Acute Respiratory InfectionsLeader Mother Flipchart

Module 5 of 6

Health Managers: This page (cover page) different from all other picture pages. Add a solid background color (outside the pictures) should. Place pictures within an oval or some other shape to make them different from other pages. Give instructions to the illustrator.

Repeat Picture 2.2B

Health worker is showing the mother the calendar to remind her when to give her child pills.

REPEAT Picture 4.3 A

Mother washing hands to prevent cough and when caring for a child.

Repeat Picture 3.2A

Mother cleaning the child’s nose with a cloth.

Repeat Picture 5.4B

A mother cooking with a fire and smoke leaving out the vent holes.

Insert FH and USAID and other logos here.

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Leave this page blank.

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Acute Respiratory Infections Table of Contents:

Lesson 1: Respiratory Infections Defined, Effects and Danger signs......4Lesson 2: Treatment for Severe Respiratory Infections and TB............12Lesson 3: Recovery and Care for Children with Respiratory Infection...20Lesson 4: Respiratory Infection Transmission and Prevention:............28Lesson 5: Preventing New Respiratory Infections:..............................36

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. Make the images as large as possible and use as much of the space on the page as possible. Captions should be small (12-13 size font), allowing as much room as possible for the images. Images should be pre-tested in the community before being finalized. After pre-testing and adapting images based on test results please send developed flipcharts to mhanold@fh.org, cwetzel@fh.org, and jhettinger@fh.org for approval before printing.  If flip chart files are too big to send via FH email, post them on this online website: (http://www.yousendit.com/) or send it on a CD via DHL to the FH DC office.

Lessons, stories, and activities in the Acute Respiratory Infection Lesson Plan complement the information provided in Acute Respiratory Infection Leader Mother Flipchart.

AcknowledgementsMany thanks to the illustrators including (your local illustrator’s name), Octavio Gonzales and Petra Röhr-Rouendaal. Carolyn D. Wetzel and Julie A. Davis are greatly appreciated for reviewing and editing the materials. Games used in the lessons are available through the HIV/AIDS Alliance. See below for full details.

International HIV/AIDS Alliance. (2002). 100 Ways to Energize Groups: Games to Use in Workshops, Meetings and the Community. Available at www.aidsalliance.org.

Röhr-Rouendaal, Petra. (1997). Where There is No Artist: Development Drawings and How to Use Them. London, UK:Intermediate Technology Publications.

Suggested Citation: Hanold, Mitzi J. (2010) Acute Respiratory Infection 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 and all other notes in green after you have added the appropriate logos and information.

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Lesson 1: Respiratory Infections Defined, Effects and Danger signsThis is the text for the back of page 3 with (Picture 1.1)

Materials for Lesson 1:1. Attendance Registers 2. Breath Counters and timers for each Leader Mother (DRC only) *3. Seven rocks and a watch or phone to shows minutes and seconds (Moz only) *

1. Game: Cough, Sneeze, Sniff

2. Attendance and Troubleshooting

3. Story: Hardship Has a Cough (Picture 1.1)The rainy season comes and Hardship begins coughing. His nose is full of thick yellow liquid2. After three days, Mother B’s husband notices that Hardship’s chest looks different. His lower chest sinks when he inhales. “Should we take Hardship to the clinic?” Mother B’s husband asks. “Is this sickness serious?” Mother B’s husband does not know.

4. Ask

? What is the child’s sickness?? Should he take the child to the clinic?

Why? ? What are the danger signs?

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

* Materials with an asterisk should be organized by the Activity Leader.2 Use a local word for mucus (thick jelly-like liquid).

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Story: Hardship Has a Cough (Picture 1.1)

Unless noted, all images in this Module show Of Great Worth or Hardship at 20 months.

Picture A. A close up of Mother B and Hardship standing outside. There are dark clouds in the sky (rain clouds) and the wind is blowing behind them. They are wearing warm clothes (or have blankets wrapped around them - adapt as locally appropriate) They are trying to keep warm. Hardship is coughing. There are lines coming out of his mouth showing it is a hard cough (see below). His nose has yellow liquid coming out of it. Mother B is looking at him.

Caption Pictures A: The rainy season comes and Hardship begins coughing. His nose is full of thick yellow liquid.

Picture B. [Mother B’s husband] is sitting in a chair - [Hardship – 20 months] is laying on his back across Mother B’s husband’s lap. Mother B’s husband has lifted Hardship’s shirt and is looking at his chest. There are dark shadows just under Hardship’s ribs where the skin has caved in. There is a thought bubble coming from Mother B’s husband’s head. In the bubble is a question mark and a picture of a health clinic.

Caption Picture B: After three days, Mother B’s husband notices that Hardship’s chest looks different. His lower chest sinks when he inhales. “Should we take Hardship to the clinic?” Mother B’s husband asks. “Is this sickness serious?”

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Respiratory Infection Defined (Picture 1.2)This is the text for the back of page 5.

5. Show

? What do you see in these pictures?

6. Explain

Respiratory infections are a sickness of the nose, throat, and chest.

o In this picture, we see the respiratory organs inside Hardship’s body.

o The arrows point to the nose, throat, and lungs.o The nose, throat, and lungs help the body to breathe.

This sickness fills the nose, throat, and lungs with thick liquid.

o Within one or two days a child can become very sick.o In this picture, Hardship has a respiratory infection.o The thick liquid fills the passages in his nose, throat

and lungs. o When there is sickness, the thick liquid may turn

yellow or green. The thick liquid causes coughing and a dripping nose. Hardship has difficulty breathing because of the thick liquid.

o To get rid of the thick liquid, Hardship coughs, and his nose drips.

o Coughing pushes the liquid out of the lungs and throat.

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Respiratory Infection Defined (Picture 1.2)Picture C. A profile of Hardship (20 months old)

showing the nose canal, throat and lungs inside the body. (Use the diagram below as an example). Draw large

arrows pointing to the child’s nose, throat, and lungs. The nose, throat, and lungs are healthy and free of liquid.

Picture D. Draw the profile of Hardship again showing the nose, throat, and lungs inside the body. There is yellow/green liquid in the nose and dripping down the throat. There is some green and yellow liquid filling the “branches” inside the lungs.

Caption Picture A: Respiratory infections are a sickness of the nose, throat, and chest. These organs help the body to breathe.

Caption Picture B: Hardship has a respiratory infection. This sickness fills his nose, throat, and lungs with thick liquid.

Picture E. On half of the picture, draw the profile of Hardship coughing (showing his head and chest). Draw lines from his mouth to show it is a strong cough. Yellow/green liquid drops are in the air from the cough. Draw another picture of Hardship's face - looking forward. In this image his nose is dripping yellow/green liquid.

Picture F. Mother B is trying to breastfeed Hardship (20 months). He is turning his head away from Mother B's breast and gasping for air. His nose has yellow/green liquid filling each nostril. Show lines around his ribs showing that he is having difficulty breathing. He is kicking his legs. His eyes are wide (fear). Mother B is looking at Hardship. Her forehead has wrinkles showing that she is worried.

Caption Picture C: The thick liquid causes coughing and a dripping nose.

Caption Picture D: Hardship has difficulty breathing because of the thick liquid.

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Mild and Severe Respiratory Infections (Picture 1.3)This is the text for the back of page 7.

7. Show

? What do you see in these pictures?

8. Explain

Some respiratory infections are mild. Children with mild infections can be cared for at home.

o Mother A is breastfeeding Of Great Worth. She gives hot drinks [substitute with locally available nutritious drinks that can be given to children] and soft foods to help soothe the child’s throat.

Some respiratory infections are severe. If the child is not taken to the clinic immediately, the child will die.

o This child has fever. That’s a danger sign. o The mother does not take the child to the clinic. o She continues to work. o The child dies because he did not receive treatment. If you see a danger sign, the infection is severe. Go

immediately to the clinic. o This mother knows fever is a danger sign. o She took the child to the clinic on the same

day and received treatment.o The child got better and is healthy now.

? What danger signs have we learned in previous lessons?

o Unable to suck, swallow or drinko Child vomits every time he eats or drinkso Child does not respond when touched or

spoken to o Convulsions

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Mild and Severe Respiratory Infections (Picture 1.3)

Picture A. Mother A is holding Of Great Worth (20 months) on her lap. Of Great Worth is coughing. Yellow/green liquid drops are in the air from the cough.

Picture B. Mother A is breastfeeding Of Great Worth (20 months). On a table in front of her is a cup of steaming liquid and a bowl of fruit. Of Great Worth is wrapped in a blanket.

Caption Pictures A-B: Some respiratory infections are mild. Children with mild infections can be cared for at home.

Picture C. Another mother (not Mother A or Mother B) is holding a child (20 months) on her lap. Yellow/green liquid drops are in the air from the cough.. The child has heat waves coming off his head.

Picture D. Draw an arrow from the child in Picture C to Picture D. The mother is working (weaving a basket or some other local handicraft). The child is laying in a blanket next to the mother. The sun is at 7 am.

Picture E. Draw an arrow from Picture D to Picture E. A child sized grave. The sun is setting at 7pm.

Caption Picture C-E: Some respiratory infections are severe. If the child is not taken to the clinic immediately, the child will die.

Picture F. Repeat Picture C using a different mother and child.

Picture G. Draw and arrow from picture F to Picture G. The mother from Picture F is receiving medication from a health worker at the clinic. The mother is holding the child from Picture F.

Picture H. Draw an image of the child from Picture F. The child is standing and laughing. He looks healthy and round.

Caption Picture F-H: If you see a danger sign, the infection is severe. Go immediately to the clinic.

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Danger Signs of Severe Respiratory Infections (Picture 1.4) This is the text for the back of page 9.

9. Show

? What do you see in these pictures?

10. Explain When you see signs of severe infection, take the child

immediately to the clinic.o Take the child on the same day that you see the sign.

When the child breathes in, there is a harsh noise.o Listen to the child’s breathing when he is calm. o If you hear a noise when the child breathes out or is

crying, this is not a danger sign. The child is breathing faster than normal. The lower chest

goes in when the child breathes in. These are signs of pneumonia.

o His breath is fast like a runner’s breath.o Normally when a child breathes in, the chest and

stomach move out. Child coughs or has difficulty breathing for more than 30

days. Child has fever or any other childhood danger sign.

11. Activity: Chest In-drawing and the Breath Counter

14. Practice and Coaching

15. Request12. Probe 13. Inform 16. Examine

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Danger Signs of Severe Respiratory Infection (Picture 1.4)

Picture A. Mother A and Father A are taking a child wrapped in a blanket to the clinic. Repeat the image from Module 3, Picture 5.4C.

Draw arrows from Picture B, C, D, E and F pointing to Picture A.

Picture B. A child (20 months old) sitting with his mouth open on his mother’s lap. He is not wearing a shirt. He is inhaling (his lower belly is out). Draw crooked lines coming out of his mouth showing that his breath is making noise. His mother has her hand cupped around her ear. She is turning her ear towards the child (listening). Draw an arrow pointing into his mouth to show the child is breathing in.

When you signs of severe infection, take the child immediately to the clinic.

When the child breathes in, there is a harsh noise.

Picture C. A large image of a child (20 months old) sitting down. His mouth is open and there is a puff of air coming out of his mouth. In a smaller image above the child we see two children (5 years of age) are running as fast as they can. There are lines of motion behind them. One child (in front) has stopped. He is stooping over with his hands on his knees. He has lifted up his head and is panting (breathing very fast). There is a puff of air coming out of his mouth.

Picture D. A large image of a child (20 months old) lying on his back. He is not wearing a shirt. His mouth is open. There is an arrow pointing into the mouth (he is breathing in). There is an adult hand pointing to the skin just under the ribs. The skin is sunken (caved in) in a line just under the ribs and in between the two bottom ribs. See the following website for a video: http://www.youtube.com/watch?v=Zlf40C7lGI0

Child is breathing much faster than normal. Lower chest goes in when the child breaths in. These are signs of pneumonia.

Picture E. Child (20 months old) coughing. There is a calendar behind him with 30 days marked off.

Confirm that these danger signs match those given by the MOH.

Picture F.Repeat picture 5.4 from Module 3 of a child with fever.

Child coughs or has difficulty breathing for more than 30 days.

Child has fever or any other childhood danger sign.

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Lesson 2: Treatment for Severe Respiratory Infections and TuberculosisThis is the text for the back of page 11.

Materials1. Attendance Registers 2. Find out the cost of treatment for severe respiratory infections.*

1. Game: Simon Says

2. Attendance and Troubleshooting

3. Story: The Neighbor Asks for Treatment (Picture 2.1)

Mother B received medication at the clinic for Hardship’s breathing problems. He had pneumonia. After four days of treatment, Hardship is doing much better. Now Hardship’s chest does not go in when he inhales. A neighbor comes to visit. “You still have three pills and Hardship looks healthy,” the neighbor says. “My child has a cough. Can you share your pills with me?”

4. Ask

? Why does the neighbor want the medication?

? Should Mother B share Hardship’s treatment?

? The last time your child was sick, did you give all the medicine?

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

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Story: The Neighbor Asks for Treatment (Picture 2.1)

Picture A. Mother B is dropping a pill into Hardship’s mouth. Hardship looks very thin and sick. A health worker is standing next to Mother B with a glass of water. On the table is a blister pack of ten pills for Hardship. One blister is empty (the pill Mother B is giving Hardship).

Notes to the Health Manager: Find out the average number of treatment days for infant pneumonia. I have used 10 days in the following pictures. If the local antibiotic requires 14 - 21 days, please change the blister packs in Pictures 2.1, 2.2, and 2.3 to represent 14 days (or more).

Mother B received medication at the clinic for Hardship’s breathing troubles. He had pneumonia.

Picture B. Mother B is standing next to a woman (neighbor) in her house. She is holding Hardship on her hip. Hardship is happy and smiling. He is more round and plump than Picture A. Mother B is holding the blister pack in her hand. There are three pills left in the pack. The neighbor is holding a child (12 months) in one arm. The child is coughing. The neighbor is holding out her hand towards Mother B – asking if she can have the remaining pills in her hand.

After four days of treatment, Hardship is doing much better. “You still have three pills left and Hardship looks healthy,” the neighbor says. “My child has a cough. Can you share your pills with me?”

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Treat Severe Infection Immediately (Picture 2.2) This is the text for the back of page 13.

9. Show

? What do you see in these pictures?

10. Explain

Begin treatment for severe infection immediately.o Give treatment on the same day that you see the

danger signs. o Mother A gives Of Great Worth her first treatment

before she leaves the health clinic. Give the treatment exactly the way the health worker

explained. o The health worker is telling Mother A to give Of Great

Worth one pill, each morning for 10 days.o The black X’s represent the days she should give

treatment. Even if the child looks better, continue giving treatment all

the days recommended by the health worker.o The black X’s show the days Mother A gave

treatment.o Mother A continues to give one pill each morning

even if her child seems better. o Some respiratory infections require 10 days of

treatment. o Some respiratory infections like tuberculosis require

6 months of treatment.

? Do you believe that medicine will cure this sickness? Why? How do you know?

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Treat Severe Infection Immediately (Picture 2.2)

Picture A. Mother A is helping Of Great Worth drink from a glass of water. There is a blister pack of 10 pills on the table in front of Mother A. A health worker is sitting across from Mother A.

Picture B. The health worker is showing Mother A a calendar. The calendar has seven days in a row marked with black X’s. She is pointing with one hand to the days on the calendar. In the other hand she is holding the blister pack of pills. Mother A is holding Of Great Worth in her arms. Of Great Worth is coughing. There are lines coming from Of Great Worth’s mouth showing her cough is strong.

Caption Picture A: Begin treatment for severe infection immediately.

Give the treatment exactly the way the health worker explains.

Picture C. Father A is dropping a pill into Of Great Worth’s mouth. He is holding a glass of water in his other hand. Behind them, Mother A is placing a black X on the calendar. There are already six X’s on the calendar in a row (like the calendar in Picture B). She is drawing the seventh X.

Even if the child looks better, continue giving treatment all the days recommended by the health worker.

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Give all the Medicine (Picture 2.3) This is the text for the back of page 15.

9. Show

? What do you see in these pictures?

10. Explain

Give all the medicine recommended by the health worker. Full treatment chases the sickness far away.

o Sickness is like a thief that steals health from a child.o Giving all the medicine is like a man chasing a thief

far away from the community. Do not share your child’s treatment with others. Sickness,

like a thief, will come back quickly.o This mother is sharing her child’s treatment with a

friend. o The sickness will return quickly to both children.o Do not share of give only half of a child’s treatment.

If the child’s health does not improve, return to the clinic. o In the pictures, the mother gave all the medicine.o The child still had a cough and symptoms of

respiratory infection.o The mother returned to the clinic.

? Is it important for caregivers to treat childhood illness? Why? o A caregiver is able to prevent death by giving

treatment. o Simple practices can save the child’s life and allow

them to live into old age.o Each child is different from all others. o Your child is unique and valuable.

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Give all the Medicine (Picture 2.3)

Picture A. Mother A is placing the last pill into Of Great Worth’s mouth. There is an empty blister packet (or pill box). She is next to a window. Outside the window we see a man chasing a thief out of the village. (Repeat the image in the window of Module 3, Picture 5.3).

Caption Picture A: Give all the medicine recommended by the health worker. Full treatment chases the sickness far away.

Picture B. In the front of the image we see a woman holding a coughing child giving half of her pills to another woman holding a coughing child. (She is pouring half of the pill container (or handing a half of a blister pack to the woman. Show only their upper bodies. In the background we see the thief with his bag of goods hiding behind a small tree outside a house. (Refer to the thief images in Module 3 Picture 5.3). Put a large Red X on this picture.

Caption Picture B Do not share the treatment with others. Sickness, like a thief, will come back quickly.

Picture C. A Mother (not Mother A or Mother B) is turning over the pill container and it is empty (or a mother is looking at the foil blister pack and it is empty). In the background is a calendar with 7 days marked off with black X’s. Her child is sitting on her lap coughing.

Picture D. The mother from Picture C is walking with her coughing child on a path towards the health clinic. We see the health clinic in the background.

If the child’s health does not improve, return quickly to the clinic.

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Severe Respiratory Infection: Tuberculosis (Picture 2.4)This is the text for the back of page 18.

9. Show

? What do you see in these pictures?

10. Explain Tuberculosis is a severe respiratory infection for adults. It is

very contagious. o Mother A’s husband is coughing on his son.o Children usually get TB from a sick adult in their

house. If someone in your house has tuberculosis, take everyone to

the clinic to be tested.o Mother A has taken everyone to the clinic for a TB

test.o A person can have tuberculosis, without showing

signs of sickness. In adults, the dangers signs are a cough for more than three

weeks, coughing up blood, fever, and sudden weight loss. o Mother A’s husband has fever and sweats at night.o He has lost a lot of weight in three weeks.

In children, the danger signs are loss of interest in feeding, fever, and sudden weight loss.

o This infant has tuberculosis. He doesn’t breastfeed as he used to. He has lost a lot of weight in a few weeks.

11. Activity: Saving Money for Treatment

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

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Severe Respiratory Infection: Tuberculosis (Picture 2.4)

Picture A. Mother A’s husband (Module 4, Picture 2.2A and 2.5 for pictures of Mother A’s husband). In this picture, his face, arms, and body are very thin. He is bent over coughing. There are lines coming out of his mouth showing that the cough is strong. His oldest child (boy 8 years) is standing opposite him. He is holding up his hands in front of her face and turning her head away from his father. He is protecting himself from the germs in the cough.

Picture B. A nurse if giving the 8 year old boy (from Picture A) an injection in his forearm. Behind him, Mother A is holding Of Great Worth and standing with his 4 year old sister. They are waiting in line to get an injection from a nurse.

Tuberculosis is a severe infection for adults. It is very contagious.

If someone in your house has TB, take everyone to the clinic to be tested.

Picture C. Mother A’s husband - head, neck and shoulders. He is coughing into a cloth. There is thick yellow liquid on the cloth with blood. Behind him is a calendar with each day for three weeks marked with red X’s.

Picture D. Mother A’s husband‘s head and shoulders. His face shows he is in pain (headache). He has one hand on his forehead. There are heat waves coming off his head. There is a moon in the background (it is night).

Picture E. Mother A’s husband is healthy, well built and muscular. There is an arrow pointing to the second picture of the same man. In the second picture, he is very sick with very thin arms, legs, and face. His clothes are hanging off his body (he’s too thin).

In adults, the dangers signs are a cough for more than three weeks, coughing up blood, fever, and sudden weight loss.

Picture F. An infant (12 months) turning away uninterested from his mother’s breast. His mother is trying to feed him.

Picture G. An infant (12 months) with fever. Repeat image D with a child. There is no moon in the child’s picture.

Picture H. Repeat Picture E – only using a child of 12 months. In the first image the child is round and fat and laughing. In the second image the child has a thin face, arms and legs and no body fat. The child is not smiling.

In children, the danger signs are loss of interest in feeding, fever, and sudden weight loss.

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Lesson 3: Recovery and Care for Children with Respiratory InfectionThis is the text for the back of page 19

Materials1. Attendance Registers 2. Two oranges, balls of fabric, or balls of twine for the game.3. Foods and cooking supplies for the Recovery Porridge. Ask each woman to bring a

small bowl and spoon for her child.*

1. Game: Ball under Chin

2. Attendance and Troubleshooting

3. Story: Special Care at Home (Picture 3.1)Mother B is giving Hardship medicine like the health worker suggested. Hardship is improving slowly. Mother A comes to visit Mother B to find out how Hardship is doing. Mother A asks, “What are you doing to help Hardship’s cough?” Are you giving Hardship special foods to help him recover? Mother B says that she is giving medicine. Why should I give special treatment if I am giving medicine?

4. Ask

? Is Mother B giving her child special care?? If the child is taking medication, do you need to

give the child special care?? What special care do you give to a child at

home to help them recover? Let’s compare your thoughts with the messages on the following pages.

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Story: Special Care at Home (Picture 3.1)

Picture A. Mother B is showing Mother A the calendar on the wall where she is marking off the days of Hardship’s medicine. The calendar has four days in a row with a black X on them.

Mother B is giving Hardship medicine like the health worker suggested. She tells Mother A about her treatment calendar.

Picture B. A large picture of Hardship (20 months) sitting on Mother B’s lap. Hardship is coughing. Mother A is sitting next to Mother B. Mother A is pointing at Hardship. Mother A has a word bubble above her head with a question mark inside.

Health Manager: In this picture Mother B is not feeding Hardship good foods to help the child recover. Include a common food that does not contain many nutrients (for example, cassava). The pages that follow will explain the highly nutritious foods that should be given to help a child recover.

Picture C. Mother B is feeding Hardship a family food (Health manager the food should be low in nutrition and only one color of food) from a bowl. The child is sitting on her lap. Mother A is pointing to the porridge and talking. Mother A has a word bubble above her head with a question mark inside.

What are you doing to help Hardship’s cough?

Mother A asks, “Are you giving Hardship special foods to recover?”

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Helping the Child Breathe (Picture 3.2)This is the text for the back of page 21.

5. Show

? What do you see in these pictures?

6. Explain

Clean each nostril with a warm cloth to help the child breath.o Mother A is using the corner of a cloth to clean her

child’s nose.o Then she washes her hands and the cloth with soap

and water. Loosen snot by helping the child breath hot water steam.

o Wet, warm air helps to loosen the thick liquid in the nose and chest.

o The cloth helps to hold the steam.o Father A is sitting with the child to make sure the

steam is not too hot. Give warm liquids to children six months and older.

o Warm liquids loosen the thick liquid in the nose and chest and ease coughing.

o Extra liquids help to make snot thinner. Breastfeed and offer more liquids than usual.

o Drinking more liquids helps to thin the thick liquid in the nose and throat.

o Give back liquids that are lost through coughing and dripping nose.

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Helping the Child Breathe (Picture 3.2)

Picture D. Mother A is inserting the tip of a small rolled up cloth to clean inside of Of Great Worth’s nose. Next to her is a

bowl of steaming water. In a circle at the bottom of the picture two adult hands are rubbing together covered in a soap bubbles. Water is dripping from the hands. If you use the image here, add Octavio Gonzales’ name to the acknowledgements on page 2 of the flipchart and page 6 of the lesson plan.

Picture E. Mother A is lifting up a cloth to look at Of Great Worth. The cloth is draped over the head of Father A and Of Great Worth. Of Great Worth is sitting on Father A’s lap. There is a bucket of steaming water in front of the chair. They are both leaning forward so the steam from the bucket is filling the air under the cloth and washing over their head and chest.

Caption Picture A: Clean each nostril with a warm cloth to help the child breath.

Caption Picture B: Loosen snot by helping the child breath hot water steam.

Picture F. Mother A is giving Of Great Worth (20 months) a cup of steaming porridge. Next to the porridge are cups of other common hot liquids or nutritious porridges that can be given to children.

Health Managers: give instructions for other hot liquids that are nutritious and healthy for children 6 months to 12 years. One suggestion might be hot water with lemon squeezed inside.

Picture G. Mother A is breastfeeding Of Great Worth (20 months).

Caption Picture C: Give warm liquids to Breastfeed and offer more liquids 24

loosen snot and ease coughing. than usual.

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Feeding Guidelines for Recovery (Picture 3.3)This is the text for the back of page 23.

7. Show

? What do you see in these pictures?

8. Explain

Add small amounts of Vitamin A foods to meals each day.o Add organ meat, red meat, fish, sweet potato, and

papaya, plantain, pumpkin, peas, carrots, and red palm oil.

o These foods have vitamin A and will help the child get better.

Offer sick children favorite foods and soft foods. o Soft foods are easy for children to swallow. o Eating favorite foods will encourage the child to eat.

Offer extra foods to the child each day when the child is sick.o Chase the illness far away. o If caregivers give less food than normal, the sickness

will return. o If the child has trouble eating solid foods, give them

thick soups and porridges to help them recover. Offer extra foods and liquids for two weeks after the sickness

is gone. o Strengthen the child’s body with healthy foods.o For infants less than six months, offer one or two

extra breast milk feeds each day during the sickness and for two weeks after the illness.

o The red X’s show that Mother A has given extra foods for two weeks after the sickness ended.

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Feeding Guidelines for Recovery (Picture 3.3)

Picture A. Mother A is cooking family foods in a large pot. Around the edges of the image are foods high in vitamin A including meat, fish, sweet potato, papaya, peas, plantain, pumpkin, carrots and red palm oil. There are small arrows from each food pointing to the large pot.

Health Managers: Please add locally available foods high in VITAMIN A.

Picture B. Mother A is feeding Of Great Worth (20 months old) porridge. There is mashed banana in a bowl next to a banana. There are other foods around the bowl that are locally available and soft such as mango, or plantain, or mashed cassava).

Health Managers: Please add locally “soft” foods.

Caption Picture A: Add small amounts of Vitamin A foods to meals each day.

Offer sick children favorite foods and soft foods.

Picture C. Of Great Worth (20 months) is sitting on Mother A’s lap. She is feeding him from a plate of food. There foods of many different colors (greens and vegetables) and fish. On the table are two glasses of water. The child is wrapped in a blanket. In the background is a calendar. There are five black X’s on in the first week of the calendar.

Picture D. Of Great Worth (20 months) is sitting on Mother A’s lap. She is feeding him from a plate of food. There foods of many different colors (greens and vegetables) and fish. On the table are two glasses of water. Of Great Worth is not wrapped in a blanket. The calendar in the background has the five black X’s from Picture C, followed by two weeks of red X’s.

Caption Picture C: Offer extra foods and liquids each day while the child is sick.

Caption Picture D: Offer extra foods and liquids for two weeks after the sickness is gone.

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Helping the Body Recover (Picture 3.4)This is the text for the back of page 25.

9. Show

? What do you see in these pictures?

10. Explain: Keep the child warm, especially when it is cold outside.

o Children heal better if they are warm and comfortable.o Do not overdress the child so they sweat.

Let the child sleep more often when they are sick. Sleeping with the head and chest raised may help the child breathe.

o Sleep helps the body recover. If the child has fever, cool down the body by wrapping the child

in a wet cloth. o If fever stays too long, the child may have convulsions.o Cooling down the body prevents convulsions.o A mother can also pour cool water on a towel placed

around their head of the child or give them a cold bath.? What if your child is a girl? Would you still give them special

care?o Yes! All children are unique and valuable whether they

are girls or boys.o Simple practices can protect them from sickness and

death. Simple practices can keep them alive.

11. Activity – Recovery Porridge

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

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Helping the Body Recover (Picture 3.4)

Picture A. Mother A is putting a sweater on Of Great Worth (20 months). She is already wearing socks.

Picture B. OF Great Worth is sleeping under a blanket on a mat. Next to Of Great Worth is a child sleeping on his back on a stack of blankets and pillows that are angled so the child’s head and chest are up and his upper body is at a 40% angle.

Picture Caption A: Keep the child warm, especially when it is cold outside.

Caption Picture B: Let the child sleep more often. Sleeping with head and neck raised may help the child breathe.

Picture C. Of Great Worth (20 months) is sitting. She has heat waves coming off her head and one hand on the side of her face (headache/fever). Her face is sad and pained.

Picture D.R

epeat picture 3.4C of Module 4 or you can use the image below. If you use the image above, add Octavio Gonzales’ name to the acknowledgements on page 2 of the flipchart and page 6 of the lesson plan. Mother A is wrapping Of Great Worth (20 months) in a wet cloth to reduce fever.

If the child has fever, cool down the child by wrapping the child in a wet cloth.

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Lesson 4: Respiratory Infection Transmission and Prevention: Hand washing and Separating the Sick This is the text for the back of page 27.

Materials:1. Attendance Registers

1. Game: Germs and Vaccinations

2. Attendance and Troubleshooting

3. Story: Mother B’s Husband and the Children get Sick (Picture 4.1) Hardship recovered well, but soon Mother B’s husband and the children begin to cough. Their noses begin to drip. Mother B is surprised. She has spent lots of time helping Hardship recover. Now three more people have respiratory infections. How did this happen?

4. Ask? How does someone “catch” respiratory

infection?? Could Mother B have prevented the others

from getting sick? How?? How do you prevent sick children from

spreading infection in your house?

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

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Story: Mother B’s husband and the Children get sick (Picture 4.1)

Picture A. Mother B and her family are eating together. Mother B’s husband and the two older children (boy 8 years old and girl 4 years old are coughing on the food). There are lines coming from the cough showing that the cough is strong. The girl (4 years old) has yellow/green snot coming from her nose. She is wiping it on the palm of her hand. Mother B is looking at her husband who is coughing. She has her mouth open in surprise. There is a thought bubble above her head with a question mark inside. Hardship [20 months] is sitting on her lap. Hardship is not coughing. (If food is not eaten from a communal bowl, substitute with a snack that might be shared from bowl such as cut up fruit, popped corn or another snack).

Caption Picture A: Soon Mother B’s husband and the children begin to cough. Their noses begin to drip. Mother B is surprised. She has spent lots of time helping Hardship recover. Now three more people have respiratory infections. How did this happen?

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Respiratory Infection Transmission (Picture 4.2)This is the text for the back of page 30.

7. Show

? What do you see in these pictures?

8. Explain

Germs from a sick person’s snot and saliva spread infection.o The green dots in this picture are germs.o Germs are too small to see. o A sick child’s saliva and snot are filled with germs.

Germs in the air from coughs spread infection. o Hardship is coughing on his sister. o His sister breathes in the germs and soon she

becomes sick too. Germs on hands and objects of sick children spread infection.

o Hardship’s snot gets onto his toys.o His sister’s hands now have his germs on them.o When his sister touches her mouth, eyes or wipes her

nose the germs get into her body.o Soon his sister will be sick too.

Smoke also causes respiratory infection in children.o Smoke irritates the nose and throat.o Children who breathe smoke from cooking fires have

more respiratory infections.o Children who breathe tobacco smoke have more

respiratory infections.

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Respiratory Infection Transmission (Picture 4.2)

Picture A. The head and shoulders of Hardship [20 months]. He is sticking out his tongue. His nose is dripping with yellow/green liquid. On his tongue and in the snot (yellow/green liquid) are small green dots (germs).

Picture B. A side view of Hardships [20 months]. He is standing and coughing on his 4 year old sister who is sitting across from him. There are green droplets in the cough. There are green dots in the air around the cough and landing on the face of the 4 year old girl.

Germs from a sick person’s snot and saliva spread infection.

Germs in the air from coughs spread infection.

Picture C. Hardship is sitting opposite his 4 year old sister on a mat. Hardship’s nose is dripping onto his shirt. He is lifting his hand to wipe his nose. His 4 year old sister is taking a toy out of Hardship’s other hand. The toy is covered in small green dots. The liquid from Hardships nose is covered in small green dots. Hardship’s hands are covered in small green dots.

Picture D. Mother B is sitting by the cooking fire inside her house. Hardship is strapped onto her back or sitting on a mat in the front of the picture (as culturally appropriate). Hardship is coughing. There is smoke rising from the cooking fire. The room is filled with smoke.

Germs on hands and objects of sick children spread infection.

Smoke also causes respiratory infection in children.

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Stop Germs with Soap (Picture 4.3) This is the text for the back of page 31.

5. Show

? What do you see in these pictures?

6. Explain

Wash germs off hands after caring for a sick child.o Mother A washes her hands after Of Great Worth

coughs on her.o She washes her hands after wiping the child's nose.o Soap (and ash) kills the germs.

Wash germs off toys and objects touched by a sick child.o Mother A is washing the toy. o She is washing off Of Great Worth's germs and snot

before giving the toy to another child. Wash snot off the hands and faces of sick children.

o Mother A is washing the snot and germs off Of Great Worth’s face and hands.

o Clean hands and faces of sick children often. Keep germs out of the air. Teach sick children to cough in

their elbow or on a cloth. o Mother A taught her son to cough in his elbow.o This keeps germs out of the air.o Mother A is using a cloth to catch the germs from Of

Great Worth.

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Stop Germs with Soap (Picture 4.3)

Picture A. In the center of the picture, two adult hands are covered in soapy bubbles up to their wrists. Soapy water is dripping from the hands. In one small circle, Of Great Worth (20 months) is coughing on the hand of an adult. In another small image, an adult hand is wiping the nose of Of Great Worth (20 months).

Picture B. Mother A is washing the toy from picture 4.2C. Soapy water is dripping off the toy. There is a bar of soap next to the water basin. She is pouring clean water over the toy with a separate cup.

Wash germs off hands after caring for a sick child.

Wash germs off toys and objects touched by a sick child.

Picture C. [Mother A] is washing Of Great Worth’s hands and face with soap. Her hands and face are covered in soap bubbles.

Picture D. Mother A’s oldest son is coughing (8 years). He is holding his arm up and coughing into the bend in his elbow (see below). Next to him, Of Great Worth is coughing. An adult hand is placing a small cloth over her mouth.

Wash snot off the hands and faces of sick children.

Keep germs out of the air. Teach sick children to cough in their elbow or on a cloth.

35

Separate Sick Children to Stop Germs (Picture 4.4) This is the text for the back of page 33.

9. Show? What do you see in these pictures?

10. Explain

Give sick children a separate sleeping mat. o Of Great Worth sleeps in a separate bed.o Germs in the air from a sick person can infect others

in the bed. Give sick children their own bowl of food to prevent others

from getting sick.o Germs on fingers and hands stick to food and can

cause infection in others.o If a sick person coughs on your food, their germs on

the food may make you sick too. Discourage healthy children from playing with sick children.

o Germs on toys and hands can spread germs.o Mother A doesn’t let others play with Of Great Worth

when she is sick. o She doesn’t want to spread her germs to other

children.? Do you believe these practices will work to stop infection?

Why?

11. Activity: The Germ Song

14. Practice and Coaching 15. Request12. Probe 13. Inform 16. Examine

36

Separate the Sick to Stop Germs (Picture 4.4)

Picture A. Father A and Mother A are sleeping in one bed with their children: boy 8 years old and girl 4 years old. They are sleeping under mosquito net. On the other side of the room, Of Great Worth [20 months] is sleeping on a mat by herself under a mosquito net. The child is coughing.

Health Managers: Adapt the text according to local custom. Do people sleep on mats or beds? If they sleep on beds, where should a sick child sleep if there is only one bed for the children?

Picture B. Father A and Mother A are eating with their two children (boy 8 years and girl 4 years) from one bowl of communal food. Of Great Worth is eating food next to them from her own small bowl. If family foods are not communal use snack foods that might be shared like cut up fruit or popped corn.

Give sick children a separate sleeping mat to prevent others from getting sick.

Give sick children their own bowl of food to prevent others from getting sick.

Picture C. Two boys are sitting on a mat. One boy is playing with a local toy. The other boy is reaching up towards Mother A who is standing next to the boys holding Of Great Worth in her arms. She is holding up one palm towards the boy to say “No.” Of Great Worth is coughing.

Caption Picture C: Discourage healthy children from playing with sick children.

37

Lesson 5: Preventing New Respiratory Infections: Exclusive Breastfeeding, Vaccinations, Healthy Feeding, and Reducing Indoor SmokeThis is the text for the back of page 35.

Materials:1. Attendance Registers2. Two cooking rooms for the activity*

1. Game: Transmission Game

2. Attendance and Troubleshooting

3. Story: A Tree planted by a Stream (Picture 5.1)

Mother A tells a story. There is a tree planted by a stream. Its roots drink from the stream. The stream and soil provide healthy foods for the tree. The tree always has fruit and green leaves.The tree by the stream does not break or become sick when strong winds blow. The tree remains strong. “Hardship can be strong like this tree, “says Mother A. “Every child can be strong if planted like this tree.” “How?” asks Mother B.

4. Ask

? Why does the tree keep its leaves and not break when the winds blow?

? What did Mother A mean when she said Hardship could be like a tree?

? What are actions we can take to help our children be like a strong tree and resist infections?

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

38

Story: A Tree Planted by a Stream (Picture 5.1)

Health Managers: Choose a local fruit tree for this illustration.

Picture A. Mother A is talking to Mother B. She is standing next to a large and healthy fruit tree planted next to a stream. Some of the roots of the tree are hanging into the water. Other large roots can be seen at the base of the tree. The tree has many pieces of fruit on it. There are other trees planted away from the stream. They are smaller, with fewer leaves and no fruit.

Mother A tells a story of a tree planted by a stream. Its roots drink from the stream. The stream provides healthy food and nutrients for the tree. A tree planted by a stream always has fruit and green leaves.

Picture B. Repeat the image of the tree above. Now the wind is blowing strong around the tree. Many of the other trees are bending over and losing their leaves. Branches are breaking off of the smaller trees. The large tree is healthy and strong and still has all of its leaves and fruit.

Picture C. Hardship is standing in front of the trunk of the large tree. They can be seen in the background. Mother A and Mother B are standing in front. Mother A is pointing at Hardship. Mother B is looking at Hardship. She has a question mark in thought bubble above her head.

A tree by the stream does not break or become sick when strong winds blow.

“Hardship can be strong like this tree. “says Mother A. “How?” asks Mother B?

39

Breastfeed and Vaccinate to Keep the Body Strong (Picture 5.2)

5. Show

? What do you see in these pictures?

6. Explain

Give only breastmilk for the first six months of the infant’s life.

o Breastmilk gives the body all the food that it needs in the first six months.

o Breastmilk protects your child from infections.o This child is healthy and fat because his mother gave

only breastmilk for six months. Exclusively breastfed infants (5 months and younger) are

sick less often than children (5 months and younger) who eat and drink other foods and liquids.

o This child had porridge and water.o He is thin and had many illnesses during the first six

months of life. Vaccinate your children to prevent severe respiratory

infections.o Vaccinations prevent severe respiratory infection that

may cause death (tuberculosis, whopping cough, and measles).

o Vaccinations help to keep a child strong. Breastmilk is like the stream that feeds the body with

nutrients. Vaccinations protect the tree from strong winds.o Children are valuable and their lives are of great

worth.o Giving breastmilk and vaccinations help to protect

children from harm.

40

Breastfeed and Vaccinate to Prevent new Respiratory Infections (Picture 5.2)

Picture A. A small image of a mother (not Mother A or Mother B) breastfeeding a child (4 months). Next to the picture of her breastfeeding is an arrow. The child is sitting in a cloth diaper, smiling and healthy. His arms and legs are round and chubby. If cloth diapers are not used, draw the child naked or wearing pants.

Picture B. Repeat the image of the mother breastfeeding a child (4 months). Underneath the image is a plus sign (+) and a cup of liquid. Under the cup is a plus sign (+) and a bowl of porridge. To the right of these images is an arrow. A large picture of the same child in a cloth diaper. Here the child is thin. The outline of her ribs can be seen. His arms and legs have no muscle. He is coughing. Lines are coming from his

cough showing it is a strong cough. If cloth diapers are not used, draw the child naked or wearing pants.

Give only breastmilk for the first six months of an infant’s life.

Exclusively breastfed infants (5 months and younger) are sick less often than children (5 months and younger) who eat and drink other foods and liquids.

Picture C. A picture of a health worker giving Of Great Worth (20 months) an injection in the leg. Health Managers – verify the most common place (shoulder, leg or buttocks for child vaccinations).

Picture D. Repeat the large image of a strong tree from Picture 5.1A. (In a small circle), repeat the breastfeeding image from Picture A - draw and arrow from the breastfeeding image to the stream. (In a small circle), repeat Picture C (vaccination) - draw an arrow to the roots of the tree.

Vaccinate children to prevent severe respiratory infections.

Breastmilk is like the stream that feeds the body with nutrients. Vaccinations protect the tree from strong winds.

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Healthy Feeding prevents Respiratory Infection (Picture 5.3) This is the text for the back of page 39. Health Managers – insert the staple food common in your country and adapt foods listed below based on availability in your country.

7. Show

? What do you see in these pictures?

8. Explain Add a variety of foods to [insert the name of the local staple

food such as sorghum, manioc, corn or rice] each day to prevent infection.

o Of Great Worth eats foods with Vitamin A. She eats mango, papaya, orange sweet potato, carrots and dark green leafy vegetables.

o She eats foods with iron, like legumes, organ meat, and dark green leafy vegetables.

o She eats foods with vitamin C, like oranges, lemons, jackfruit, tomatoes, okra, avocado, papaya and mango.

o Of Great Worth eats foods with protein, like beans, lentils, nuts, split peas, eggs, meat, chicken and fish.

o Her mother adds a sprinkle of iodized salt and a spoonful of oils to her foods.

Children who eat well get sick less often. o Of Great Worth has been sick five days in the last

three months. o Hardship has been sick 14 days in the last three

months.o Of Great Worth eats better and gets sick less often.

Children who don’t eat well are more likely to die from illness.

o Hardship’s body is weak because he doesn’t eat a variety of foods.

o He is more likely to die from respiratory infection than Of Great Worth.

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Healthy Feeding prevents Respiratory Infection (Picture 5.3)Picture A. Repeat image and foods used for Module 2, Lesson 2, Nutrient Rich Foods for children 12 to 23 months. Health Managers: please fill in the nutritious foods that represent each food group for this picture. Of Great Worth (20 months) is sitting at the bottom eating from a bowl of family foods.

Add a variety of foods to the local staple food (such as sorghum, manioc, corn or rice) each day to prevent infection.Picture B. Of Great Worth is sitting next to

Hardship. Both children are coughing. Hardship looks very thin and weak. Above each child are three months of the calendar. On the calendar behind Of Great Worth, there are black X’s on five days in the second month only. Behind Hardship, there are black X’s on seven days in the first month, four days in the second month and the last three days of the third month. Below Of Great Worth is a variety of foods like: peanuts, sorghum, papaya, oil, and green leafy vegetables (include one food from each circle above). Below Hardship there is just cassava/manioc (insert local staple food only).

Picture C. A close up of the upper body of each child from picture C. Both child are coughing. Hardship is leaning over and in pain from the cough. The cough is shaking his entire upper body. Of Great Worth is coughing, but the cough is not as strong. He is not leaning over. His upper body is calm.

Children who eat well get sick less often.

Children who don’t eat well are more likely to die from illness.

43

Reduce Indoor Smoke to prevent Respiratory Infections(Picture 5.4)

7. Show

? What do you see in these pictures?

8. Explain Smoke prevents a tree from growing well. Likewise, smoke

harms children who breathe it every day. o Smoke causes the leaves and fruit to wilt and fall off.

When cooking, open doors and windows to let out smoke. Add vents to let smoke out.

o Mother A has added long vents at the top of the wall to let the smoke out of the house.

o Mother A is cooking next to the window. Discourage children from sitting in cooking rooms.

o Mother A has asked her children to watch Of Great Worth while she is cooking.

o She has given them work to do outside. Smoke in the open air. Keep small children away.

o Do not smoke in rooms where children play or sleep. o The smoke stays in clothes, bedding and the walls.o The old smoke in the room can cause respiratory

infection.

11. Activity: Visiting Cooking Rooms

14. Practice and Coaching

15. Request12. Probe 13. Inform 16. Examine

44

Reduce Indoor Smoke to prevent Respiratory Infections (Picture 5.4)

Picture A. Draw a picture of a tree by the stream. Under the tree is a cooking fire. The branches above the fire are black and the leaves have fallen off. There is no fruit on the tree. The tree looks smaller and less healthy than picture 5.1A.

Health Managers: If there is another analogy that works better than using the fire under the tree, please adapt as appropriate..

Picture B. Mother A is sitting next to a cooking fire. There are long rectangular holes along the top of the wall in addition and two windows on each side of the fire. The smoke is flowing out of the room through the holes at the top.

Smoke prevents a tree from growing well. Likewise, smoke harms children who breathe it every day.

When cooking, open doors and windows. Add vents to let out smoke.

Picture C. Mother A is cooking. The doors and windows are open in the cooking room. We can see Of Great Worth strapped onto the back of (the 9 year old boy if appropriate or the 4 year old girl). They are sitting outside.

Picture D. A group of men are smoking together in the shade of a tree. Two small children are approaching. One man is standing up and holding both hands with palms facing the children. He is telling them to not to come closer.

Discourage children from sitting in cooking rooms.

Smoke in the open air. Keep small children away.

45