Essential Nutrition, Hygiene, and Care during Infancy

Leader Mother Flipchart (Part I)

Module 3 of 5

2

Essential Nutrition, Hygiene, and Care during Infancy

Part I

Table of Contents

Lesson 1: Importance of Maternal Postpartum Care ...................... 3

Lesson 2: Exclusive Breastfeeding: Benefits, Frequency and HIV .. 11

Lesson 3: Exclusive Breastfeeding: Hydration, Emptying the Breast

and Complementary Feeding ................................................... 19

Lesson 4: Danger Signs during Childhood Illness ........................ 27

Lesson 5: Overcoming Breastfeeding Problems: Poor Position,

Engorgement and Breast Lumps .............................................. 35

Lesson 6: Clinical Services and Growth Monitoring and Promotion . 43

Lessons, stories, and activities in the Essential Nutrition, Hygiene, and Care

during Infancy Lesson Plan complements the information provided in Essential Nutrition, Hygiene, and Care during Infancy Leader Mother Flipchart.

Acknowledgements

Hanold, Mitzi J. (2010) Essential Nutrition, Hygiene, and Care Actions during

Pregnancy 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 AID-FFP-09-00004-00. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the U.S. Agency for International Development.

Many thanks to our illustrators Pascal Bizimana, Léonidas Nisabwa and

Octávio Consalves. Editors include Carolyn Wetzel (FH), Dr. Dieudonné

Bikorimana (FH), Jean Marie Musavyi (PNSR-Mini Santé), Bernard Bisamakoro (IEC-Mini Santé), Rémègie Beberi (IEC-Mini Santé), Elie Ningabire (PRONIANUT-Mini Sante), Dr Isumbisho Mazambi (IMC), Rémy

Kibinakanwa (Caritas) and Mary Hennigan (CRS). For questions or comments, please contact the author at fhdc@fh.org.

Lesson 1: Importance of Maternal Postpartum Care

Materials for Lesson 1:

1. Attendance Registers

2. A woman’s health card

3. Container of iron pills

4. Sixteen small objects (bottle caps, rocks or leaves)*

1. Game: I’ve Never

2. Attendance and Troubleshooting

3. Story: Barumwete Goes Back to Work (Picture 1.1)

Two days after delivery, Barumwete begins her work again. In the

morning, she sweeps her compound and goes to the market. In the afternoon, she begins preparing food, but she is not able to finish.

She lies down and quickly falls asleep. Her son sees that her bleeding is heavy and runs for help.

4. Ask about Cultural Practices

? Why is Barumwete bleeding?

? How long should a woman rest after delivery?

? How many days did you rest after delivery?

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

Story: Barumwete Goes Back to Work (Picture 1.1)

Two days after delivering, Barumwete begins her work again. In the morning she sweeps her compound and goes to the market.

In the afternoon, she begins preparing food, but she is not able to finish. She

lies down and quickly falls asleep. Her son sees that her bleeding is heavy and runs for help.

Maternal Care after Delivery (Picture 1.2)

5. Show

? What do you see in these pictures?

6. Explain

Ask someone to stay with you after delivery for one week or

more.

o This woman (Kwarama) lets Karorero rest.

o She cooks for the family.

o She cares for the children.

For six weeks after delivery rest often. Work less than normal.

o Women lose a lot of blood during delivery.

o Women who do not rest bleed more.

o Women who bleed too much are at risk of severe sickness and death.

Eat two additional snacks each day to gain strength after delivery.

o This mother eats beans, lentils, green leafy vegetables and organ meats, to make her blood strong.

o These foods are high in iron.

o Additional snacks help her body to make breast milk.

o She drinks more water than normal to help her body make breast milk.

Wash yourself each day and each time you pass feces until the skin is healed.

o Germs from feces may get into the wounds from childbirth.

o Washing with soap or ash will kill germs and help the skin to heal.

? Is it difficult to rest after delivery?

? Who can help the mother complete her work after the Kwarama

leaves?

? What advice would you give to a new mother about resting after

delivery?

6

Maternal Care after Delivery (Picture 1.2)

Ask someone to stay with you after delivery for one week or more.

For six weeks after delivery, rest often. Work less than normal.

Eat two additional snacks each day to gain strength after delivery.

Wash yourself each day and each time you pass feces until the skin is healed.

Services after Delivery at the Centre de Santé (Picture 1.3)

7. Show

? What do you see in these pictures?

8. Explain

Take iron pills each day for six months after giving birth.

o Take iron pills with food.

o Iron helps to make the mother’s blood strong.

o Iron gives energy and strength to the mother.

Receive Vitamin A in the first six weeks after giving birth.

o The mother receives a drop of Vitamin A during her visit.

o Vitamin A helps to restore the mother’s health.

o Vitamin A in the mother’s breast milk helps the infant to resist sickness.

Receive a tetanus vaccination if your card is not complete.

o Tetanus causes lockjaw and painful convulsions.

o Vaccinated mothers are protected from germs that may have entered the body during delivery.

o Breastfeeding infants are protected by drinking their mother’s

milk.

o Karorero’s vaccination will protect her for 10 years.

? How many of you are taking iron pills?

? How many of you have already received vitamin A?

? Why are these services important?

8

Services after Delivery at the Centre de Santé (Picture 1.3)

Take iron pills each day for six months after giving birth.

Receive Vitamin A in the first six weeks after giving birth.

Receive a tetanus vaccination if your card is not complete.

Danger Signs after Delivery (Picture 1.4)

9. Show

? What do you see in these pictures?

10. Explain

If you see any of these signs, go immediately to the Centre de

Santé.

Fever

Genitals have a bad odor

Sharp pains in the belly

o These first three signs are for infection inside the womb.

o Many women die from untreated infections after delivery.

Heavy bleeding or bleeding that doesn’t stop after two weeks.

Urine or feces leaking from the body.

o If you see one of these signs, do not wait. Go to the Centre

de Santé.

? How does a woman know if her bleeding is heavy? What is the

normal amount of bleeding after delivery?

? Why is it important to go immediately to the clinic?

11. Activity: Care After Delivery

14.Practice

and

Coaching

12. Probe 13.Inform 15.Request 16.Examine

10

Danger Signs after Delivery (Picture 1.4)

If you see any of these signs go immediately to the Centre de Santé.

Fever

Genitals have a bad odor Sharp pains in the belly

Heavy bleeding or bleeding that doesn’t stop after two weeks

Urine or feces leaking from the body

Lesson 2: Exclusive Breastfeeding: Benefits, Frequency

and HIV

Materials for Lesson 2:

1. Attendance Registers

2. A ball of paper, string or cloth

1. Game: Ball Toss

2. Attendance and Troubleshooting

3. Story: Karorero’s Friends Support Her (Picture 2.1)

Karorero and the other Leader Mothers listen to the teaching about

exclusive breastfeeding. Each one of the women in the care group makes a commitment to exclusively breastfeed for the first six

months. They know this will be difficult, but they commit to support each other, encourage one another and not give me any other foods

or liquids for six months.

4. Ask about Cultural Practices

? What did Karorero and the others mothers

do? Why?

? How can these women help each other to

keep this commitment?

? Who in your life encourages you to give

only breast milk?

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

12

Story: Barumwete’s Friends Support Her (Picture 2.1)

Karorero and the other Leader Mothers listen to the teaching about exclusive

breastfeeding. Each one of the women in the care group makes a commitment to exclusively breastfeed for the first six months.

They know this will be difficult, but they commit to support each other, encourage one another and not give me any other foods or liquids for six months.

Benefits of Exclusive Breastfeeding (Picture 2.2)

5. Show

? What do you see in these pictures?

6. Explain

Give only breast milk to infants from birth to six months. Never give water, beer or other foods.

o Breast milk is the best food and drink for infants.

o Breast milk does not need to be mixed or prepared.

o Breast milk does not cost money.

Giving only breast milk for six months prevents new pregnancy.

o Exclusive breastfeeding prevents monthly bleeding.

o Breastfeed whenever the child wants it day or night.

o Giving other foods and liquids allows the women to become pregnant again.

Giving other foods and liquids before six months brings diarrhea.

o Other foods and liquids make the child sick.

o Many infants die from diarrhea each year.

o Exclusively breastfed infants have diarrhea less often.

Giving other foods and liquids stops the child from growing tall

and fat.

o Giving foods before six months slows the child’s growth.

o Breast milk makes children grow tall and fat.

14

Benefits of Exclusive Breastfeeding (Picture 2.2)

Give only breast milk to infants from birth to six months. Never give water, beer or other foods.

Giving only breast milk for six months prevents new pregnancy.

Giving other foods and liquids before six months brings diarrhea.

Giving other foods and liquids stops the child from growing tall and fat.

Breastfeeding Frequency and Maternal Health (Picture 2.3)

7. Show

? What do you see in these pictures?

8. Explain

Breastfeed whenever the child is hungry day and night.

Breastfeed at least 10 times each day.

o Infants have small stomachs that need food often.

o Breastfeed whenever the child shows signs of hunger.

o Breastfeeding on demand stops the mother’s monthly bleeding.

o Breastfeeding on demand prevents pregnancy for six months.

Breastfeed even if you are sick.

o Sick mothers still have healthy milk for their infants.

o Even very thin mothers have healthy breast milk.

Eat beans, organ meats, garlic, whole grain rice, red palm oil,

peanuts, squash seeds, fish and eggs.

o Mothers who eat these foods have healthier children.

o Eat two additional snacks each day.

? What are the signs that a child is hungry?

o The infant moves his tongue in an out, makes sucking noises, sucks on his fingers, turns his head from side to side or cries.

? Did you eat any of the foods in this picture yesterday?

? Which one of these foods can you add to your meals tomorrow?

16

Breastfeeding Frequency and Maternal Health (Picture 2.3)

Breastfeed whenever the child is hungry day or night. Breastfeed at least 10 times each day.

Breastfeed even if you are sick. Sick mothers still have healthy milk for their infants.

Eat beans, organ meats, garlic, whole grain rice, red palm oil, peanuts, squash seeds, fish and eggs.

Exclusive Breastfeeding for Mothers with HIV (Picture 2.4)

9. Show

? What do you see in these pictures?

10. Explain

Mothers with HIV offer only breast milk for the first six months of life.

Infants given infant formula are more likely to die from diarrhea.

o This mother is saying “No” to infant formula.

o She knows infant formula is more likely to make her child

sick.

o Even if HIV treatment is not available, breastfeed your child.

Mothers with HIV do not give animal milk, water, tea, porridge or other drinks for six months.

o All foods other than breast milk are dangerous for infants less than six months.

o These foods cause sickness.

o After six months begin giving foods and water.

Adding other foods and liquids makes it easier for HIV to pass to

the child.

o This child has HIV because he was given foods before he was

six months old.

o To lower the possibility of passing HIV, give only breast milk.

11. Activity: Enough Breast Milk

14.Patience

and Coaching

12. Probe 13.Inform 15.Request 16.Examine

18

Exclusive Breastfeeding for Mothers with HIV (Picture 2.4)

Mothers with HIV, offer only breast milk for the first six months of life. Infants given infant formula are more likely to get sick and die from diarrhea.

Mothers with HIV do not give animal milk, water, tea, porridge or others foods to infants for the first six months.

Adding other foods or drinks makes it easier for HIV to pass to the child.

Lesson 3: Exclusive Breastfeeding: Hydration, Emptying

the Breast and Complementary Feeding

Materials for Lesson 3:

1. Attendance Registers

1. Game: Showing our Emotions

2. Attendance and Troubleshooting

3. Story: Barumwete Drinks Beer (Picture 3.1)

Karorero goes to visit Barumwete at her house. When she arrives

Barumwete is drinking beer. “Barumwete, what are you doing?” Karorero asks. “I am trying to increase my breast milk for

Mvuyekure.” My breasts are not as full as they used to be. Beer will help to bring more milk.”

4. Ask about Current Practices

? Why is Barumwete drinking beer?

? Is beer healthy for Barumwete and her

child?

? What do you do to increase your breast

milk?

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

20

Story: Barumwete Drinks Beer (Picture 3.1)

Karorero goes to visit Barumwete at her house. When she arrives Barumwete is drinking beer.

“Barumwete, what are you doing?” Karorero asks. “I am trying to increase my breast milk for Mvuyekure.” My breasts are not as full as they used to be. Beer will help to bring more milk.”

Increasing Milk Production (Picture 3.2)

5. Show

? What do you see in these pictures?

6. Explain

Beer decreases a mother’s breast milk.

o This mother drinks beer to increase her breast milk.

o The infant must work harder to get milk from the breasts.

o The child drinks less when beer is in the breast milk.

o As the child feeds less, her breasts produce less milk.

Beer in breast milk brings hunger and sickness.

o Beer in breast milk damages the child’s body.

o Beer slows the child’s growth.

o Beer in the mother’s milk has made this child very sick.

Drink more water to increase breast milk.

o Karorero drinks water every time she breastfeeds.

o Breastfeeding reminds her to drink water.

o She drinks more water than normal.

Breastfeed more often to increase breast milk.

o When a child feeds more often, the mother’s body produces

more milk.

22

Increasing Milk Production (Picture 3.2)

Beer decreases a mother’s breast milk.

Beer in breast milk brings hunger and sickness.

Drink more water to increase breast milk.

Breastfeed more often to increase breast milk.

Empty the Breast before Switching (Picture 3.3)

7. Show

? What do you see in these pictures?

8. Explain

When the infant begins to feed, the milk is thin and white. As the infant feeds, the milk becomes thicker and yellow in color.

o The thin white milk satisfies the infant’s thirst.

o The thick yellow milk satisfies the infant’s hunger.

o The infant will eagerly suck and swallow often when drinking thin milk.

o The infant will suck slowly and grow sleepy from the thick milk.

Let the child feed until he is satisfied on one breast and pulls away.

o The child will pull away from the breast when he is full.

o Taking the child away too early does not leave him satisfied.

o Taking the child away before he gets the yellow milk leaves him hungry.

If he wakes, continue feeding with the other breast.

o Some children are satisfied on one breast only.

o Others feed for a shorter time on the second breast.

? Which breast should the mother begin her next feeding?

o The breast where the child fed the shortest amount of time.

? How can feeding this way increase breast milk?

24

Empty the Breast before Switching (Picture 3.3)

When the infant begins to feed, the milk is thin and white. As the infant feeds, the milk becomes thicker and yellow in color.

Let the infant feed until he is satisfied on one breast and pulls away.

If he wakes, continue feeding with the other breast.

Complementary Feeding (Picture 3.4)

9. Show

? What do you see in these pictures?

10. Explain

Begin giving thick porridge to infants after breastfeeding at six months of age.

o Give breast milk first, before giving porridge.

o At six months, infants are ready for foods.

At six months, infants are ready for water and juice.

Continue breastfeeding whenever your child wants it day and

night. Breastfeed for 24 months or more.

o Even after foods are given, breastfeed often.

o Breast milk protects infants from illness.

o Breast milk helps infants to grow well.

? At what age should mothers give water or juice to children?

o After six months of age

? At what age should mothers give soup or ugali?

o After six months of age.

? Why do some mothers give foods and liquids other than breast milk before six months of age?

? How can you convince them to wait until six months?

11. Activity: Breastfeeding Song

14.Practice

and

coaching

12. Probe 13.Gutomora 15.Kwiyemeza 16.Gusuzuma

26

Complementary Feeding (Picture 3.4)

Begin giving thick porridge to infants after breastfeeding at six months of age.

Continue breastfeeding whenever your child wants it day and night. Breastfeed for 24 months or more.

Lesson 4: Danger Signs during Childhood Illness

Materials for Lesson 4:

1. Attendance Registers

2. The Danger Sign Song

1. Game: Taxi Rides

2. Attendance and Troubleshooting

3. Story: Mvuyekure Has Trouble Breathing (Picture 4.1)

Yesterday Mvuyekure began to cough. His nose filled with thick

liquid. Today, Mvuyekure has trouble breathing. His chest moves

up and down but he doesn’t seem to be getting enough air. Barumwete decides to wait until the afternoon. Maybe he will get

better.

4. Gutohoza

? What is wrong with Mvuyekure?

? Is this a severe sickness? Should

Barumwete take him to the clinic now?

? What are the danger signs that tell the

mother to take the child to the clinic?

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

28

Story: Mvuyekure Has Trouble Breathing (Picture 4.1)

Yesterday Mvuyekure began to cough. His nose filled with thick liquid.

Today, Mvuyekure has trouble breathing. His chest moves up and down but he doesn’t seem to be getting enough air. Barumwete decides to wait until the afternoon. Maybe he will get better.

Childhood Danger Signs (Picture 4.2)

5. Show

? What do you see in these pictures?

6. Explain

If you see any of these signs, take the child to the health clinic

immediately. Do not wait to see if the child gets better.

Child has a fever.

o Fever is the first sign of malaria.

Child has difficulty breathing.

Child coughs for two weeks or more.

Child is unable to suck, swallow or drink.

Child vomits every time he eats or drinks.

o Child vomits every time he breastfeeds.

o Child vomits every time he eats or drinks.

Child doesn’t respond when touched or spoken to.

o Child is sleepy and won’t wake. o Child is not able to move or respond.

Child has convulsions, fits and spasms.

o The child’s arms and legs stiffen.

o His body shakes.

? Why is it important to go immediately to the Centre de Santé?

? Do you have money set aside for going to the Centre de Santé?

30

Childhood Danger Signs (Picture 4.2)

If you see any of these signs, take child to the clinic immediately:

Child has fever. Child has difficulty breathing. Child coughs for two weeks or more. Child is unable to suck or swallow breast milk or other liquids. Child vomits every time he eats or drinks. Child doesn’t respond when touched or spoken to. Child has convulsions, fits or spasms.

Breastfeeding during Illness (Picture 4.3)

7. Show

? What do you see in these pictures?

8. Explain

When a child is sick offer your breast even if the child does not

look hungry. Offer one additional feeding each day.

o Sick children lose water from sweating, fever and diarrhea.

o The additional feeding replaces liquids lost from the body.

o Breastfeeding helps the infant recover quickly.

o Breastfeeding comforts sick infants.

Karorero offered her breast even when Biguvu was not hungry.

Now, Biguvu is well.

o Sick children may lose their appetite.

o Karorero breastfed Biguvu one additional time each day.

o Biguvu is no longer sick.

This mother breastfed less often during sickness. Her child’s sickness is worse.

o Her child is losing weight.

o His sickness is severe.

o His sickness has lasted much longer than Biguvu’s sickness.

? Do mothers usually offer the breast if a child does not look

hungry?

? Do you think these messages will help children recover? How?

32

Breastfeeding during Illness (Picture 4.3)

When a child is sick, offer your breast even if the child does not look hungry. Offer one additional feeding each day.

Karorero offered her breast even

when Biguvu was not hungry. Now, Biguvu is well.

This mother breastfed less often

during sickness. Her child’s sickness is worse.

Feeding during Illness (Picture 4.4)

9. Show

? What do you see in these pictures?

10. Explain

For children older than six months offer one additional snack and one

additional breastfeed each day during illness.

o She adds an additional bowl of fruit on days when her child is ill.

o Additional foods and liquids help the child to recover.

o Additional foods and liquids help the child to stop losing weight.

Encourage sick children to eat even if they are not hungry.

o This mother and father sing to their child to help them eat.

o Eating more during sickness chases the illness away.

o Offer favorite foods to encourage children to eat.

o Add sugar and honey to foods to encourage children to eat.

Offer one additional snack and one additional breastfeed for two

weeks after the child has recovered.

o The calendar shows us the days when the child was sick.

o He looks sad on days of sickness.

o His mother gives one additional snack on each yellow day.

? What can a mother give a child with diarrhea?

o Mix a packet of SRO with one liter of water.

o Offer it to the child each time the child has diarrhea.

11. Activity: The Danger Sign Song

14.Practice

and

Coaching

12. Gucaca 13.Gutomora 15.Request 16. Examine

34

Feeding during Illness (Picture 4.4)

For children older than six months, offer one additional snack and one

additional breastfeed each day during illness and for two weeks after the child has recovered.

Encourage sick children to eat even if they are not hungry.

Lesson 5: Overcoming Breastfeeding Problems: Poor

Position, Engorgement and Breast Lumps

Materials for Lesson 5:

1. Attendance Registers

1. Game: Myriam Says

2. Attendance and Troubleshooting

3. Story: Pain while Breastfeeding (Picture 5.1)

Barumwete has pain in her breast when breastfeeding. There is a small lump on the side of one breast. She decides not to breastfeed

on this breast. She feeds for two days from the other breast. The pain does not go away. The lump and the skin around it become

very hot.

4. Ask about Current Practices

? What is bothering Barumwete?

? What do you think Barumwete should do to

ease her pain?

? What breastfeeding troubles do you have?

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

36

Story: Pain while Breastfeeding (Picture 5.1)

Barumwete has pain in her breast when breastfeeding. There is a small lump on the side of one breast.

She decides not to breastfeed on this breast. She feeds for two days from the other breast. The pain does not go away. The lump and the skin around it become very hot.

Breast Pain and Good Position (Picture 5.2)

7. Show

? What do you see in these pictures?

8. Explain

Breastfeeding in poor position causes pain.

o Mvuyekure is too far away from Barumwete.

o The milk does not flow easily from Barumwete’s breast.

o Mvuyekure is not satisfied after feeding this way.

To stop pain, hold the infant close. Support his head and body

with your arm.

o This makes it easier for the infant to suck.

o This position does not cause pain when breastfeeding.

o This infant is satisfied after feeding.

The infant’s mouth is open wide. His bottom lip is curled back.

Most of the dark skin around the nipple is covered by his mouth.

o His chin is touching the breast.

o This child will be satisfied after feeding.

o This position does not cause pain for the mother.

? What sounds should you hear from the infant when there is good

attachment?

o Infant takes slow deep sucks.

o The infant can be heard swallowing.

38

Breast Pain and Good Position (Picture 5.2)

Breastfeeding in poor position causes pain.

To stop the pain, hold the infant close. Support his head and body with your arm.

The infant’s mouth is open wide and his bottom lip is

curled back. Most of the dark

skin around the nipple is covered by his mouth.

Swollen Breasts (Engorgement) (Picture 5.3)

7. Show

? What do you see in these pictures?

8. Explain

Breasts may be very full and hard. Infants have trouble

breastfeeding.

o The infant cannot attach to the breast.

o The mother’s breasts are sore.

o It is uncomfortable to breastfeed.

Remove breast milk until the breast is soft.

o This will make it easier for the infant to attach.

o This will make it more comfortable for the mother.

Place hot, wet cloth on the breast before each feeding.

o Heat will help the milk to flow freely.

o Heat will soothe the breast.

Breastfeed often to reduce swelling. Rest often.

o As the child feeds the breasts will empty and relieve pain.

o Breastfeed more often to relieve swelling.

o This mother rests in bed to help her body heal.

? What other things have you done to relieve breasts when they are too full?

40

Swollen Breasts (Engorgement) (Picture 5.3)

Breasts may be very full and hard. Infants have trouble breast feeding.

Remove breast milk by hand until the breast is soft.

Place hot, wet cloth on the breast before each feeding

Breastfeed often to reduce swelling. Rest often.

Painful Breast Lump (Picture 5.4)

9. Show

? What do you see in these pictures?

10. Explain

Some mothers have a painful lump in the breast.

o There are many paths in the breast that carry milk.

o When one path is blocked, milk builds up on the path causing pain.

Place hot, wet cloth on the sore breast before each feeding to help the milk to flow.

To help the milk flow, offer the sore breast first at each feeding.

o The infant’s sucking will help to pull the blocked milk out of

the breast.

o Rest often to help the body heal.

Drink more fluids to increase breast milk and open the blocked

path.

If you have a breast lump and fever, go quickly to the Center de

Santé.

o Fever may be a sign of infection.

o Headache, nausea, body aches and chills are also signs of infection.

11. Activity: Infant Attachment and Position

14.Practice

and

Coaching

12. Probe 13. Inform 15.Request 16.Examine

42

Painful Breast Lump (Picture 5.4)

Some women have a painful lump in the breast.

Place hot, wet cloth on the breast before each feeding.

To help the milk flow, offer the sore breast first at each feeding.

Drink more fluids than normal to open the blocked passage.

If you have breast lump and fever go quickly to the Centre de Santé.

Lesson 6: Clinical Services and Growth Monitoring and

Promotion

Materials for Lesson 6:

1. Attendance Registers

2. Infant growth charts from two other women.*

3. Each mother will bring her infant’s vaccination card.*

1. Game: I Scared a Lion

2. Attendance and Troubleshooting

3. Story: Biguvu is Longer than His Age Mates (Picture 6.1)

Barumwete and her neighbors are sitting in their neighbor group talking. Their infants are playing together on a mat. Barumwete

says, “Look at this. These children are all the same age, but they are not growing the same. Biguvu is tall and thick. My child looks

too small and too thin. Only Karorero’s child is growing well. How can that be?”

4. Ask about Cultural Practices

? Why is Biguvu growing better than the

other children?

? Do you think that all of these children could

be as healthy as Biguvu? How?

? How is your child growing compared to

others? How can you help your child to

grow better?

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

44

Story: Biguvu is Longer than his Age Mates (Picture 6.1)

Barumwete and her neighbors were sitting in their neighbor group talking.

Their infants are playing together on a mat. Barumwete says, “Look at this. These children are all the same age, but they are not growing the same. Biguvu is tall and thick. My child looks too small and too thin. Only Karorero’s child is growing well. How can that be?”

Childhood Immunizations (Picture 6.2)

5. Show

? What do you see in these pictures?

6. Explain

Take your child to the clinic for immunizations at 6 weeks, 10

weeks, 14 weeks and 9 months.

o This mother holds her child so that the doctor can give the

injection.

o This mother brings her child back for new immunizations.

o Even if the child is sick, go to the clinic for immunizations.

Vaccinations prevent sickness and death.

o Biguvu and his brother were vaccinated.

o They did not get sick with polio or tetanus.

o They are healthy and strong.

These children were not vaccinated. One child died. The other

has polio.

o One child has a lame leg.

o He was not vaccinated against polio.

o The other child had tetanus.

o He died before his second birthday.

o Vaccinations stop sickness before it starts.

? What are some reasons that mothers do not take their child to

receive vaccinations?

? How can we help mothers to remember to take their children for

vaccinations?

46

Childhood Immunizations (Picture 6.2)

Take your child to the clinic for immunizations at 6 weeks, 10 weeks, 14 weeks and 9 months.

Vaccinations prevent sickness and death.

These children were not vaccinated. One child died. The other has polio.

Growth Monitoring and Promotion (Picture 6.3)

7. Show

? What do you see in these pictures?

8. Explain

Take your child 23 months and younger for growth monitoring each month. Health workers weigh the child.

o Karorero takes Biguvu to be weighed each month.

o Take older children (24 to 60 months) every three months.

Health workers measure the length or height of the child.

o Biguvu is lying on a board with numbers.

o Karorero holds his head still and calms him down.

o The health worker moves the board to see how long he is.

The health worker gives advice to each mother to help the child grow.

o The health worker explains her findings to Karorero.

o She gives Karorero advice on helping Biguvu to grow well.

o She gives advice on foods to give Biguvu once he is six

months old.

o Karorero asks the health worker questions about his growth.

? Should you take a sick child for growth monitoring?

o Yes, get the child weighed and measured.

o Ask the health worker for advice on the sickness.

o Health workers can refer very sick children to a hospital or special clinic.

? When was the last time you took your child for growth monitoring?

48

Growth Monitoring and Promotion (Picture 6.3)

Take your child 23 months and younger for growth monitoring each month. Health workers weight the child.

Health workers measure the length or height of the child.

The health worker gives advice to each mother to help the child grow.

Understanding the Growth Chart (Picture 6.4)

9. Show

? What do you see in these pictures?

10. Explain

When the child’s growth line stays within the broad road, they are growing well.

o The broad road shows the weight of healthy children.

o The line for Biguvu is within the broad road. He is healthy.

o Biguvu’s line has gone down with sickness, but stays in the

road.

o Biguvu only drinks breast milk.

If the child’s growth line falls below the broad road, they are not growing well.

o Mvuyekure is given other foods and liquids.

o He suffers from diarrhea and sickness.

o He is too thin for his age.

o Healthy children his age are much heavier.

? What should Barumwete do to help Mvuyekure grow?

11. Activity: Reviewing Growth Charts

14.Practice

and

Coaching

12. Probe 13.Inform 15.Request 16.Examine

50

Understanding the Growth Chart (Picture 6.4)

When the child’s growth line stays within the broad road, they are growing well.

If the child’s growth line falls below the broad road, they are not growing well.