Show


10. Explain Livestock with parasites are often sick and vulnerable to disease.

o Livestock with parasites do not grow well. o They produce less milk and eggs than animals without

parasites. Workers with parasites have little energy. They are not able to

work long hours.o Anemia (weak blood) makes them tired, drowsy and

weak.o Parasites reduce a worker’s productivity.o When children are ill with parasites, workers may be

prevented from working in the field.

? If all the parasites were treated in your community, how would life be different?

o Livestock would be healthy and more productive.o Children would be sick less often.o Families would be healthier.

11. Activity: The Parasite Skit


34

Impact of Parasites on livestock and food security (Picture 4.4)

Notes for the Health Manager: Talk with FH agronomists to gather information for common animal diseases in your region. Ask them for physical signs of disease for chickens, goats, ducks or pigs.

Picture A. Include common livestock kept in your region such as chickens, goats, ducks and pigs. In the corner of the drawing, is a circle including some of the worms from picture 4.2.D. See the sample below: chickens have ruffled feathers, are inactive, and heads are lowered. Some are dead.

Caption Picture A: Livestock with parasites are often sick and vulnerable to disease.

Picture B. Repeat image 1.4 A of [Father B] resting from his field work.

Caption Picture B: Workers with parasites have little energy. They are not able to work long hours.

35

Lesson 5: Parasite Transmission and Prevention with Essential Hygiene ActionsThis is the text for the back of page 35.

Materials1. Attendance Registers 2. Banana or other object for the game

1. Game: Pass the Parasite


3. Story: Get Your Own Food (Picture 5.1)[Mother A] believes that [Mother B]’s children have parasites. “Parasites!” [Mother B] says. “I will not let parasites steal from my children! Their bellies will be filled with food, not worms! I have made many changes already. I know that I can stop parasites too!”

Ask

? Why is [Mother B] so confident that she can overcome the parasites?

? How can someone get rid of parasites? ? Do you take action to prevent (or get rid of)

parasites?


36

Story: Get Your Own Food! (Picture 5.1)

Picture A. [Mother A] is sharing flipchart page 4.2 with [Mother B]. [Mother B] is sitting with her children on a mat with [Mother A]. None of them are wearing shoes. [Mother A] shoes are sitting next to the mat. [Mother B] and the children are leaning in to look at the pictures. [Mother B]’s mouth and eyes are wide open. Her hands are on her face in surprise! All of the children are wearing a red piece of clothing.

Caption Picture A: [Mother A] believes that [Mother B]’s children have parasites.

Picture B. Repeat picture 4.2 B of a stomach with worms.

Picture C. Draw a stomach and body similar to picture 4.2 B, however, in this picture the stomach is filled with good food like carrots, and mangos and staple foods.

Caption Picture B-C: “I will not let parasites steal from my children. Their bellies will be filled with food, not worms!”

37

Parasite Transmission in Soil and Foods (Picture 5.2)This is the text for the back of page 37.

5. Show


6. Explain

The feces of an infected person contain parasite eggs.o These eggs hatch into parasite worms when they are

swallowed. Children swallow the eggs when they eat unwashed foods

from the soil. o Bits of soil containing the eggs are eaten with the

fruit or vegetable. Some eggs hatch and enter the body through bare skin.

o Worms enter the feet when children walk barefoot.o Children get lots of worms when they crawl or play in

the dirt. o Children get parasites when they eat soil or put dirty

hands in their mouth. We eat parasite eggs when infected meat is not fully cooked.

o The meat of infected animals contains parasite eggs. o If the meat is raw, or not hot all the way through, the

eggs remain alive.o The eggs hatch into parasite worms when they are

swallowed.

38

Parasite Transmission in Soil and Foods (Picture 5.2)

Picture D. A close-up of a child squatting with a bare bottom leaving feces in a grassy area. In the corner of the image inside a circle is a worm and a small pile of parasite eggs next to the worm. Draw an arrow pointing from the eggs to the feces.

Picture E. A close-up picture of [Hardship] biting into a dirty tomato. He is sitting in a grassy area with another tomato on the ground next to him.

Caption Picture A: The feces of an infected person contain parasite eggs.

Caption Picture B: Children swallow the eggs when they eat unwashed foods from the soil.

Picture F. A close up of the legs and feet of a child standing in the grassy area with no shoes. An arrow is pointing to the bottom of the feet.

Picture G. Show the mouth of someone biting into a piece of meat (cow or pig). The meat is red or pink inside (not fully cooked).

Caption Picture C: Some eggs hatch and enter the body through bare skin.

Caption Picture D: We eat parasite eggs when infected meat is not fully cooked.

39

Preventing Transmission in Soil and Foods (Picture 5.3)


7. Show


8. Explain

Always use a latrine. Then, wash hands with soap. o Wash hands with soap before eating and preparing

foods, and after using the latrine. o If feces are found in the area around the house,

throw it into a latrine. o If you don’t have a latrine, bury feces away from the

house and at least 20 meters from water sources. Wash raw foods with soap and water before eating.

o Help children to wash hands with soap and water before eating.

o Wash children’s hands after they have been playing outside.

o Caregivers should always wash their hands before preparing food or feeding an infant or child.

Wear shoes. Do not sit on the ground; use a mat.o Always wear shoes when walking outside to protect

your body from parasites. Cook meat until it is hot throughout.

o Never eat meat that is raw or pink inside.o Parasite eggs are killed by the heat. Then the meat

is safe to eat.

40

Preventing Transmission in Soil and Foods (Picture 5.3)

These pictures should look similar to Pictures 5.2 – however, in these pictures the people are PREVENTING worm infection.

Picture H. [Mother B]’s neighbor is walking out of a latrine. She is wearing a red piece of clothing. She is walking towards the Tippy Tap next to the latrine.

Picture I. [Hardship] is watching [Mother B] as she washes dirty tomatoes with soap and water.

Caption Picture A: Always use a latrine. Then, wash hands with soap.

Caption Picture B: Wash raw foods with soap and water before eating.

Picture J. A close up of the legs and feet of a child standing in the grassy area with shoes.

Picture K. Show the mouth of someone biting into a piece of meat (cow or pig). The meat is brown (or white) and fully cooked. There is hot steam coming off the meat.

Caption Picture C: Wear shoes. Use a mat to sit on the ground.

Caption Picture D: Cook meat until it is hot throughout.

41

Parasite Transmission and Prevention in Water (Picture 5.4)This is the text for the back of page 41.

9. Show


10. Explain: Urine and feces from an infected person contain parasite

eggs. The eggs infect snails. Snails release parasites which enter the skin of others in the water.

o Like a mosquito that carries malaria, snails carry the parasite to others.

o The parasites enter the skin of those who swim, wash or walk in the water.

o Parasites enter the body of those who drink the water.

? How can we prevent infection?o Always use a latrine. o Purify your water before drinking. o If you see snails, don’t get in the water.

- Gather water from a protected water source. - Find a new place to swim and wash.

11. Activity – The Village Walk


42

Parasites Transmission and Prevention in Water (Picture 5.4)

Picture A. Copy the image below – making adaptations. The boy on the left side should be about 4 years old. He should be wearing a red shirt. The boy on the right side should be [Hardship]’s oldest brother (8 years).

Picture Caption A: Urine and feces of an infected person contains parasite eggs. The eggs infect snails. Snails release parasites which enter the skin of others in the water. Picture B. The boy above

in the red shirt is walking out of a latrine.

Picture C. Use an image

from the Water Purification Module 3, Picture 4.3. [Mother A] is giving her oldest child (boy 8 years) a glass of purified water.

Picture D. [Mother A] is squatting with [Of Great Worth] looking at snails by the edge of the water. They are both wearing shoes. Behind her is a large sign that shows a boy washing in the lake. There is a big red X on these images on the sign.

Caption Picture B: Always use a latrine.

Caption Picture C: Purify water before drinking.

Caption Picture D: If you see snails, don’t get in the water.

43

Lesson 6: Regular Treatment of ParasitesThis is the text for the back of page 43.

Materials1. Attendance Registers 2. Ask each woman to bring her child health card to this meeting *

1. Game: The sun shines on…


3. Story: Deworming for All (Picture 6.1)

A health worker comes to [Mother B]’s house. She asks the children to come for deworming treatment. “My children were treated eight months ago,” says Mother B. “They aren’t sick.” “No,” says the health worker. “All children receive treatment every six months.” Mother B is confused. “Isn’t treatment only for the sick?”

4. Ask? Mother B doesn’t think her children need

treatment. Why?? Do your children take deworming pills every

six months? Why or why not?


44

Deworming for All (Picture 6.1)

Picture A. A nurse is standing at Mother B’s door. She is holding a flipchart of picture 4.2D on it (all the parasites). She is pointing at the children.

Picture B. Repeat 3.4D from Module 3 – the children all receiving deworming pills. (Remove the 6 moons in the corner).

Caption Picture A: The health worker is asking the children to come to a deworming campaign.

Caption Picture B: “My children were treated 8 months ago. They aren’t sick anymore,” says Mother B.

Picture C. The nurse is holding out her hand and signaling for the children to come. She is talking to Mother B.

Picture D. A close up of Mother B’s face. Her mouth is open and she is looking up. She is confused.

Caption Picture C: “No,” says the health worker. “All children receive treatment every six months.”

Picture Caption D: Mother B is confused. Isn’t treatment only for the sick?

45

Deworming Pregnant Women and Children (Picture 6.2)This is the text for the back of page 47.Note to the Health Manager: Deworming pregnant women is recommended for regions where HOOKWORM prevalence is more than 20% in the general population. If HOOKWORM prevalence is lower, adapt this page to discuss deworming for children only.

7. Show


8. Explain

To prevent malaria, pregnant women will take one deworming pill in the fourth month of pregnancy.

o Many pregnant women have worms already and don’t know.

o Go to a health worker at the first sign of pregnancy.o When a pregnant woman’s belly begins to show and

she feels movement inside, three months have passed. She is ready to take a deworming pill.

o Women who take deworming pills have healthier pregnancies and infants.

Beginning at 12 months of age, children should receive a deworming pill every six months.

o Most children have worms and don’t even know it. o Treating children for worms prevents malnutrition. o Deworming pills help children to grow well and do

well in school. o Deworming children will reduce parasite infections in

others. o If you are not sure if your child has been treated, ask

the health worker at your next visit.

46

Deworming Women Mothers and Children (Picture 6.2)

Picture A. A pregnant woman is taking a a pill from a health worker. She is just beginning to show (4 months pregnant).

Caption Picture A: To prevent malaria, pregnant women take a deworming pill in the fourth month of pregnancy.

Picture B. Repeat picture from Module 3, Picture 3.4 D. [Hardship] (18 months) is receiving a deworming pill.

Caption Picture B: Beginning 12 months of age, children should receive deworming pills every six months.

47

Signs of Parasite Infection (Picture 6.3)This is the text for the back of page 47.

5. Show


6. Explain

Child frequently scratches his anus.o Some parasites deposit eggs outside the anus.o The eggs cause itching especially at night.

Worms are seen in the child feces.o Remember, not all worms can be seen! o The child may have worms even if you cannot see

them. Child has bloated stomach or stomachache for three days. Child has poor growth and poor appetite.

o Parasites living in the belly can decrease hunger.o Parasites slow down the child’s growth.

Child has blood in the urine. If you see any of these signs, take the child to the clinic

immediately.o Take the child on the same day.

? What are the symptoms of parasites in adults?o The symptoms are the same.o If you see one or more signs, go to the clinic.

48

Signs of Parasite Infection (Picture 6.3)

Picture A. Show a child’s legs and buttocks. The child is wearing red shorts. He is scratching his anus.

Picture B. Repeat the image of feces with worms from Module 2, Lesson 3, Picture 2.

Caption Picture A: Child frequently scratches his anus.

Caption Picture B: Worms in the feces.

Picture C. Show [Mother B]’s oldest child (boy 8 years old). He has a bloated stomach, but his arms and legs are very thin. He is holding his stomach and has a grimace on his face because of pain.

Picture D. Show a 2 year old child’s bare bottom and legs. The child is standing up from a child’s potty (white bowl that is small enough for a child to sit on). In the white bowl is urine (yellow) but the surface is red where the last few drops of urine have fallen and they contain blood.

Caption Picture C: Bloated stomach or stomachache for 3 days.

Caption Picture D: Blood in the urine.

Picture E. Repeat 4.1 B of the children uninterested in eating.

Picture F. Repeat picture 1.1C of [Father B] taking the child to the clinic.

Caption Picture D: Poor growth and poor appetite.

Caption Picture E: If you see any of these signs, take the child to the clinic immediately.

Feeding Guidelines (Picture 6.4) Some changes have been made from the text from Module 3, Lesson 5.3)

49

9. Show


10. Explain Chase the illness far away. Offer extra food and fluids to the child

each day. Give all the medicine from the health worker.o If caregivers give the same amount of food as normal or

only half of the medicine, the thief will wait in the bushes for another chance to break in.

Give the child his favorite foods, soft foods and foods rich in Vitamin A.

o Vitamin A foods include mango, papaya, carrots, orange sweet potato, green leafy vegetables, meat and fish. Notes for the Health Manager: please adapt foods listed here according to local varieties. See foods as mentioned in Module 2, Lesson 4.

o Soft foods are easier for children to swallow. Eating favorite foods will encourage the child to eat.

o Vitamin A foods help the child to recover quickly. Offer extra foods and fluids each day for two weeks after the

signs have disappeared.o Extra foods help to strengthen the child’s body.

11. Activity: Health Card Check


50

Feeding Guidelines (Picture 6.4)Repeat Flipchart Pictures B, C and D from Module 3,

Lesson 5.3

Picture A. Repeat picture from Module 4, Picture 5.3 D

Caption Picture A: Chase the parasites far away. Offer extra food and fluids each day. Give all the medicine from the health worker.

Picture B. Repeat Picture 5.3B of [Mother B] breastfeeding [Hardship]. REMOVE the image in the background of the thief. AND the malaria pills on the table.

Picture C. Repeat picture from Module 3 Picture 5.3B of [Mother B]’s oldest son feeing [Hardship]. REMOVE THE IMAGE OF THE THEIF FROM THE Background.

Caption Picture B: Give the child his favorite foods, soft foods and foods rich in vitamin A.

Caption Picture C: Offer extra foods and fluids each day for two weeks after the child has recovered.

51

Lesson 7: Maintaining the Care Group This is the text for the back of page 51. I have included this lesson in flipchart format so that it will be taught to Leader Mothers and neighbor groups (beneficiaries). This will increase the awareness and understanding of how the groups will continue after the FH program is complete. Adapt the following module based on your relationship and agreement with MOH and the Community Development Committee. If they plan to help monitor, train or supervise workers following the completion of the program, adapt the lesson to those agreements.

Materials1. Attendance Registers 2. Notebook and pencil*

1. Game: I Scared a Lion


3. Story: The Promoters are Leaving! (Picture 7.1)There is a rumor going around the village that the health program is ending. [Mother B] heard two promoters say that they will no longer be FH promoters. “Oh no!” said [Mother B]. “If the promoters leave our care group, our teachings will stop. How will we survive without these health messages?” She quickly runs to tell [Mother A].

4. Ask? Why is [Mother B] so upset? ? When are the promoters leaving the care

groups? ? How do you feel about them leaving?

Let’s see what [Mother A] says about the program.

52

The Promoters are Leaving! (Picture 7.1)Notes for the Health Manager: Guide the illustrators on the type of clothing worn by FH promoters and a “MYAP manager” (picture A-C).

Picture A. Two promoters wearing FH clothing are talking together. [Mother B] is walking nearby (on the left side of the picture). [Mother B]’s face is turned to look at the promoters. The image in the next box represents what the two promoters are discussing. Use a thought bubble to show that the picture represents the words they are speaking.

Picture B. Inside a thought bubble (see below), the same promoters from Picture A are handing their flipcharts and FH clothing to the MYAP manager.

Caption Picture A-B: [Mother B] heard two promoters say that they will no longer be FH promoters.

Picture C. Show a close up of [Mother B]. She has wide eyes and her mouth is open in surprise. Her two hands are on her cheeks.

Picture D. [Mother B] is running towards [Mother A] who is sweeping. [Mother B] is waving her arms and calling out to [Mother A].

Caption Picture C-D: “Oh no!” How will we survive without these health messages?” She runs to tell [Mother A].

53

Choosing a Care Group Mother (Picture 7.2)This is the text for the back of page 53. Notes for the Health Manager: 1) Adapt the title of the leader of the Care Groups as locally appropriate. I have used the title “Care Group Mother” to help mothers understand that the children (Leader Mothers) and grandchildren (neighbors) must be cared for like a mother cares for her children. Translate Care group Mother into the local language or use similar words such as “Grand Mother” or “Great Mother,” etc. 2) I suggest that one Care Group Mother is elected for each care group. You may also choose to have one care group mother for every 3-4 care groups (containing a total of 24 – 40 Leader Mothers). Adapt as appropriate.

5. Show


6. Explain

Like a midwife who comes to help a mother give birth, the promoters have come to help us birth the care group program.

o The birth is not the end; it is the beginning! o Like a new mother, we must begin to care for the

program ourselves. Leader Mothers will choose a Care Group Mother.

o The Care Group Mother will care for the program and help it to grow.

o The Care Group Mother needs to be a good teacher and a “model family mother.”

o She must be willing to train and coach new Leader Mothers.

The promoter will coach the Care Group Mother.o The Care Group Mother will begin teaching some of

the lesson each month. o The promoter will watch her. She will help her

improve. o The promoter will slowly give all responsibility to the

Care Group Mother.

Choosing a Care Group Mother (Picture 7.2)

54

Picture A. A midwife is leaving the house of a woman who has just given birth. The newborn infant is in the mother’s arms. The midwife is standing by the door with her supply bag. She is saying goodbye to the family.

Pictures A and B should be very similar. The Promoter in Picture B should stand in the same way as the Midwife in Picture A so that it is easy to understand the comparison. The family position should be very similar to the position of all of the Leader Mothers.

Picture B. Ten Leader Mothers are standing with their flipcharts under their arms. They are saying goodbye to the FH promoter. The FH promoter is standing by the door with her suitcase. The Leader Mothers are saying goodbye.

Caption Picture A-B: Like a midwife who comes to help a mother give birth, the promoters have come to help us birth the care group program.

Picture C. The FH promoter (wearing an FH T-shirt or vest) is congratulating (shaking her hand or other appropriate gesture) of the new Care Group Mother. Other women (from picture B) are dancing and singing around her. Adapt as necessary so that this would match the appropriate response by a care group. Give guidance to the illustrator regarding the FH clothing worn by the promoter.

Picture D. The Care Group Mother (same woman as in Picture C) is teaching a new lesson to the care group (same 10 women from picture B. The promoter (wearing FH clothing) is sitting next to her, watching her.

Caption Picture C: Leader Mothers will choose a Care Group Mother.

Caption Picture D: The promoter will coach the Care Group Mother.

55

Maintaining Neighbor Groups (Picture 7.3)This is the text for the back of page 55. Notes to the Health Manager: I am using “neighbor groups” to describe the beneficiaries from this point forward. Once the FH program ends, the terms “donors and beneficiaries” will no longer be appropriate. Adapt as needed with words in the local language.

7. Show


8. Explain

The Care Group Mother will make sure each Leader Mother is teaching eight of her neighbors.

o At Care Group meetings, Leader Mothers will report how many neighbors they have taught.

o The Care Group Mother will visit Leader Mothers teaching their neighbor groups.

Women who are not pregnant and do not have children less than two years will graduate.

o This allows new mothers to join the group.o We must make sure they hear the messages so their

children will survive and be healthy. New women will be added to neighbor groups that are too

small. o Some neighbors move away or no longer attend

meetings. o The Care Group Mother will find pregnant women and

mothers of children less than two years to come.

? Why should we continue to share the health messages? Would it be wrong to end the program now?

o Having the messages, but not sharing them is like a mother with full breasts who refuses to breastfeed.

o God has allowed you to hear these messages. It is a good use of this “gift” to share it with others.

56

Maintaining Neighbor Groups (Picture 7.3)Notes for the Health Manager: Adapt the text for caption A regarding the number of neighbors used in care groups in your region. Adapt the pictures (A-C) so the numbers are the same.

Picture A. A Leader Mother (choose one woman from Picture 7.2B) is teaching a group of 8 women. The Leader Mother is holding a flipchart. They are all sitting down on a mat together in a circle. Three of the women are pregnant. Five of the women have children under age two. The Care Group Mother (same woman as in Picture 7.2 C) is sitting on a chair watching the Leader Mother as she teaches.

Caption Picture A: The Care Group Mother will make sure each Leader Mother is teaching eight of her neighbors. Picture B. A group of 3 women (none of

them are pregnant) is standing with their children. The children are between the ages of 4 and 12. They are being honored by the Care Group Mother. Around them are other mothers dancing and singing. Some of the dancing mothers are pregnant.

Notes for the Health Manager: This image should demonstrate the “graduation” that you envision for mothers who are finished with the program (or whose children are no longer in the target group). Adapt according to local custom.

Picture C. A Leader Mother from Picture 7.2 B (different than 7.3A) is holding a flipchart in front of a group of the 5 women. They are all sitting down on a mat together in a circle.

The Care Group Mother is standing next to the group with three pregnant mothers. She is introducing the pregnant women to the group.

Caption Picture B: Women who are not pregnant and do not have children less than two years will graduate.

Caption Picture C: New women will be added to neighbor groups that are too small.

57

Training New Leader Mothers (Picture 7.4)This is the text for the back of page 57.

9. Show


10. Explain If a Leader Mother stops teaching, the neighbor groups will

choose a new Leader Mother.o Some Leader Mothers move away or are no longer able to

teach. New Leader Mothers can watch and learn from experienced

leaders. o Experienced Leader Mothers will show them what to do.o Experienced Leader Mothers will help them overcome

problems in the neighbor groups. The Care Group Mother will continue to teach every two weeks.

o As new leaders come, they will learn the lessons.o Care Groups will start again with Module One when all

lessons have been taught. The Care Group Mother may invite health workers and midwives

to share new information at the care group meetings.

? Mother B was worried the program would end. Do you believe the program can continue?

11. Activity: Preparing for the Transition


58

Training New Leader Mothers (Picture 7.4)

Picture A. The Care Group Mother is standing next to a flipchart in front of a group of seated mothers (several mothers are breastfeeding). On the flipchart are two women’s names. Under one name are four lines or votes (////) Under the other name are two lines. The Care Group Mother is drawing a third line under the second name. One woman is talking while pointing towards the second name on the flipchart.

(Notes for the Health Manager: Give guidance to the illustrators as to how voting is done in your region. Draw a picture of the method which was used to elect Leader Mothers in your program.

Picture B. Two Leader Mothers are walking towards a house together. Each of the mothers has a flipchart.

Caption Picture A: If a Leader Mother stops teaching, the neighbor group will choose a new leader.

Caption Picture B: New Leader Mothers can watch and learn from experienced leaders.

Picture C. A close-up of the Care Group Mother teaching. In her hand is the front page of Module 1’s flipchart (Introduction and Breastfeeding). We see the backs of a group of Leader Mothers listening. Next to several mothers we see a flipchart.

Picture D. A nurse is teaching a group of women. Only the backs of the women can be seen. The nurse is facing us and teaching with a blank flipchart.

Caption Picture C: The Care Group Mother will continue to teach every two weeks.

Caption Picture D: You may invite health workers and midwives to share new information.

59

References for the Illustrator:

Tapeworm (segments are 1cm long – entire worm can be several meters long)

60

(Optional Page) Prevent Malaria by Reducing Breeding Sites (Picture 2.5)

This is the text for the back of page 17. If indoor spraying does NOT happen in your country (or is not widespread, I suggest that you include an alternate page – you can print both for future reference, but only use four of the five pages for teaching.

9. Show


10. Explain

Mosquitoes breed in standing water. o They lay eggs in the water. o We can reduce malaria, by reducing the places

mosquitoes lay eggs. Dig drainage rows to disperse pools of standing water.

o Create drainage or rock piles under Tippy Taps and around community water supplies to prevent puddles from forming.

Empty buckets, cups, and cans. Store them upside down.o Put lids on buckets to keep our rain water and

insects. Bury or burn old trash, tires and cans that trap water.

11. Activity: Hanging a Mosquito Net


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Prevent Malaria by Reducing Breeding Sites (Picture 2.5)

Notes for the Health Manager: These illustrations from Mozambique may be used as is – as long as you source Mozambique’s illustrator. Or it can be redrawn to match the other illustrations. If redrawn – use images of [Mother A] and [Father A] in the illustrations.

Caption Picture B: Mosquitoes lay their eggs on top of the stagnant water.

Caption Picture B: Dig drainage rows to disperse pools of standing water.

Caption Picture F: Empty buckets, cups and cans. Store them upside down.

Caption Picture A: Bury or burn old cans, tires and cans that trap water.

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