Mphatlalatsane (Early Morning Star) Health and Nutrition ... · Mphatlalatsane (Early Morning Star) Health and Nutrition Programme Manual 5 Session 1: We are all special and unique

Mphatlalatsane (Early Morning Star) Health and Nutrition Programme Manual

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Mphatlalatsane (Early Morning Star)

Health and Nutrition Programme

FACILITATOR’S MANUAL


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Mphatlalatsane (Early Morning Star) Health and Nutrition Programme

Facilitators Manual

August 2016 License for the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme is held by Mark Tomlinson, Marguerite Marlow, Sarah Skeen, Jackie Stewart, Lucie Cluver and Lorraine Sherr via Creative Commons Attribution-No Derivatives and NonCommercial 4.0 International Public License.

The conditions of the License including the following: • ATTRIBUTION: Appropriate credit must be given when using the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme according to the Creative Commons definition, including (a) the name of the authors and attribution parties, (b) a copyright notice, (c) a license notice, (d) a disclaimer notice, and (e) a link to the material; • NON-COMMERCIAL: The Mphatlalatsane (Early Morning Star) Health and Nutrition Programme materials are to be made available free of charge; • NO DERIVATIVES: No changes to any Licensed Materials are allowed without prior approval. The License is applicable to any changes, adaptation, or translation of Licensed materials; Any deviation of the terms of the License is strictly prohibited. The authors of the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme also request that individuals and organizations adhere to the following principles: • IMPLEMENTATION: Implementation of the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme shall only be conducted by certified facilitators. Implementers shall adhere to all protocols regarding implementation and training of the programme; • TRAINING: Training of staff in the implementation of the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme shall only be conducted by certified trainers and for personnel within the same organization unless permission is granted by Parenting for Lifelong Health; • MONITORING: Process and outcome data collected during the implementation of the Mphatlalatsane (Early Morning Star) Health and Nutrition Programme shall in principle be shared with the authors of the programme and Parenting for Lifelong Health.


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Introduction In 2014, as part of its orphans and vulnerable children (OVC) programming, the United

States Agency for International Development (USAID) and the President’s Emergency

Plan for AIDS Relief (PEPFAR) funded programmes for children under age five affected

by the HIV epidemic. These interventions in three southern Africa countries (Eswatini

[formerly Swaziland], Lesotho, and Zimbabwe) took an approach combining early

childhood development (ECD) with HIV testing and treatment.

In Lesotho, the Mphatlalatsane programme (Sesotho for “early morning star”) was

implemented with the aim to increase HIV testing and treatment while improving ECD

outcomes. The intervention uses a group-based parenting programme delivered to

groups of five to six caregivers and their children at local village preschool centres. The

programme consists of eight weekly sessions, with each session lasting for two to three

hours. Each session consists of training and support for caregivers to engage with their

children in sensitive book-sharing, combined with activities and group discussions to

convey messages on health, nutrition and the importance of testing for HIV. The

programme is delivered by trained and supervised community health workers, with an

intervention facilitator (IF) and a community-based mentor (CBM) in each team. The IF

delivers the book-sharing component of the intervention while the CBM delivers the

health components.

The book-sharing component of the Mphatlalatsane programme makes use of group

presentations and one-on-one assistance from a trained facilitator to provide caregivers

with the skills to practice quality book-sharing with their infants or toddlers. Quality book-

sharing between a caregiver and young child may be especially effective as a means

of promoting infant cognitive and language development. The introduction of sensitive

and reciprocal book-sharing could have a profound effect on children’s intellectual

development and readiness for school. Separate book-sharing programmes for

caregivers with younger children (ages 12-30 months) and for caregivers with older

children (31-60 months) have been developed in order to speak to the different

developmental needs of children of different ages. For both the younger children group

and the older children group, there are eight sessions, with a new book of the week each

week. The health and nutrition content delivered at each session does not differ for the

two age groups.


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Session Structure All intervention sessions start as a group and end as a group. The book-sharing

component is delivered first, followed by the health/nutrition component. At each

session, there is also the opportunity for individual book-sharing time with the facilitator.

The structure of each session is as follows:

1. Group opening session (Includes positive reflections from the week)

2. Group book-sharing teaching/discussion with facilitators

3. Brief individual book-sharing session (10-15 minutes) with each caregiver-child pair

4. Group health/nutrition teaching/discussion with facilitators

5. Group closing (includes goal setting and concluding with a positive comment

about what was learnt or enjoyed from this session)

6. Caregivers leave with a take home card and the book of the week

Affirmation and celebrating successes form a big part of the intervention sessions

(through the use of tokens, setting goals and an emphasis on positive feedback). At the

beginning of the sessions (especially in the first few sessions) it should be stressed that any

information shared in the group must be treated as confidential and private. Group

members need to be able to talk about their experiences and offer respect to other’s

personal lives and sensitive information that might be shared during a session. The issue

of privacy and confidentiality means sharing the meeting experience without revealing

sensitive information about other members.

The table below provides an outline of the eight intervention sessions and the topics

covered in each session:

BOOK-SHARING* HEALTH AND NUTRITION

Younger Children Older Children Session 1 Book-Sharing Intro Part 1 Book-Sharing Introduction We are special Session 2 Book-Sharing Intro Part 2 Naming and Linking Growth and Nutrition Session 3 Pointing and Naming Talking about Feelings Feeding; Hygiene&Sanitation Session 4 More Pointing and Naming Talking about Intentions HIV: Introduction Session 5 Making Links Talking about Perspectives HIV: Treatment Session 6 Talking about Feelings Numeracy and Comparisons HIV: Barriers and Fears Session 7 Summary Summary Summary Session 8 Review and Graduation Review and Graduation Review and Graduation *For book-sharing session content and materials, see separate book-sharing manuals


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Session 1: We are all special and unique

Overview: The first session promotes the message that each caregiver and child of the

caregiver in the group is special and important. As a group, they will explore what they

do well as caregivers, and how they can help their children grow and develop as best

they can. The session provides a brief overview of the nature of the intervention sessions

and what the group can come to expect for the coming 8 weeks.

SUMMARY OF SESSION ONE: BEING SPECIAL AND UNIQUE Step 1

Greeting and welcome ; getting to know the group

Step 2

Open group with song

Step 3

Childhood memory

Step 4

Fingerprint activity

Plant discussion

o Group identity

o Gentle group discussion about importance of nutrition

Step 5

Magic beans activity

Step 6

BOOK-SHARING (group presentation)

Step 7

Book-Sharing individual sessions

Step 8

“Squidgies” activity

Step 9

Close group: Teambuilding chant

Caregivers leave with the book of the week and take home card


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STEP 1: GENERAL INTRODUCTION Introduce yourselves (IF and CBM each gets a turn) and briefly tell them what the project

is about (why you are here and why they are here)

Thank them for coming and tell them what they can come to expect of the next 8 weeks

(remember that Session 1 is very important to make a good impression on the group – to

make them feel comfortable and included in what is happening in the session)

Highlight the importance of attending ALL 8 SESSIONS:

- new book each week for their child

- growth monitoring for their children in Session 2

- new activities, videos and discussion points for caregivers each week

- big graduation ceremony at session 8

STEP 2: OPENING SONG/DANCE/PRAYER Explain to the group that each week will open with a group activity to start off the new

session to unite them as a group and to make everyone feel comfortable. Let the group

decide how they would like to open the session: song/dance/prayer. It is up to the group

what they feel comfortable with.

Then, give them the option of singing the song “Ke ne ke le ngoana” / I was a baby:

Ke ne ke le ngoana I was a baby (Translation)

Ke ne ke le ngoana, ke sa tsebe letho.

Ka fuoa mme, ea ntlhokomelang;

Ka ma tsoho a nsika/kuka, Ka thari a

mpepa,

a ba nthuta puo!

Kajeno ke holile, ke tseba ho bala;

Ngoe, peli, tharo, ‘ne, hlano, tselela,

supa, robeli, robong, leshome!!!!!!

I was a baby, I knew nothing.

I was given a mother, who took care of

me;

With her arms she cuddled me, with a

blanket she carried me on her back

and she taught me how to

communicate.

Today I am all grown, and can read;

One, two, three, four, five, six, seven,

eight, nine ten!


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STEP 3: WHAT MAKES US SPECIAL (10 MINUTES) Following the ice-breaker the group sits down. The IF’s and CBM’s introduce themselves

by giving their name again but also telling the group something that makes them unique.

One of you gives an example of something good that a parent did and one gives an

example of a funny experience when you were a child. All the participants have a

chance to do the same. They can choose either.

The IF reflects that not one of those stories or experiences were the same, the people in

the stories were different and the feelings they have about those experiences are also

different.

STEP 4: FINGERPRINT EXERCISE (30 MINUTES) The CBM asks the group if they know that each one of us has different fingerprints. The

IF’s and CBM’s then get out the poster and ink pads. The IF says, “Today we have started

as a group of unique and special caregivers, with unique and special children, each with

our own individual fingerprints. But we have come together as a group. We are not alone,

we have each other”

“To show that we have come together we are going to put all our individual fingerprints

on this picture, we will help you.” Help them use the ink and pen to put their own name

and their child’s name and fingerprint on the plant picture. IFs and CBM help everyone

including the children complete the plant picture, each person representing a leaf. (If

there is a sibling, then two leaves on one stem.)

The picture is then put up on the wall and the CBM invites everyone to look for their name

and fingerprint, and those of their group members, noticing how none look the same.

Then get everyone to sit down. “Can you see how together we have formed something

special? A plant, this is our group. We say our plant needs protection e.g. from wind,

insects that might eat it. A child would need protection against abuse. In the same way,

our group needs protection. One way we can protect our plant or group is through

CONFIDENTIALITY. This means that we need to be able to trust that what we tell each

other in this group must stay in this group. It’s not information that must be spread through

the community.


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Confidentiality: Be brave enough to tell your story/have the courage to share, but kind

enough not to spread it through the community. We need to be able to trust each other.

Does everyone agree?”

“This group also needs to feel safe, a warm place for us all. Sometimes we have different

opinions or ways of doing things and that’s okay. We will come across examples of this in

our group. What will be important is that we allow for different opinions and doing things

and that we respect each other and show tolerance for differences. Does everyone

agree?”

Explore basic ideas of nutrition and education for children by asking the group, “What

does this plant need to grow?” (light, warmth, water, good soil). The CBM then fills in the

flower, “see what happens when a plant gets what it needs, it flowers”. She then asks the

group, “What does a child need to become all we want them to be as adults, happy,

healthy, and clever?” (Love, shelter, food, education etc.)

Have a short discussion on these issues e.g. what kind of food, any kind, sweets and chips?

Education, from when junior school or younger, can we do anything now? “We will tell

you more later about what you can do to get your child an early start”

STEP 5: MAGIC BEANS (30 MINUTES) Give each caregiver (with their child beside them) ONE bean (two if siblings). NB: make

sure you have a different colour bean for each child because each colour bean is a

different type of animal.

Form a circle; put all the beans in a bowl, with a bottle full of warm water. You say (add

one drop at a time saying), “here are our unique children, now we will give them love

(drop of water from bottle), we will give them shelter (another drop), healthy food

(another drop), education (another drop). Let the children dance and play” (swirl the

water around while freeing the animals inside).

The CBM gathers the group around and lets everyone see that the beans have turned

into little creatures, all different. “We added the same things, yet they all came out

different, unique but all grown up. It is our job as parents to do the best job we can, with


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what we have around us, to help our children be the best they can be. Each animal gets

named according to which child it belongs to. As the CBM lifts each animal she reflects

of its characteristics e.g. the butterfly has wings to fly, the elephant is so strong. CBM

makes a note of which animal is for which child.

STEP 6: BOOK-SHARING SESSION 1 GROUP PRESENTATION Begin the session with everyone introducing themselves and about their family structure

and their children. Invite a general discussion about the parents’ hopes and fears for their

children. Explain how book-sharing could help meet those hopes and overcome those

fears. Explain the structure of the training programme – that you will be teaching them

some new skills every week, and that you will be showing them how to use these skills with

their children. Tell them that you will use video examples of other caregivers in

Mokhotlong to show them how to do this. Then, each caregiver-child pair will get a

chance to practice their new skills and that your job as the IF is to support them. Tell them

that you are not there to see what they do wrong, but to help them do the best book-

sharing with their child. Emphasise that book-sharing is not about reading – a child or

caregiver does not need to know how to read in order to do book-sharing: it is about the

pictures in the book, not the words.

Tell the group that you will be filming the individual sessions (if they are comfortable with

that) and tell them WHY you do this: so that you can play the videos at the last 2 sessions

where every caregiver will be able to see themselves and their progress over the past 7

weeks. Start the presentation, accompanied by the visual cards/slides and video

materials.

STEP 7: INDIVIDUAL BOOK-SHARING SESSIONS In a private space, each caregiver gets a turn to share the book of the week with his/her

child, in the presence of the facilitator. The role of the facilitator is to provide support and

encouragement to the caregivers in their positive book-sharing skills, and to guide them

in consolidating the principles from the session. Where appropriate, the facilitators can

take over as the adult book-sharing partner and model particular behaviours. This is

especially important in the first session.


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Note: During the individual session, pick up on what that caregiver said in the group

session about making a special time and place for book-sharing with their baby and

explore the options with them.

STEP 8: SQUIDGIES CBM: “There is something else I want to show you. See these hard seeds (show green

packet)? I can make them grow. But they will only grow when the get what their little

bodies need, otherwise they will stay as they are, little and underdeveloped. But these

seeds are like are our children, they take time to grow like trees.” Do the same step as

you did the magic beans: “our children need…one drop = good food, one drop=water

etc. We will leave this bowl until the next session so they have time to grow and will look

again to see what has happened.”

During the next few weeks, we will look together as a group at what we can do to help

children develop and grow as best they can. There will be many things that you as

parents do already, and we will help each other to think of other ways that help children

to get a head- start in life and help prepare them for primary school.

STEP 9: GROUP CLOSING CBM: “Over the next several weeks we will meet once a week and talk about all the

great things you are already doing, and what other ideas or suggestions we have for

what else you could do to help your children have the brightest futures possible! We will

talk about issues of health. We will talk about the power of books. Do you all want this

help? Will this be helpful for you? Are you willing to do your part, outside of the group

meetings, to help your child grow and learn?”

As parents we play a vital role in the lives of our children, we can make a big difference

in their futures. “As parents we have power. Education is light!” Form a circle, all

caregivers put their hands in the middle and say, “As parents we have power. Education

is light!” three times, soft to loud. Ending with a loud Sesotho cry.

Caregivers leave with their ‘Take Home Card of the Week’ and the book of the week.

NB: Remind the caregiver to bring the child’s health book to Session 2 for the weighing

and measuring activity.


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Session 2: Growth and Nutrition

Overview: In this session, the CBM discusses why it is important for children to grow and

how to help children stay healthy. The facilitator and mentor, together with the caregivers

then weigh and measure all the children as a group activity and the CBM records the

date of birth, age, sex and child’s weight, height, MUAC). The results from this activity will

be discussed after the book-sharing session. All caregivers will have a one-on-one session

with the CBM about their child’s growth regardless of the results.

SUMMARY OF SESSION TWO:

Step 1


Step 2

“Squidgies” activity: Revisit

Step 3


Step 4


Step 5

Group discussion about Growth and Nutrition

Step 6

Discuss the importance of growth monitoring

Step 7

Take weight, height and mid-upper arm circumference of each child

Highlight that help is available – referrals possible

Step 8

Individual meetings to discuss growth of each child

Step 9

Close group: affirmation/compliment exercise (tokens - bears)

Caregivers leave with the book of the week and take home card


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STEP 1: OPENING SONG STEP 2: SQUIDGIES ACTIVITY: REVISIT (5 MINUTES) “Who can remember some of the things we spoke about last week when we did this

picture of the plant and we did the magic beans?” Summarise main points:

• We and our children are unique and special.

• Our children need certain things to grow well.

• The right food, shelter, love, education e.g. books etc.

“Let’s look at our seeds that got all they needed to grow. They took much longer than

the beans from last week because they are like trees and like our children. Oh my gosh,

look how they have grown and changed. Pass the bowl around. Everyone can touch

and feel. These little seeds are just like our little children. But if we didn’t look at them and

see they were smaller then we wouldn’t know. Looking and seeing, measuring and

weighing is VERY important because then we can know if things are going well or if we

need to get help”.

STEP 3: BOOK-SHARING SESSION 2 GROUP PRESENTATION • Remind the caregivers why book-sharing will be helpful to their babies.

• Ask the caregivers how they felt they got on over the previous week. Did some things

go well? Did some things go not so well?

• Ask the caregivers to give feedback on finding a special place and a special time for

book- sharing with their baby. Did it work? Why/why not?

Each of the group members should be given an opportunity to give feedback.

Start the presentation, accompanied by the visual cards/slides and video materials. End

with the book of the week. Get the members of the group to make suggestions of what

might catch their baby’s interest and what they might talk about.

STEP 4: INDIVIDUAL BOOK-SHARING SESSIONS Each caregiver gets a chance to practice the skills they have learnt during the group

presentation, while the IF provides praise and feedback.


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STEP 5: GROUP DISCUSSION ABOUT GROWTH AND NUTRITION Use the visual aids on your tablet device (Nutrition Slides for Session 2) to deliver the key messages (below)

KEY MESSAGES VISUAL AIDS

• When we measure the weight and height of a child, we can learn many things about how they are growing.

• A child who is underweight might not be getting enough nutrients and vitamins so his or her body does not grow properly.

• This might be because the child is not eating enough or eating the wrong food, which is not nutritious enough,

• OR the child has an illness which prevents the body from using the nutrients they are eating.

Many things can influence child growth and development. QUESTIONS:

• What do we see in this picture? • How do you think food affects a child’s growth? • How do you think access to health services can affect a

child’s growth? • What about when and how you feed your child? • Does water, hygiene and sanitation affect a child’s growth

and health?


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• One important thing that can influence how a child grows is food. Food is important for all of us, and children are no exception

• Making sure that a child gets enough of the right types of food – healthy food that contains good nutrients and vitamins – will help a child to grow and develop properly.

• Today we will talk about nutrition and what foods available in your community are good to help children grow and develop

• Children need to eat different foods like adults do, but in

smaller amounts

• At each meal, feed your child a staple food along with

different nutritious foods

• Questions about the picture:

o What types of meals do we give our children?

o Can we see some of the food types on these pictures that

we give our children?

• When you give your child a varied diet, it helps your child

to get all the vitamins and minerals a child needs to stay

healthy and grow.

• Vitamin A and Iron are two important vitamins and minerals

for children


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• Staple foods give your children energy to play, learn and grow.

They make one feel full and less hungry.

• Big energy givers: fats and oils – vegetable oil, margarine, lard,

pumpkin seeds

• Smaller energy givers: starches like sorghum, wheat, maize,

rice, potatoes, bananas and fermented porridge

• Remember: Staple foods do not contain enough nutrients by

themselves. You also need to give body- building foods and

protective foods

Question: what energy-giving foods do you give to your children?

• Body-building foods contains many nutrients which build

our bones, muscles, teeth and blood. This is especially

important to help children grow.

• Body-building foods: liver, red meats, pork, fish, chicken, milk,

peanuts, eggs, cheese, beans, peas and lentils

Question: what body-building foods do you give to your children?


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• Protective foods help to fight against infections like colds,

diarrhea, and tuberculosis. They help to keep your child from

getting sick.

• These include variety of vegetables and fruits like

spinach, cabbage, pumpkin, beetroot, apricots,

oranges, peaches and tomato

• It is important not to overcook vegetables, because this

takes a lot of its protective function away

• Question: what protective foods do you give to your

children?


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STEP 6: IMPORTANCE OF GROWTH MONITORING

“Weighing children frequently is important: The only way we will really know if your child

is healthy is if we check their weight and height. It is only when we know this that we can

know if things are going well or if we maybe need some help from a nurse or an

organization. We are lucky that no matter what the problem, there are people to help

right here in Lesotho. Don’t worry if you don’t know who those people are, we will help

link you with the right people if you need them”.

It is important to weigh children often to make sure they grow properly. It makes it possible

to discover early if they do not pick up enough weight or if they lose weight. If a child is

born with a low birth weight it is especially important to monitor their weight frequently.

We will weigh children today and again at the end of the 8 weeks. We will meet with you

all individually after book-sharing today to talk about your child’s weight and height.

STEP 7: WEIGHING AND MEASURING THE CHILDREN (30 MINUTES)

• Weighing and measuring children together as a group.

• Record weight, height and MUAC and calculate result with the tablet

Thank the caregivers for their cooperation and explain that they will each have a chance

after book-sharing to discuss the results with the CBM.

The Growth App will calculate 3 different results (weight-for-height, height-for-age and

MUAC), all of which are shown on a results screen. The results will identify children as

“healthy” or as “needing special care”.

STEP 8: INDIVIDUAL MEETINGS WITH EACH CAREGIVER (20 MINUTES)

Use the results to talk to the caregiver about the child’s growth Results screen

The results screen will display all three results for the CBM. These are “Healthy Child” and

“Child needs Special Care”. “Child needs Special Care” are divided into three

categories (see table below) that warrant different referral/treatment procedures.

However, the counselling


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for these conditions overlap. The different colours therefore indicate the different levels

of malnourishment to the CBM.

• Do not use the words wasting or stunting or malnourished

• Have the referral forms ready

Result What to say What to do

Normal (no stunting/

wasting/malnutrition)

• Your child is growing well • Normal growth is a sign of

health

No referral needed

At risk (mild wasting/malnutrition) • We have some concerns

about your child’s growth

• We would like to refer

you to the clinic as I am

not a health specialist.

But we will refer you to

the clinic where the

experts are

• Would it be okay with you

if I make this referral?

Refer

Moderate (moderate stunting/

wasting/ malnutrition) Refer

Severe (moderate stunting/

wasting/ malnutrition)

Refer

STEP 9: CLOSING THE GROUP (15 MINUTES)

“Sometimes things don’t go as we would like. Life can be hard. We don’t have enough

food, or the right food, or our children get sick or we get sick. None of this is our fault!

Sometimes things just go wrong. BUT, there is always help if we have a problem. It is only

when we know there is a problem that we can know to seek help. By weighing and

measuring our children we know if we are on the right track or if we need some help. We

are here to help so the first step is to do what we have done today, weigh and measure

your children.


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Session ends with CBM talking about importance of encouraging and praising each

other. “It makes us feel good about ourselves and motivates us to keep trying. We, as

parents, need to support and encourage each other and we need to support and

encourage our children”. Hand out the tokens, explain that each token is a

compliment to be given to one person in the group. She begins by complimenting the IF

and handing her the token. She then asks each person to one by one to compliment the

person on their right and hand over the token at the same time. The whole group listens

to the compliments. The CBM asks the group how it felt to be complimented. She then

compliments the group as a whole by saying how well they are all doing and how proud

she is of them and looks forward to seeing them all next week. She also tells them that if

they are worried about anything discussed today they are welcome to chat at any time

to the CBM.


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Session 3: Feeding; Hygiene & Sanitation

Overview: Session 3 continues with nutrition and health. The CBM discusses feeding

recommendations for children of different ages, strategies for feeding children when sick

and general hygiene and sanitation tips. The session further focuses on the message of

group support by demonstrating the value of relationships in the group and encouraging

members to appreciate and lean on one another.

SUMMARY OF SESSION THREE:

Step 1


Step 2

Share a positive

Step 3


Step 4


Step 5

Group session about nutrition and health

Step 6

Water carrying activity with message of supporting each other

Step 7

Closing group – tokens of appreciation


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STEP 1: OPENING SONG: BANA BA BE TJE (KIDS SHOULD BE LIKE THIS)

Bana ba be tje Kids should be like this

Bana ba be tje;

Babe mafehle-fehle

Ba fetjoe ka lebese

Ba phele ha monate

Kelello li be chatsi

Kids should be like this (show a happy gesture)

They should be healthy

Should be fed milk

Should live happily

Should have bright brains

STEP 2: SHARE A POSITIVE (IF & CBM) (15 MINUTES)

Session begins with CBM welcoming everyone and asking them each to tell the group

ONE success since the last session in relation to book-sharing or health. She begins by

telling the group something that she has managed to accomplish since last seeing the

group. The group must then clap for her. The process continues until everyone has had

a turn.

STEP 3: BOOK-SHARING SESSION 3 GROUP PRESENTATION

Begin the session with the presentation for Session 3, accompanied by the visual

cards/slides and video materials.

STEP 4: INDIVIDUAL BOOK-SHARING SESSIONS

Each caregiver gets a chance to practice the skills they have learnt during the group


STEP 5: GROUP SESSION ABOUT NUTRITION AND HEALTH

• Link back to last week’s session: Weight and height can tell us lots of things, it gives

us information.

• It is only when we know this that we can know if things are going well or if we maybe

need some help from a nurse or an organization.

• There are also things that we can do at home that can help our children grow and

stay healthy:


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KEY MESSAGES VISUAL AIDS

Feeding children of different ages:

• How we feed a 1 year old child is not the same as

how we feed a child who is 4/5 years old

• Question: Have you noticed your child’s

appetite and feeding needs change as they

get older? How has it changed?

Feeding 1-2 year olds:

• Breastfeed as often as your child wants up to

age 2 or beyond

• Continue to give 3–4 meals of nutritious foods,

chopped or mashed if necessary, ¾–1 cup at

each meal

• If you are mix feeding, give breastmilk first before

feeding other complementary foods


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• Give 1–2 snacks per day between meals

depending on your child’s appetite (snacks

like banana).

• Question: what other snacks can we think of?

• Feed your child from her own plate or bowl.

Continue to actively help your child to eat


• Young children of this age need to start

eating a similar diet to adults, but in smaller

quantities

• Do not force your child to eat

• Increase the quantity of food as your child

grows older


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• Children should eat 3 small meals a day and 2 small

snacks in-between the meals (such as half a

banana or an apple)

• Give your child breakfast before preschool or

before leaving for a day journey

Improved Porridge

• Porridge is a good meal for children.

• A good idea is to add other nutritious foods to

porridge to improve the nutritional value of the

porridge

• Here are some ideas for how to add other foods

to your child’s porridge


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Recipe for Improved Porridge: Recipe 1:

Ingredients:

4 cups maize/sorghum

flour 2 cups wheat flour

¾ cup cooking oil 1teaspoon peanut

butter 1 cup

powdered milk

Method: Roast maize/sorghum flour and wheat flour until golden brown – let it cool. Add cooking oil and peanut butter and rub in. Add powdered milk and keep the mixture into a clean container with a tight lid.

Recipe 2: Ingredients:

½ cup maize flour

2 tablespoons of cooked beans

1 tablespoon of chopped spinach/cabbage

½ tablespoon of vegetable oil

Method: Mix maize to make a thick porridge, add cooked beans, spinach/cabbage, vegetable oil and cook for 2 minutes.


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When a child is sick:

• Children who are sick need more food than usual to help

their bodies fight the illness and get better.

• Feed your child continuously and as much as is possible

• Give more fluids (breastfeed more for a breastfed child)

and encourage her to eat soft, varied, appetizing,

favourite foods

• After illness, give food more often than usual and encourage

the child to eat more

• One serious illness can set a child back developmentally, so

it is important to seek care early and adhere to every care

recommendation

• When a child has diarrhea, you can make a home-

made re- hydration fluid to give to your child for 2 days

Home-made re-hydration fluid:

Use 1 level teaspoon of salt, 6 teaspoons of sugar and 1 liter (4

cups) boiling water


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Hygiene and Safe Food Preparation

The following tips can protect you and your child from illness, and can help your child to grow

Wash your hands with soap and water:

• before preparing food

• before eating

• before feeding your child

• after using the latrine or toilet

• Your child should have his or her own cup and bowl

• When cleaning your child’s utensils, just rinse and leave in the

sun to dry – do not use a dirty/wet cloth to dry it

• Ash can be used when you do not have soap to clean

hands/cooking surfaces – just remember to make a separate

heap of ash for this: do not use the same ash that was used to

cover human waste


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• Wash your child’s hands and face with soap and water

before he/she eats

• Obtain clean water for drinking, boil it properly and use a

clean scoop to draw it

• Prepare food in a clean area and keep it covered

• Thoroughly reheat any food that has been kept for more than

an hour

• Don’t keep leftovers


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STEP 6: SUPPORTING EACH OTHER (WATER CARRYING ACTIVITY)

Fill a bucket with water – each person gets a chance to put the bucket of water on their

head. While each person gets a chance to do this, ask them how it feels carrying it on

your own: is it heavy? Now have two people carry the bucket together. Ask them how it

feels to share that heavy bucket with someone else: Does it feel lighter when you share

the bucket?

The lesson: life is often hard and we must remember that our neighbours might be

struggling and need our help, we must help even if only through listening and

encouraging them. Sometimes we need help and we need to be able to reach out and

ask for help. We all need help at some point in our lives. Being a mother/grandmother is

at times very hard, we get tired, we worry, and sometimes we even cry as things feel

overwhelming. But the strongest and bravest people know when to ask for and accept

help.

STEP 7: CLOSING GROUP (TOKENS OF APPRECIATION)

This week we are giving you the tokens to take home. We want you to hand them out to

someone in this group (each person must take a name of one person in the group to

make sure each person is given a token), either to compliment, praise, encourage, listen

or help them in some way outside of this group. Come back next week and tell us what

someone did for you. We will give everyone 2 tokens. You can only give a person one,

one must be the name you have, and you must have none left when you return next

week. We need ALL the tokens to be returned so remind the caregivers to keep them in

a safe place.


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Session 4: HIV (Introduction)

Overview: The topic of HIV is introduced during this session. The CBM uses a video (the IFs

and CBMs are the actors) to illustrate how the community and individuals are affected

by HIV:

A woman carriers a red back pack (symbolising HIV) on her back. The back pack is heavy

and it is weighing her down. She then goes to the clinic and the sister unpacks the bag

with her. The bag is filled with stones and the stones represent different things related to

HIV. E.g. one stone being her status has worried her, second stone is that she might be

symptomatic but there is medication she can take to help her feel better etc. This leads

to a discussion about the importance of testing and the benefit of ART.

SUMMARY OF SESSION FOUR:

Step 1


Step 2

Reflect on compliments or help from group members

Step 3

BOOK-SHARING (Group presentation)

Step 4


Step 5

Trust building: wind in the trees

Step 6

Health Discussion and KEY HIV MESSAGES

Step 7

Passing the ball

Step 8

HIV Video (Part 1)

Step 9

Close group: spiders web


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STEP 1: OPEN WITH SONG STEP 2: FEEBACK FROM TOKEN EXERCISE (10 MINUTES) Ask the group to tell us one nice thing that was said or done for them by a group member

during the week. Take in all tokens. Reflect that it felt good for everyone. Our group needs

to support each other as much outside of the sessions as in the sessions. Please try to

continue connecting and supporting each other this way each week, even after this

intervention has finished.

STEP 3: BOOK-SHARING SESSION 4 GROUP PRESENTATION Begin the session with the presentation for Session 4, accompanied by the visual slides

and video materials.

End with the book of the week. Get the members of the group to make suggestions of

what might catch their baby’s interest and what they might talk about.

STEP 4: INDIVIDUAL BOOK-SHARING SESSIONS

In a private space, each caregiver gets a turn to share the book of the week with his/her

child, in the presence of the IF.

STEP 5: TRUST BUILDING: WIND IN THE TREES (15 MINUTES) Each mother has a chance to stand in the middle of the group, they must have a scarf

covering their eyes, cross their arms and lean back. The rest of the group is in a close

circle with one foot in front of the other, arms out, ready to catch and gently push the

mother forward where another team member catches her. This exercise is unpacked

afterwards. How did it feel to lean back? How did it feel to support mother? Stand while

discussing that we need to trust and help each other in this group.

Remind the group to be open as much as they can. The more we put into discussions the

more we will get out. Remind everyone of the plant, our group, make up of such special

people. But in the beginning we said this group needed protection that was around

confidentiality, respect and tolerance. Get everyone’s agreement on this again before

continuing with session.


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STEP 6: INTRODUCING HIV (DISCUSSION):

How does what happen with you as a caregiver/parent affect what happens with your

child? What health issues do caretakers/parents struggle with in this community? (discuss

illnesses) As caretakers/parents, what are you concerned about for your own health?

One of the things that can affect a parent or family is HIV:

PREVENTION OF HIV:

• What do we know about how HIV works?

• What are different ways that people can get HIV?

• What are different ways that people can prevent HIV?

• What do we think people should do when they find out they are HIV+?

STEP 7: HIV IN OUR COMMUNITIES: PASSING THE BALL EXERCISE All the caregivers stand in a row with their hands behind their back, while one caregiver

stands facing them. The caregivers pass the ball behind their backs while the caregiver

in front tries to guess who has the ball. This exercise portrays the message that we cannot

know by looking at people who has HIV:

• HIV affects the whole community

• People do not get HIV because of what they did wrong

• HIV will affect many people: look to your left, and look to your right. One of you

will have HIV. It doesn’t matter who it is.

• Just as HIV affects us as adults, so HIV affects children as well.

STEP 8: HIV VIDEO AND DISCUSSION PART 1 (45 MINUTES) Show the first half of the video on tablet.

The first half of the video is then used as discussion points to these questions:

• Why do you think the mother was being weighed down by worrying about having

an HIV test?

• How do you think she felt when her status was confirmed but the nurse told her

that she could still live a long and happy life if she took her ART’s?

• Do you think she will take the medication? What could make her not take it?


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• If she didn’t take it and she got sick, for example, bad chest infection. How would

that affect her child?

• What other health issues do caretakers/parents struggle with in this community?

(discuss illnesses)

• As caretakers/parents, what are you concerned about for your own health?

KEY MESSAGES (MAKE SURE YOU HAVE COVERED THEM):

• We might not all be infected, but we are all affected by HIV.

• People with HIV can stay well and live for many years if their HIV infection is

diagnosed early and they receive good care, treatment and support = KNOWING

YOUR STATUS IS IMPORTANT

• Your status is confidential. It is between you, the nurse and the counsellor.

• Families need to know that antiretroviral therapy can prevent HIV-related death

and illness in young children.

• Testing is important for everyone: adults and children.

STEP 9: CLOSING GROUP (15 MINUTES)

• Group ends with the spiders web exercise. This web represents the strength in our

group. Together we are strong. Each of us plays our part in supporting each other. If one

of us let’s go, the group suffers. Together we are strong. We have built a strong group

over the last four sessions. Repeat group chant and Sesotho cry while letting go of wool:

“AS PARENTS WE ARE POWERFUL. EDUCATION IS LIGHT” As it settles on the floor we say

that our influence on our children and communities is great, we must use of influence

well and leave this world a better and stronger place.

• Tell the group that if they have any worries, questions or feelings after the session

today they must feel free to stay behind after the group to discuss with the CBM.

Remember a strong person knows when to ask for help. Our job is to be here for you and

help where we can, when we can’t we can refer them to people who can.


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Session 5: HIV (Treatment)

Overview: During the book-sharing session, the intervention facilitator shows how to use

stories to make links between what happens in the book and things in the child’s life, and

shows caregivers of older children how to talk about different perspectives. In this session,

the CBM continues with the discussion about HIV in adults and children; the importance

of testing for HIV and the benefits of getting on treatment early. The CBM facilitates a

demonstration of ART through a drawing and song.

SUMMARY OF SESSION FIVE: Step 1

Open group: Song

Step 2


Step 3


Step 4

HIV and our children

Step 5

HIV Video (Part 2)

Group discussion about benefits of treatment and barriers to taking medication

Step 6

HIV Treatment Demonstration

Step 7

Close group: Group activity to lift spirits (song about the eagle and the chicks)

Caregivers leave with the book of the week


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STEP 1: OPEN WITH SONG OF GROUP’S CHOICE







STEP 4: HIV AND OUR CHILDREN DISCUSSION (45 MINUTES) Ask the group these questions; make sure you have brought across the following health

messages by the end of the discussion:

1. How does HIV affect young children’s development?

The impact of HIV on families can have a negative effect on children’s brain and body

growth, feelings and relationships with friends and family especially if help isn’t accessed.

2. How does HIV affect children’s health?

• Children with HIV may get the same common illnesses as uninfected children, but

these illnesses are often worse and happen more often, and may not get better as

easy as other children with medicine.

• HIV infection is very aggressive in children, and makes them sick more quickly than

adults.

• Pneumonia, frequent/unexplained diarrhoea and unexplained/untreatable wasting

are particularly serious problems in children with HIV.

• Without treatment, young children with HIV may get very sick or even die.

• What we learn from all these points above is that it is VERY IMPORTANT for children to

start HIV care and treatment early even before they have any signs or symptoms.


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3. What can be done to help children with HIV?

Children with HIV can stay well and live for many years if their HIV infection is diagnosed

early and they receive good care, treatment and support.

It is important to identify young children with HIV so that they can be given appropriate

care and benefit from life-saving antiretroviral treatment

STEP 5: HIV VIDEO AND DISCUSSION – PART 2 (30 minutes) • Show the second half of the video on the tablet.

• The second half of the video is then used as an introduction to discuss GENERAL

BARRIERS TO TAKING MEDICATION

• What barriers are there that prevent people from going on treatment/ARVs?

• What do you think would prevent people from staying on their medication? Key

Messages:

• Testing is important for adults and children.

• The sooner someone gets tested, the sooner they can get the medicine they

need, which will keep them healthy

• Treatment with antiretroviral drugs prevents illness and death and enables them

to lead healthy and happy lives = THERE IS HOPE

• It is important to identify young children with HIV so that they can be given

appropriate care and benefit from life-saving antiretroviral treatment.

• When adults and children take their medication every day, they will get better.

Let’s talk about how the medication helps people with HIV to get better:

STEP 6: HIV TREATMENT EXERCISE (15 MINUTES) Do you all know the story of the eagle who swoops down to catch the baby chicks? HIV

is like the eagle, and the baby chicks are your white blood cells (or soldiers that protect

you from illness). Baby chicks have a mother hen. The mother hen protects the baby

chicks from the eagle. If the mother hen is there, the eagle cannot swoop down and

take the baby chicks away. But if the mother hen is not there, the baby chicks are not

protected – they are in danger.


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QUESTION TO THE GROUP? What do you think the Mother Hen represents in this story if the

eagle is HIV and the baby chicks are the white blood cells?

ANSWER: the mother hen represents the HIV treatment medication = ARVs. In the same

way that the mother fights off the eagle, so does ARVs fight of the HIV from taking over

the white blood cells.

Draw picture using paper and colour pens to explain to the group the importance of

staying on treatment when someone is HIV+. You can also link this to what happened in

the video.

When adults or children with HIV take medication every day, they will feel well. We will

draw how this works. (Draw circles on the paper). These circles are the white blood cells

(soldiers) that protect us from illness. When we take medicine, the medicine protects the

white blood cells (draw small circles around each of the big circles). The HIV virus wants

to attack these cells and make them weak, that makes us weak. (Draw small circles

around an unprotected blood cell. The medication protects the white blood cells so that

HIV cannot enter. When you forget to take your medicine, the white blood cells are

unprotected, and the HIV takes control. (Draw more HIV circles around the white blood

cells). In the video, when Me Matabo stopped taking her medication, she gave HIV

control. Now HIV forms a layer around the white blood cells. And then the HIV destroys

the white blood cells. After the health worker advised

her to go back on the medication, the medication could then again protect the cells

tightly so that HIV cannot take control of the soldiers that are still healthy. Because she

was taking her medication, the healthy white blood cells could multiply because she was

eating healthy

Ask for questions or comments.

STEP 7: CLOSING GROUP (5 MINUTES): Sing and act out the song of the eagle, mother hen and baby chicks as a group.


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Session 6: HIV (Barriers and Fears)

SUMMARY OF SESSION SIX: Step 1

Open group: Song

Step 2

Acting out Feelings Exercise

Step 3


Step 4


Step 5

Taking children for testing

Hypothetical case (group discussion) – Mpho’s Day Out

Step 6

Explore barriers to testing

Step 7

Role-play – Rude Nurse

Step 8

Group closing session

STEP 1: OPEN GROUP WITH A SONG OR THE TEAM-BUILDING CHANT

STEP 2: ACTING OUT FEELINGS (30 MINUTES) Everyone stands in a circle. Two people stand in the middle and must act out a feeling.

Let’s give them some examples, happy, sad and angry. They can add others if they want.

Two people stand in the middle and one must act out of feeling towards the other person

e.g. anger. The group must guess. The CBM does it first with the IF.


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The exercise is unpacked by saying that we as people have many feelings. We feel those

feelings in our hearts but we often show those feelings in our body language

and the way we act. Give examples from group e.g she had a cross face but did you

also notice she folded her arms or wagged her finger in my face. We need to support

each other when we have sad or angry feelings, we need to know each other to know

what the signs are etc. We also need to be able to recognize our own feelings, to know

ourselves well.

Last week we spoke about HIV that would have made you have many feelings, maybe

you felt scared, relieved, sad, and angry. Can anyone tell us how they felt after last

week’s session? Take some examples and thank people for being open. Then say that

this week we are going to continue to talk about HIV but now we are going to talk about

how it can affect our children. As we go along please feel free to talk about how it makes

you feel. There are no right or wrong feelings but feelings need to be spoken about in

order for us to feel lighter or better.







STEP 5: TAKING CHILDREN FOR TESTING Tell the story of Mpho: a story of a little girl who needs to go to the clinic for a check-

up/test.


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The story describes the process of getting ready, travelling to the clinic, the animals and

familiar faces they see and greet along the way. When they get to the clinic, the queue

is long, and Mpho starts to feel scared. What if the nurse is rude to her? What if she hurts

her? Luckily her mother is there to hold her hand and sit next to her while they talk to the

nurse. The nurse explains to Mpho that the test will be over very quickly. Afterwards

Mpho’s mother gives her a big hug and tells her how brave she was. After the visit to the

clinic, they make their way home and she tells her father/other family member about her

day when she gets home. This story will be written and illustrated to suit the local context.

The story can say that the caregiver herself, and maybe also the sibling also needed to

be at the clinic for something, to emphasize a family approach and encourage “testing”

as a more general concept for the whole family.

They discuss the story as a group and explore what factors would prevent families from

accessing health care. The CBM explores with the group the various barriers to testing for

both themselves and their children.

Discussion about “Mpho’s day out”:

What did you like about the story? What didn’t you like? Could you see any similarities

between your life and the family in the book? What was different?

Explore how the group would feel about testing for HIV; testing themselves and their

children for HIV

What barriers are there that prevent people with HIV from going for an HIV test?

What are things that make it difficult to attend the clinic or take your child for a test?

In a group context, explore fears around testing and possible disclosure: Use hypothetical

example (i.e. what would someone who goes for an HIV test or take their child for a HIV

test worry about? What would the reactions be of the people around her?)

STEP 6: EXPLORE BARRIERS TO TESTING AND HOW TO GET SUPPORT Barriers to testing:

- Fear of taking the test

- Fear of the results


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- Nurses treating people badly

- Disclosure

• Discuss each barrier (and any other that the group might bring up) and look at what

the group comes up with as possible solutions/suggestions.

• Look at past experiences – has the group encountered any of these fears themselves?

• Emphasise the importance of support in these situations (taking a friend, talking about

these fears, asking for the group here for support)

• Know their rights and the services available to them

Disclosure:

How to disclose to children/family:

- which age

- why do we disclose

- to who should we disclose

- how should we disclose

Remember: Disclosure is a process. Very young children can be told using simple words

that they have a chronic illness without mentioning HIV. As they grow older and can

understand and cope with the consequences of knowing their HIV status, children can

be given more information. Emphasize to parents that they do not have to disclose right

away, and that there are many ways of doing this.

STEP 7: ROLE PLAY – RUDE NURSE IF and CBM act out a situation where a nurse at the clinic is rude and judgmental towards

a caregiver who is there to test for HIV or who has not been taking ARVs. The role play

needs to show a positive model of how a patient can deal with such a difficult situation

and show how the patient is able to stand up for herself. Then discuss the role play as a

group.

STEP 8: CLOSING GROUP Team-building exercise (each IF/CBM needs to decide which will work best for their

group)


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Session 7: Summary

Overview: In Session 7, the key principles and messages from the past 6 sessions are

revisited and discussed with the group. This session summarises ALL the previous SIX

sessions. Below is an outline of what content has been covered over the group process.

The facilitator and mentor must meet before this session to talk about the journey of THIS

particular group so that can specific examples can be included.

Opening song

BOOK-SHARING summary session

Health and nutrition session summaries

Group closing: Spiders web exercise

STEP 1: OPEN WITH SONG OF GROUP’S CHOICE Have the group decide on a song that they would like to sing to open the session.


and video materials. Go through the book-sharing summaries, showing lots of video

material. The video material used in this session should be a collection of clips of the

participants themselves enacting optimal book-sharing behaviours – i.e. recordings of

the individual sessions of the previous 6 sessions. This serves as a valuable tool to illustrate

their progress over the course of the program.




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STEP 4: REVIEW THE HEALTH/NUTRITION CONTENT OF EACH SESSION GIVING

EXAMPLES FROM THIS PARTICULAR GROUP We have travelled a long and enjoyable journey together as a group over the past

several weeks. We are sad to be saying goodbye but happy that we hope you have

found these sessions useful for you, your child and your life. Let us look back at what we

can remember. Please add in your memories as we talk about how we remember our

journey together.

• Session 1:

We came together as individuals but left as a group. Do you remember we had our plant

that needed certain things to grow just like our children? What did we say our children

needed to grow and develop? (Brief discussion on nutrition and growth) We also

introduced you to the idea of book-sharing. Can you remember how you felt in the first

session when we spoke about these ideas?

• Session 2:

In session 2 we spoke a lot about nutrition and we measured and weighed all these lovely

children. We also spoke about lots of good nutrition, what we and our children can eat

to stay healthy and grow. Can you remember what kinds of food we said?

• Session 3:

As a group we discussed the right food for the ages of our children. Who can remember

what kinds of food a child between the ages 1-2 years and 2-5 years? We also discussed

hygiene, what did we talk about? We also spoke about ways of making our porridge and

pap more nutritious. Can you remember we said about hygiene and sanitation? Have

you been able to apply any of these lessons in your own life?

• Session 4:

Session 4 we watched the video of a women who was feeling sick but was scared to go

for an HIV test. What can you remember about what we discussed about HIV and

testing?


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• Session 5:

We discussed how HIV can affect children and we spoke about the barriers to staying on

medication. Can you remember our drawing and example from our villages of what

happens when a person stops taking their medication? Let us sing our Eagle song again.

• Session 6:

In our last session we spoke about our feelings and our need to support each other.

Remember the bucket exercise? The load felt heavy when we carried the bucket by

ourselves but when we carried it with our neighbour the load was shared and it felt lighter.

We have spoken over many weeks about how we all need each other, we need to feel

appreciated and thanked, we need to help others and we need to ask for help and

accept it when we need it. What else do you remember about this session?

What else has stood out for you over our past six sessions? Discuss examples with group.

STEP 5: CLOSE GROUP – SPIDER WEB EXERCISE

Do the spider web exercise again: Either this process can end here or you can decide to

continue the journey with each other, your friends and neighbours. You have learnt many

things, many things that can have a long term impact on the future of your children. Do

you think you will continue doing some of the things you have learnt?


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Session 8: Review and Graduation

• Before we end let us each take a turn to thank each person here today for

something we have appreciated about them over the past several weeks.

• Show more book-sharing videos to emphasise how far each caregiver and child

has progressed and congratulate them on their success by pointing out their major

areas of improvement in book-sharing

• What songs did you enjoy the most? Finish off the group singing some songs that

the group enjoyed.

• Hand over the books to each caregiver and child

• Conduct feedback interview with the group

Documents

Mphatlalatsane (Early Morning Star) Health and Nutrition ... · Mphatlalatsane (Early Morning Star) Health and Nutrition Programme Manual 5 Session 1: We are all special and unique