Integrated Diarrhoeal Prevention and Management Project ...misaccess.psi.org/bcc_catalog/web/files/SWHP Manual 1.4final.pdf · Training Manual Integrated Diarrhoeal Prevention and

�Training Manual

Integrated Diarrhoeal Prevention and Management Project

for Safe Water and Hygiene Promoters (SWHPs)


Training Manual

� Training Manual


inside front cover

�Training Manual


Section 1: PSI/Malawi Background

Section 2: The Child Survival Project: An Integrated Diarrhoea Prevention Program

Section 3: A Technical Review: Diarrhoea Prevention and Management

3.1 WhatisDiarrhoea?

3.2 CausesofDiarrhoea

3.3 WhatAretheSymptomsofDiarrhoea?

3.4 WhataretheEffectsofaChildHavingDiarrhoea?

3.5 DiarrhoeaPrevention

3.6 Whataresourcesofwatercontamination?

3.7 Whataredifferentwaystotreatmydrinkingwater?

3.8 WhatareSafeWaterStorageContainers?

3.9 WhatAretheContainersThatAreNOTRecommended?

3.10 HowcanImakemycurrentstoragecontainera“SafeWaterStorageContainer”?

Section 4: Reviewing Child Survival Products

4.1 WaterGuard

4.2 WaterGuardWaUfa

4.3 AddressingBarrierstoPurchase/UseWaterGuardorWaterGuardWaUfa

4.4 TreatmentforDiarrhoeaandDehydrationwithThanziORS

Section 5: Hand Washing

5.1 Whyishandwashingwithsoapimportant?

5.2 Keyelementstorememberabouthandwashing

5.3 Whenshouldyoutellyourclientstowashtheirhands?

5.4 ProperHandWashingTechnique

Section 6: Conducting Effective IEC and IPC Activities

6.1 CommunityMotivation

6.2 PositiveMotivationandtheFRAMESMethod

6.3 TheRoleofaSafeWaterandHygienePromoter

6.4 MotivatingClientsforBehaviourChange

6.5 SWHPReportingMechanism

Integrated Diarrhoeal Prevention and Management Project Training Manual for Safe Water and Hygiene Promoters (SWHPs)

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PSI/Malawi is a non-profit organisation dedicated to improvingandsustainingthehealthofallMalawians.PSI/Malawiispartofaninternationalgroupworkingover70countriesandisaworldleaderinsocialmarketing. PSI is known for using evidence basedandeffectivemethodstopromotehealthybehaviouramongthevulnerablelow-incomepeople.

What is Social Marketing?Social marketing is the adaptation of commercialtechniques/technologies (research, market analysisandbranding,advertising,pricingandcommercialinfrastructures) to influence the voluntary behaviour ofthetargetgrouptoimprovetheirpersonalhealthandthatofthesociety.

Why Does PSI/Malawi Use Social Marketing?PSI’s products and services are sold at highlysubsidisedcostpricesinordertomakethemaffordabletoeventhemosteconomicallydisadvantaged.PSI/Malawisellsproductsandservicesinsteadofgivingthemawayfortworeasons:

Section 1:

Whenproductsarefree,therecipientoftendoesnotvalueorevenusetheproductBysellingproductsandservices,PSIcantaptheresourcesofthelocalcommercialinfrastructure,which is financially motivated to stock and deliver them.

Research plays a vital role in every PSI program.Evidencebaseddecisionmakingguidesouroverallstrategyanddictatesmarketing,communicationandprogrammaticdecisions.

PSI/Malawifocusesonthreemainareas:HIV/AIDSPrevention(ChishangoCondoms,YouthAlert,SchoolsProgramme,FaithCommunitiesProgrammeandTargetedOutreachCommunications)MalariaPrevention(ChitetezonetsandMbwezeraChitetezo)DiarrhoealPreventionandTreatment(ThanziORS,WaterGuardliquidandWaterGuardWaUfa,PromotionofHygieneandsanitation)

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The IDP Project is a holistic approach to diarrhoeapreventionfocusingonthreemainareas:a. DiarrhoeaPreventionb. Dehydrationtreatmentcausedbydiarrhoeac. PromotionofHygieneandSanitation

Under this programme, USAID funds PSI/Malawi towork in collaboration with NGOs already operatingwaterandsanitationprojectsinMalawitoexpandtheirdiarrhoeal prevention and management program.TheseNGOs includetheFreshWaterProject,WorldVisionInternational,WorldRelief,theBlantyreSynod,andWaterAid.

Section 2: The Child Survival Project: An Integrated Diarrhoea Prevention Program

The project will work with IDPP partners to expanddistributionofWaterGuardandnewThanziORSintothe ruralareas thataremost inneedofdiarrhoealprevention and treatment products. This strategywill make sure that these products become readilyavailablewithinreachofthecommunity.

Under this project, health communications willreinforcetheneedto:

TreatdrinkingwaterallyearroundPracticegoodhygieneandsanitation likehandwashingTreating dehydration caused by diarrhoea asearlyaspossiblewithNewThanziORS.

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3.1 What is Diarrhoea? “Diarrhea is loose, watery stools. A person withdiarrheatypicallypassesstoolmorethanthreetimesaday.”

Diarrhoea is commonly believed to be naturaland a normal part of a child growing up—it is not!Diarrhoea is nature’s way of letting you know thatthereissomethingharmfulinyourbody,likeagerm,bacteria, or parasite. Diarrhoea is easy to prevent,andcaretakersshouldprotecttheirfamiliesbyusingtreateddrinkingwaterandpromotinggoodhygieneandsanitation.Caretakersshouldtreatdiarrhoeaassoonassymptomsarise.

3.2 What are the causes of diarrhoea?Diarrhoea is most commonly caused by bacteriaor viral infections. Many times, diarrhoea-causingbacteriaandvirusesarewaterborneorfood-borneandareoftencausedbypoorhygieneandsanitation.

Waterbornebacteriaandvirusescaninclude:cholera,giardia, Cryptosporidium, and others. Commonsymptoms that one has a waterborne illness caninclude cramps, diarrhoea, nausea, vomiting, andfever.

Diarrhoea is the second leading cause of childmorbidity and mortality among fewer than five children in Malawi. Surveyed caretakers in Malawireported that 22% of children under five experienced diarrhoea in the last two weeks and only 36% ofchildrenreceivedtreatmentatahealthfacility.Ofthe22% thatexperienceddiarrhoea,61%were treatedwithORSand18%werenottreated.

3.3 What Are the Symptoms of Diarrhoea?Diarrhoea in children can cause the followingsymptoms:

StomachachesandcrampingFrequent, watery stools (and in more serioussituations,pusorblood)Irritability

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Section 3: A Technical Review: Diarrhoea Prevention and Management

LossofappetiteSluggishnessanddecreasedenergyVomiting

Severe diarrhoea can cause dehydration. Signs ofdehydrationincludethefollowing:

DecreasedurinationAbsenceoftearswhencryingDrymouthTiredness

3.4 What are the Effects of a Child Having Diarrhoea?Diarrhoea causes a loss of important vitamins andnutrients that mustbe restored. With severe casesofdiarrhoea,therecanbemoreserioussideeffects.Whenachildisseverelydehydrated,theamountoffluid in the child’s bloodstream decreases, making it difficult for organs to get enough oxygen and nutrients.

Globally,diarrhoearesultsintwomillionchilddeathsand 443 million missed school days. A child’seducationiscompromisedbytheirhavingdiarrhoeabecausetheyaresickandforcedtomissschool,ortheyattendschoolbutareuncomfortable,distractedandcannotconcentrateontheirlessons.

Diarrhoea does not only affect the child, but thecaretakeraswell.Caretakersareforcedtoabandonotherresponsibilitiesforexamplecannotparticipateindevelopmentactivitiesas theycare for theirsickchild.Severediarrhoeaisalsocostly—itisexpensivetotakeachildtoaclinic,totreatthechild,andnursethembacktohealth.

Thisisaneasilypreventablehealthproblem!

For Discussion: When is diarrhoea common in Malawi and why?What age group are most affected by diarrhoea?What are the effects of a child having diarrhoea?

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3.5 Diarrhoea Prevention

the possible sources of water contamination afterwaterisdrawn:

Whilepickingupandcarrying thendowa,dirtyfingers can contaminate water during transportDirt, germs and bacteria that contaminate thedrinking water after it is drawn from borehole(ex:fromplacingleavesontopofthewater)AchilddippingtheirdirtyhandsintothendowaathomeUsingonecupsystem;thesamecupisusedfordrawing and drinking water by many people inthefamily

For Discussion:Is water from a borehole always safe? How does contamination during transport occur? Why is it important to treat drinking water year-round from a protected water source?

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Although diarrhoea is a serious threat to childrenunder five, it is easily preventable through the followingways:a. Drinkingsafewatereverydayallyearroundb. Storingwaterinsafecontainersc. Washinghands thoroughlywithsoapatcritical

timesd. Practicinggoodhygieneandsanitation

3.6 What are sources of water contamination?Although water is drawn from “safe” sources likeprotected boreholes, a significant proportion of water contaminationoccursduring transport to thehouseholdoratthehouseholdlevel.Anunprotectedwatersource,likeariverorstream,iseasilycontaminatedby:

AnimalsdrinkingordefecatinginthewaterPeoplewashingclothesinthewaterPeople bathing or relieving themselves in thewaterRun-offfromlatrines,sewage,orcrops

Itiseasytothinkthatifyoudrawyourwaterfromaprotectedwatersource,likeaboreholeorprotectedwell,thatyourwaterisautomaticallysafetodrink.Butthisisnotnecessarilythecase!Itisveryeasyforyourdrinkingwatertobecomere-contaminated,especiallyduringtransportandatthehouseholdlevel.Consider

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3.7 What are different ways to treat my drinking water?Boiling:Disadvantages:

To eliminate all bacteria, water must be fullyboilingfor12minutesIt is very costly to boil water (firewood)Itisharmful/costlytotheenvironmentItdoesnotpreventagainstre-contamination

Solar Disinfection (SODIS)Advantages:

InexpensiveEnvironmentallyfriendly

Disadvantages:LabourintensiveTimeintensiveItdoesnotpreventagainstre-contamination

WaterGuardAdvantages:

Protects water from re-contamination for 48hoursaftertreatmentKills most water-borne bacteria, parasites, andvirusesEasytouseRelativelyinexpensive—costslessthan1kwatchaper day to keep your family healthy (which isMUCHlessexpensivethantakingyourchildtoaclinictotreatdiarrhoea!)

Disadvantages:DoesnotmakedirtywatercleanlookingChlorinetaste(butthiscanbereducedbylettingitsettleovernight)

WaterGuard Wa UfaAdvantages:

MakesvisuallycontaminatedwaterlookcleanLessofachlorinetasteKills 99.999% of parasites, bacteria, andviruses

DisadvantagesDirectionscanbehardtofollowHigherper-litrecostthanWaterGuard

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3.8 What are Safe Water Storage Containers?Safewatercontainersideallyhaveanarrowmouth(topreventhandsfromreachinginandre-contaminatingthe water) and a tap or spigot. Other safe watercontainersinclude:

Covered Buckets with a Tap and LidAdvantages:

Tap and lid reduces risk ofrecontaminationEasy to fillStandarddosing(20litres)

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Disadvantages:Ifuncovered, it iseasyto inserthandsthroughthewidetop,causingre-contamination

Covered Clay Pots

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Advantages:Lid reduces risk ofrecontaminationWateriskeptcoolbytheclay

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Disadvantages:BreakseasilyHeavytocarryVaries in size and volume, making dosinginstructions difficultIfuncovered, it iseasyto inserthandsthroughthewidetop,causingre-contamination

Jerry Cans

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Advantages:Narrow mouth for fillingAppropriate shape anddimensions to it is not difficult tocarryStandard volume (20 litres)simplifies WaterGuard dosingLid and narrow mouthdiscouragere-contamination

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Disadvantages:DoesnotkeepwatercoolOvertime,exposuretosunlightmaydamagethe

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vessel,causingittocrackNarrow mouth makes cleaning more difficultSomejerrycansareexpensive

3.9 What Are the Containers That Are NOT Recommended?

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Uncoveredtraditionalclaypotswithwidemouthanduncovered buckets (or other vessels with a widemouthandnolid)arenotrecommended.

3.10 How Can I Make My Current Storage Container a “Safe Water Storage Container”?Ifyoudonothaveacoveredbucket,potorajerrycan,itisrecommendedthatyouusealidonthecontainerthatyouhave,andthatyoueitherpouroutthewateror scoop the water with a clean cup, making surenot to touch the water with your hands, and use adifferentcupfordrinkingthewater.

Althoughuncoveredpotsandndowascost lessandarereadilyavailable,theydonotkeepyourwatersafefromcontaminationandwateriseasilycontaminatedby dirty hands, household dirt, etc. If you useWaterGuard, than the chlorine provides residualprotection and kills any germs and contaminantsfor 24 hours after treatment while the water is instorage.

For Discussion:What are four different ways to treat your drinking water? What are their advantages and disadvantages?What is a safe water storage container?Why is it important to use a safe water storage container?Why is it important to keep a lid on your drinking water container?

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4.1 WATERGUARD

Section 4: Reviewing Child Survival Products interventionandshouldnotbeusedinthetreatmentofwateratboreholesorcommunitywells.

How do I use WaterGuard?WITHTHECURRENTBOTTLE

Use two capfuls of WaterGuard to treat 20litres of clean looking water (ex: from a tap orborehole)Usefourcapfulstotreat20litresofdirtylookingwater(ex:waterdrawnfromariverorstream).Wait30minutesforWaterGuardtodisinfectthewater-after,thewaterisreadytodrink.

THEFUTUREBOTTLE(distributiontocommencelate2007)PSI/Malawi will be introducing a “Watsopano”WaterGuardinlate2007.Thiswillbeasmallerbottlewithahigherconcentration.Thisbottlewillbeabletotreat1,000litresofdrinkingwaterperbottleinsteadofthecurrent700litresofwater.

Use one capfuls of WaterGuard to treat 20litres of clean looking water (ex: from a tap orborehole)Usetwocapfulstotreat20litresofdirtylookingwater(ex:waterdrawnfromariverorstream).Wait30minutesforWaterGuardtodisinfectthewater-after,thewaterisreadytodrink.

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What is WaterGuard?WaterGuard is a point of use water treatmentproductthatkillsgermsthatarefoundinwater.It isasimpletouse, inexpensive,andeffectivehouseholdwaterdisinfectant.It gives households a way to make their watersafe until they gain access to a piped, treatedwatersystem.WaterGuard solution provides a residual effectagainstrecontamination.Water treatment at the point of use usingWaterGuard reduces diarrhoeal episodes byabout50%.

What are the active ingredients of WaterGuard?

Chlorinethatkillsgermsfoundinwater

When should you use WaterGuard?Every time you refill your drinking water container, ithastobetreatedwithWaterGuard.Evenifthewaterisdrawnfromthepipeithastobetreatedaswatermaygetcontaminateduringstorage.Water shouldbe treatedEVERYDAY,ALLYEARROUND as water contaminations happens allyearroundanddiarrhoeacanstrikeatanytime!Evenifthewaterlooksclean,itcanhavegermsthatcausediarrhoeaatanytimeoftheyear.WaterGuard is a household water treatment

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How long will water treated with WaterGuard be safe to drink?

Itwillstaysafefor24hoursaftertreatment

What are other purposes of using WaterGuard besides using it for drinking water?

Treatedwatershouldalsobeused forwashingfruitsandvegetables,cleaningkitchenutensils,andcanalsobeusedforhandwashing.

How long does the bottle last before it expires?

The product’s shelf life is 12 months ifUNOPENED.After the bottle is opened in the home, thesolution should be used up within two monthsbecausetheintroductionofaircausesittoloseitspotency.PSI/Malawi recommends using one bottle ofWaterGuardforafamilysizeof4to6peopleforonemonth.

Where should the bottle of WaterGuard be stored?

Outofsunlight,outofthereachofchildren,inacool,dryplace.

Where can one buy WaterGuard?Fromretailers,wholesalers,pharmacies,kiosksandofcoursetheSWHPromotersandHSAsthatareinthecommunity

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What does water treated with WaterGuard taste like?

WaterGuard has a slight chlorine or metallictastetoit

What can I do about the chlorine taste?Theslightsmellortasteofchlorinemeansthatthewaterissafetodrink.Toreducethetasteofchlorine,treatyourdrinkingwaterintheeveninganduseitthenextday.

Limitations of WaterGuard:Relatively ineffective against a few chlorine-resistant parasites (Giardia lamblia,Cryptosporidium).Ifwaterhaschorine-resistantparasites, then WaterGuard Wa Ufa should beused.Reduced efficiency and disagreeable taste or odourthatmayresultwhenWaterGuardisusedtotreatwaterthatisexcessivelydirty(ex:averydirty river or stream). When this is the case,WaterGuardWaUfashouldbeused.

What do I do if the water treated with WaterGuard looks cloudy or dirty?Althoughthewater treatedwithWaterGuard issafetodrink,itmaystilllookcloudyordirty.Ifthisisthecase, you can either filter the water or use a settling technique.

To Filter: filter the treated water with a cloth. To make a filter, fold the cloth over enough times to remover dirt but still allow water to flow through easily.

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Settling technique: let water settle overnightor for a few hours and then carefully pour theclearedwater intoanewcontainer, leavingthesedimentbehind.

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Can I just use commercially-prepared bleach instead?

No, because the concentration varies so it isdifficult to ensure correct application. Commercial bleachmaycontainchemicaladditivesthatmaynotbeintendedforhumanconsumption.WaterGuard is formulated specifically for drinking waterandischeaperthancommercialbleach.

For Discussion:Why is it important to treat your drinking water year round?Should you treat water that has been drawn from a borehole or a protected well?Do you need to treat water that looks clear-looking?How do you use WaterGuard?What is your response if someone said “K25.00 is too much to pay for WaterGuard?”How do you reduce the chlorine taste with water treated with WaterGuard?

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4.2 WATERGUARD WA UFA

What is WaterGuard Wa Ufa? WaterGuardWaUfaisahouseholdwatertreatmentthat uses a combination of disinfection andsedimentationtokillandremovegermsandsolubledirt from drinking water. A small sachet of PURpurifies 10 litres of dirty water, removing microbial andchemicalcontaminants,eveninverydirtywater.ManywhohaveseenPURinactioncallit“themagicproduct”becauseinjust30minutes,eventhedirtiestwaterbecomesclearandpotable.

WaterGuardWaUfaprovidesadoubleactionsystemof purification. First, it removes the dirt that can see. Secondly, it kills the germs that might be presentin the water or in the containerwhere the water isstored. This is an ideal product when the drinkingwater comes from a visibly dirty water source (ex:riverorstream).

What are the active ingredients found in WaterGuard Wa Ufa?

WaterGuard Wa Ufa’s active ingredients arecalciumhypo-chlorite(chlorine)andironsulphate.Theseingredientsarealsousedindrinkingwatertreatmentindevelopedcountries.

Why are the ingredients in WaterGuard Wa Ufa so special?

Because when they are mixed in water,WaterGuard Wa Ufa acts like a magnet for allthedirtandgermsinwater.WaterGuardWaUfakillsthegermsandharmfulcontaminantsinthewaterandthedirtclumpstogetherandsettlesatthe bottom for easy filteration. You can actually seethisprocesshappening!

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Is WaterGuard Wa Ufa Safe?WatertreatedwithWaterGuardWaUfaisabsolutelysafe to drink. The product has undergone vigoroustestingwith internationalhealthauthorities like theWHOandtheCDCandmeetsrigorouscriteriaforsafeandpotablewater.

How do I use WaterGuard Wa Ufa?PURisaneasy-to-useproduct.Thereareonlyafewsteps:

Collect water from a source that you normallyuseintoa10litrebucketOpen the sachet of WaterGuard Wa Ufa at thecornerusingaknifePourcontentsoftheWaterGuardWaUfasachetinto10litresofwater

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Contaminatedsourcewater

Formationofflocculant after introductionofWaterGuardwaUfa

Formationofflocculent after5minutesofstirring

Decantingthewaterthroughacleancotton cloth filter

Cleanwaterreadyforstorageanduse



Stirwellfor5minutesLetthewatersettleforanadditional5minutesafterstirringUseathick,cleancottonclothwithoutholestofilter the water Dispose off the dirt away from children andanimalsPour the filtered water into a storage container andcoveritwithatightlidWait for 20 minutes. After, water is ready todrinkWash containers and the filtering cloth soon afterwatertreatmentprocess

For Discussion:What is the difference between WaterGuard and WaterGuard Wa Ufa?When is it best to use WaterGuard Wa Ufa?How do you use WaterGuard Wa Ufa?

4.3 ADDRESSING BARRIERS TO CHANGE (Barriers to Purchase or Use WaterGuard orWaterGuardWaUfa)If your clients claim that WaterGuard is tooexpensive:

Explainthatitischeaperthantakingyourchildtotheclinicfortreatmentorcheaperthanboilingalldrinkingwater.It can save your life by preventing cholera/diarrhoea.Itwillsaveyoutimethatyouhavetotakeofffromworkbytakingyourchildtotheclinic.Itcostsapproximatelyonekwachaadaytokeepyourfamilysafe

Ifsomeonestatesthattheirwater“lookssafe”becauseitisclearandcomesfromthetaporborehole:

Eventap/boreholewatercanbecontaminated.Thegermsare toosmall tosee,soeven if thewaterlooksclear,itcanbeunsafe.Flowmaybeintermittentallowingcontaminationthrough leaks where pipes are connected. Inaddition, if it isacommunity tap/borehole, thewatermustbetransportedandstoredwhichwouldallowforthepossibilityofrecontamination.

Ifsomeonehasneverbeforetreatedtheirwater,whyshouldtheystartnow?

Ifyourchildhaseverhaddiarrhoea,itmayhave

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beencausedbycontaminateddrinkingwater.Your water can have germs at any time. Youshouldalwaystreatyourwater.

Ifyourclientsthinkthattheyonlyneedtotreattheirwaterduringthedryseason:

Reinforce that water needs to be treated year-round,becauseeven if theirwater looksclean,it canhavegerms that causediarrhoeaatanytimeoftheyear.

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4.4 TREATMENT FOR DIARRHOEA & DEHYDRATION WITH THANZI ORS

What is Thanzi ORS?Thanzi isanOralRehydrationSalt(ORS).ORSisanextremelyeffectivesolutionthatrehydrateschildrenand adults and replenishes body fluids lost during diarrhoea episodes. ORS is the most effectivesolution to replenish the electrolytes and nutrientslostduringmildoracutediarrhea.

Nowthereis“Watsopano”ThanziORS.Thisisalowosmolarity formula that replenishes body fluids as wellasreducesvomitingby30%andstooloutputby20%.Italsoreducesintravenoustherapyby33%.Italsotastesmuchbetterandislesssalty!

When Should I Use New Thanzi ORS?Attheonsetofdiarrhoea.

How do I Use New Thanzi ORS?When one initially experiences diarrhoea, pour thecontentsof1sachetofThanziORSinto1litreofsafewaterandstirforittodissolve.Ifyoudonothavea1litre bottle, fill three empty Fanta or Coca-Cola bottles with treatedwaterandpour intoacleancontainer.AddIsachetofNewThanziORSandstirtodissolve,it

isreadytoadminister.Twosachetsareusuallyusedtotreatoneepisodeofdiarrhoea.

How many sachets of Thanzi should I use? The World Health Organization recommends thatmothers use 2 sachets to treat one episode ofdiarrhoea(ie.thechildshoulddrink2litresoftreatedwaterwithThanzi).ByusingtwosachetsofThanzitotreatoneepisodeofdiarrhoea,thishelpstore-hydratethechildandavoidtheneedtotakethemtoaclinic.

For Discussion: Why is it important to use Thanzi in the early stages of diarrhoea? How many sachets are typically used to treat an episode of diarrhoea?

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5.1 Why is hand washing with soap important?

Hand washing is the number one preventionagainst the spread of person-to-personinfection.Hand washing is the cornerstone of infection-controlpractice

5.2 Key elements to remember about hand washing:

Usesoapeverytimeyouwashyourhands.Howyouwashyourhandsisjustasimportantaswhenyouwashthem.(Justrinsingthemisnotenough!)Unwashed(orpoorlywashed)handscantransferharmfulmicroorganismstootherpeople.Discourage multiple uses of washbasins fromeldestgenerationtoyoungestgeneration.Instead,changethewateraftereachuseandbesuretousetreatedwaterorusethepouringmethod.

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Section 5: Hand WashingEncourage clients to share the hand washingmessage with their family, neighbours, andfriends.

5.3 When should you tell your clients to wash their hands?

AftergoingtothelatrineAfter cleaning up a child or after a childdefecatesBeforepreparingoreatingfoodBefore and after tending to someone who issickAfterhandlinguncookedfoods,particularlyrawmeat, poultry, or fishAfterblowingyournose,coughing,orsneezingAfterhandlingananimaloranimalwasteAfterhandlinggarbageBeforeandaftertreatingacutorwoundBeforeandafterfeedinganinfant/child.

5.4 Proper Hand Washing TechniquePlaceyourhandstogetherunderwaterLatherthoroughlywithsoap,coveringallsurfacesincludingundernailsRinsehandsDryyourhandscompletelywithacleantowelifavailable,orairdry

For Discussion: Why is it important to wash your hands? Why is it important to use soap? What are the critical times to wash your hands? What can happen if you do not wash your hands at critical times?

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6.1 Community Motivation Motivatingyourcommunitytoadoptgoodwaterandsanitation practices is an important task for you toaccomplish. Adoptionofhealthybehaviours isalsocalledBehaviourChange.Knowledge isnotenoughto change someone’s behaviour. For example,I may know that its bad to drink dirty water, butcircumstances in my community may not allow metochangemybehaviour(ex:WaterGuardmaynotbeavailable, I don’t know how touseWaterGuard,myvillageheadmandoesn’twantmetouseWaterGuard,I cannot find or afford the right storage vessel to store mytreatedwateretc).

AsSafeWaterandHygienePromoters,youhavetheduty to influence other factors which will help change behaviour.WecallthesetheOpportunity,AbilityandMotivationfactors.Takethesameexampleagain:ifIknowdrinkingdirtywaterisbadforme,HOWEVERifIcanbuyWaterGuardliquideasilynearby(Opportunity)AND I have full confidence in my ability to follow the dosing instructions (Ability) AND I believe drinking

Section 6: Conducting Effective IEC and IPC Activities

watertreatedwithWaterGuardwillkeepmeandmyfamily healthy (Motivation), I am much more likelytostart treatingmydrinkingwaterwithWaterGuardeverydayallyearround.

As Safe Water and Hygiene Promoters in yourcommunity you have an essential role to play ingiving your community the Opportunity, Ability andMotivationtoadopthealthierbehaviours.

But how can you do this?One of the most effective ways to change people’sbehaviours is by engaging with groups in small,targeted, focused discussions and activities, calledInter-PersonalCommunication(IPC).Thehealthtalksthatarecarriedoutatyourvillagehealthcommitteemeetings every week are a good example of IPCactivities.

Behaviour Change (and the potential for people tochangestronglyheldattitudes)ismosteffectivewhenconducted face to face or with a small group. ThisshouldALWAYSbeatwo-wayexchangeofinformation,and NEVER a one-way lecturing or teaching. Thistwo-wayexchangeallowsanindividual(theclient)tosecure clarification or additional information about a subject(safewaterstorage)fromanotherindividual(you).

WeencourageyoutoholddifferentIPCeventsinthecommunitytodisseminatetheimportantcontentsofthisguideinanaccessibleanduser-friendlymannertothemembersofyourcommunity.Tohelpyoudothis,hereareafewexamplesofIPC:

Selectpeopleinyourcommunitywhoarealreadytreating their drinking water with WaterGuard,storing water correctly etc as ‘satisfied role models’ (i.e people in the community who arehappy with using the recommended behaviourorpractice)Identifyexistingnetworkingandinterestgroupsin the community and work through them too(e.gVHCs,VDCs,BoreHoleCommittees)Usefacetofaceandroleplaysessionsasmuchasyoucan.

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Practicethehealthbehavioursyourselfinfrontofthegroupandgetthemtopracticethemselves.If you, the trusted Safe Water and HygienePromoterandtheparticipantsarepracticingthedesiredbehaviour,otherpeoplesurroundingyouinyourcommunityaremorelikelytoadoptit.

Aspects to consider when dealing with behaviourchange:

Culturalissues/acceptabilityAwarenessofaproblemClientpreferences

Maintaining positive dialogues with the communityiscriticalforestablishingbehaviourchange.Positivemotivation is key to behaviour change, as well asmotivationalinterviewingtechniques,topromotetheSafeWaterSystemandHandWashingwithSoap.

6.2 Positive Motivation and the FRAMES Method Positive motivation includes:

Using encouraging non-verbal language: be anengaged and active listener. Listen carefully toyourclient,maintaineyecontact,and let themknowthatyouareinterestedandconcernedwiththeirproblems.Thinkaboutyourclient’squestionsandthoughtfullyrespond to questions. Your interactions shouldneverbeaone-wayinteraction:itshouldbeanopendialogue.Usegesturestoindicatethatyouareinterestedinwhatthespeakerhastosay.Yourbodylanguagecan affect whether a client feels comfortablesharingtheirproblems. (tip:crossedarmscansignalthatyouareindisagreementornotopentowhatthepersonhastosay)Use motivational interviewing techniques,detailedbelowWhenthepersonisthroughspeaking,summarize

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their issues and provide your reflection on what theyhavesaid.

UsemotivationalinterviewingtechniquestopromotetheSafeWaterSystemandHandWashingwithSoap.Motivational Interviewing involves the followingelementsdescribedintheacronym‘FRAMES’:

FeedbackResponsibilityAdviceMenu(ofoptions)EmpathySelfEfficacy

Providing Feedback involves non-judgmentalsharingoflocaldataondiarrhoearatesandwaterqualitywithintheclients’community.Thisalsoincludeseducationonthecausesofdiarrhoea.Responsibility forchangewithineachclientisemphasized.Advice is given (but in a professional, non-threateningmanner).Theclientisfreetodecidehow the suggestions fit his or her own personal lifestyleandtoacceptorrejecttheadvice.Menu of options is given for dealing with theproblem.Empathic listening style is important to buildthetrustoftheclient.Self Efficacy, or self-confidence in achieving change,issupported.Itisimportanttosupportany thought, desire, or attempt at behaviourchange by expressing beliefs that change isachievableforthatperson.

Componentsofmotivationalinterviewingalsoinvolveusingthefollowing:

Open-ended questions (These are questionssuchas,“Howdoyoufeelabouttryingadifferentwatertreatmentmethod?”)TheseareNOTyes/noquestions!Affirmations (Positive statements, such as: “Yes, thatisverygood.”)Reflective listening (Repeating what your client hasjustsaid,suchas“WhatIhearyoutellingme

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isthatyouthinkWaterGuardistooexpensive.”)Summarizing(Listeningtowhatyourclientsaysandthensumitupconcisely.)

6.3 The Role of a Safe Water and Hygiene PromoterSWHPs serve as positive role models for yourcommunitymembers.Incorporatethechangesintoyour own lifestyle, using so that when communitymembers see you out in the community using theSWS and proper hand washing techniques, they’llwanttotryittoo.

DoNOTtellyourcommunitymemberswhattodo.Instead, it ismoreeffectivetoencouragethemby reinforcing the benefits of using the SWS and properhandhygiene.DoNOTusescaretactics.Positivereinforcementand knowing your facts goes a long way inencouragingchange.Listen to the concerns of your client andconstructively address their questions orcomments.AVOIDargumentation.Be open-minded and patient. Do not expectchange to happen overnight. Communitymembers will change their behaviour whenthey are ready to do so. Be supportive in themeantimeandcontinueteachingthemessage…you never know when the message will finally hit homewith a clientandmotivate him orher tochange!Encourage clients to share the SWS messagewiththeirfamily,neighbours,andfriends.

6.4 Motivating Clients for Behaviour ChangeIdentify obstacles that need to be overcomebeforebehaviourchangecanhappen.YourroleasSafewaterandHygienepromotersinfacilitatingbehaviourchange:

IncreaseknowledgeofyourclientsProvide Opportunity, Ability and Motivationfor your clients to adopt SWS and properhandwashingpracticesBerolemodelsinthecommunityonproperhandwashingandSWSuse

6.5 SWHP Reporting Mechanism SWHP will directly report to the Field Officer and indirectlyreporttoHSAsworkingintheircommunity

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NotethatSWHPswillneedtotracktheirsales.Tothisend,SWHPswillbegivenreportingstationary(3copies- one for SWHP files, one for IDPP partner, one forPSI/Malawi)andwillsubmitthesemonthlytotheir Field Officers before the 5th of the next month.

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Documents

Integrated Diarrhoeal Prevention and Management Project ...misaccess.psi.org/bcc_catalog/web/files/SWHP Manual 1.4final.pdf · Training Manual Integrated Diarrhoeal Prevention and