Advising Mothers on Management of Diarrhoea in the Home - A Guide for Health Workers (WHO, 1993, 18 p.): Summing-up exercise

Advising Mothers on Management of Diarrhoea in the Home - A Guide for Health Workers (WHO, 1993, 18 p.)

		(introduction...)
		Introduction
		Basic skills
		Information summary sheet (blank)
		Practising the steps
		Review of information using the Mother's Card
		Review of the steps
		Summing-up exercise
		(Optional): Refer the mother to a small group session if necessary
		Leading a demonstration

Summing-up exercise

Sample conversation

Let us look at an example of a conversation that may happen between a health worker and a mother. In this example, the health worker has already examined the child, named Sami, and has found that he has mild diarrhoea and is not dehydrated. Sami is 9 months old, and is still breastfeeding.

Please read the conversation and answer the questions at the end.

Health worker	Has Sami been drinking anything?

Mother	Yes.

Health worker	What has he had to drink?

Mother	Some water, rice water, and a little guava-leaf tea.

Health worker	In general, has he been drinking more than usual, less than usual, or about the same amount?

Mother	About the same amount.

Health worker	It is very good that you give him water and rice water. With the diarrhoea, what do you notice about Sami's stools? They are very watery, no? This means he is losing water, and drinking will help replace this so he will not dry up and get weak. You should continue to encourage him to drink, maybe even a bit more than usual.

	Now, has he been eating, or breastfeeding?

Mother	He hasn't eaten anything, only breastmilk.

Health worker	What seems to be the problem?

Mother	He isn't hungry.

Health worker	Yes, this often seems so. It is good that you are still breastfeeding him, and you should keep on doing that. But it is important that Sami eats, to stay strong. What could you give him, in addition to the breast?

Mother	Rice.

Health worker	Rice is very good. Maybe you could try mixing the rice with some mashed vegetable, and a little oil. If you make the food very soft, it will be easier for Sami to take. Try to get him to eat a little bit at a time, several times a day. Be patient in encouraging him to eat; he will need the food to stay strong.

	Has he taken any medicine, or other treatments?

Mother	No.

Health worker	That is fine. Sami will be well in a few days if you give him plenty to drink, and help him to eat to stay strong.

	Here is how you will know if he needs medical care:

	If he cannot eat or drink, or
	If he is very thirsty;
	If he has many watery stools, or
	If he is vomiting a lot, or
	If he has a fever, or
	If there is blood in his stools

	If you notice any of these things, continue to give Sami food and drink if you can, and bring him back to see me.

	Let me give you this card to help you remember what to do:

(Health worker reviews the rules for home care by going over the pictures on the Mother's Card).

Health worker	Now, can you please tell me what to do for Sami at home?

Mother	I will help him to eat and drink.

Health worker	Anything else?

Mother	And breastfeed.

Health worker	How much should he drink?

Mother	He should drink more than usual.

Health worker	Right. How can you encourage him to eat?

Mother	I will make soft, mashed food, and try giving him little bits at a time.

Health worker	Good. And what would tell you if you needed to come back here?

Mother	I will watch to see if he has a fever or if there is blood in his stools.

Health worker	Good, but also watch to see if he is very thirsty, if he can't eat or drink, if he vomits frequently, or if he has a lot of watery diarrhoea.

	Since you live quite far from here, I'll give you two packets of this medicine to take home and give to Sami. It must be mixed carefully with 1 litre of water. Please stay for a few minutes to attend the group talk in the next room so you can remember exactly how to mix and give it.

Now answer these questions about the example above:

Did the health worker follow the process: "Ask-Praise-Advise-Check"?

Give an example of how he praised and encouraged the mother to continue something that she had been doing.

Give an example of an open question he asked to check the mother's understanding.
Why did he refer the mother to a group session?

In general, did the health worker advise the mother correctly? Why or why not?

Exercise: Role-play

In a pair with another participant, you will now have the opportunity to practise all the skills you have learned about Advising Mothers. One participant will play the role of a health worker, while the other plays the role of a mother. Use the example you have just read as a model to follow. Remember to follow the process: "Ask-Praise-Advise-Check". Use the pictorial Mother's Card.

Note about the role-play:

This is not a complete consultation. In this situation you, the health worker, have already greeted the mother, and you have examined and treated the child. The child is 7 months old and has no signs of dehydration. You must now advise the mother.

When the role-play is finished, switch roles with your partner and repeat the exercise.

When each person has had the chance to play both roles, answer the following questions in a discussion with your group:

What went well in your situation?
What was difficult to do?
What improvements could you make in your method of advising mothers?

Practice in a real situation

Now you will have the chance to try this in a real situation. The director of the training course has arranged for you to practise advising mothers, either at a nearby health facility, or with mothers who will come to the training site. After you practise, you will meet again in your group and discuss the questions listed above.