UNICEF - IMAM Trainers guide - 030210.indd

Transcription

Trainers Guide
Integrated Management
of Acute Malnutrition
March 2010
Preface
Malnutrition including micronutrient deficiencies remains an important threat in developing
countries. Every year, an estimated 2.2 million children below five years old die of malnutrition.
Of Importance is the high infant and under five mortality rates (currently at 52 and 74/1000
live births respectively in Kenya) of which half has malnutrition as the main underlying cause.
There has been no significant change in the nutritional status of children under five years
between 1998 and 2008 with the stunting levels stagnating at about 33 percent according
to Kenya Demographic Health Survey (KDHS) of 1998, 2003 and 2008. Although the levels
of acute malnutrition nationally is at six percent, many parts of Kenya, especially the Arid
and Semi Arid (ASAL) areas have consistently experienced alarming levels of Global Acute
Malnutrition above emergency threshold of 15 percent (prevalence as high as 25%). HIV
and AIDS continue to pose a new and significant challenge in addressing acute malnutrition
as the two are intrinsically related.
In the past, the Ministries of Health have rehabilitated severely malnourished patients within
inpatient services, mainly through District and Provincial Hospitals. The practice posed a
great challenge in ensuring successful treatment as malnourished patients were increasingly
at risk of cross infection hence increased mortalities. Experience from the arid districts and
other countries have shown that the above approach also led to low program coverage and
high defaulter rates.
Globally, emerging evidence has shown that mortality rates could be reduced when only
severe acute malnourished patients presenting with medical complications are admitted as
inpatients, while those with no complications are admitted as outpatients and followed-up at
community level. This coupled with active case finding and referral at community level could
significantly reduce complicated cases of acute malnutrition and increase coverage.
The Trainers Guide is intended to equip trainers with technical knowledge of key messages
and practices related to understand malnutrition, management of severe and moderate
acute malnutrition, emergency nutrition responses, community structure and strategy for
the management of acute malnutrition and related educational and counseling messages
necessary during training of health workers.
The Ministries of Medical Services and Public Health and Sanitation will provide the necessary
leadership and coordination to all partners in the field of nutrition in addressing the problem
of malnutrition in the country.
Dr. Francis Kimani
Director of Medical Services
Ministry of Medical Services
Dr. S.K. Sharif, OGW, MBChB, M.Med.
DLSHTM, MSc
Director of Public Health and Sanitation
Acknowledgements
The development of the trainers guide was carried out under the auspices of Ministry of
Medical Services and Ministry of Public Health and Sanitation. In this regard, the support
extended by Dr F. Kimani, Director of Medical Services) and Dr S.K. Sharif (Director of Public
Health and Sanitation) and is greatly acknowledged.
Special appreciation and thanks go to the core team, which provided significant support
and contribution in the review of materials, protocols and layouts, comprising of staff from:
Ministry of Medical Services: Rosemary Ngaruro (Chief Nutritionist, and Head, Division of
Clinical Nutrition), Francis Wambua and Tom Hongo (Program Officers, Division of Clinical
Nutrition);; Ministry of Public Health and Sanitation: Terry Wefwafwa (Head, Division of
Nutrition) and Mary Kimani (District Nutrition Officer, Nairobi East); Concern Worldwide:
Mueni Mutunga (Nutrition Manager); Action Contre la Faim: Habiba Bishar (Program Manager,
Capacity Development); Save the Children – UK: Assumpta Ndumi (Nutrition Manager);
UNICEF Kenya: Noreen Prendeville (Chief, Nutrition Section), Dolores Rio and Ruth Situma
(Nutrition Specialists).
UNICEF country office is acknowledged for its consistent support towards the compilation
and development of this guide. We acknowledge and appreciate the technical support from
Emily Teshome, UNICEF Nutrition consultant, for the development of the trainer’s guide.
Trainers Guide for Integrated Management of Acute Malnutrition
Glossary of words
• Acute malnutrition/ wasting - measure of “thinness” due to rapid recent weight loss
• Anthropometry is the use of body measurements to assess nutritional status in an individual.
Body measurements include: age, sex, weight, height, oedema (fluid retention) and mid upper
arm circumference (MUAC).
• Chronic malnutrition/ stunting - occurs over a long-term and is caused by insufficient intake of
some nutrients
• Community mobilization for Nutrition Services (CMNS) - term used to cover a range of activities
that, help nutrition program implementers (i.e. nutritionists, managers and health workers) build
a relationship with the community and foster people in the community to use the nutrition
services
• Community sensitization - a way to reach out to people in the community and teach the causes,
signs and symptoms of malnutrition, and how to seek treatment opportunities.
• Emergency - extraordinary, urgent and sudden situation that require immediate intervention to
avert stress, morbidity and death.
• Emergency nutrition interventions - programmes set-up to manage malnutrition as well as
provide food to a population that does not have access to food.
• Evaluation - A process that objectively determines relevance, effectiveness, efficiency and
impact of activities in light of specified objectives.
• Global acute malnutrition (GAM) - aggregate of moderate and severe i.e. SD <-2
• In-patients - patients admitted to in-patient facility for their entire treatment.
• Integrated Management of Acute Malnutrition ( IMAM) is an appropriate facility and community
approach for the treatment and rehabilitation of severe and moderate acute malnutrition
• Kwashiorkor - bloated appearance due to water accumulation (oedema)
• Malnutrition - a state in which the physical function of an individual is impaired to the point
where he/she can no longer maintain adequate bodily performance processes
• Marasmic-kwashiorkor - a combination of both marasmus and Kwashiorkor
• Marasmus - severe weight loss leaving ‘skin and bones’ caused by inadequate intake of food
or loss of nutritients due to illnesses or injury.
• Mean - Average
• Moderate Acute Malnutrition - description of malnutrition level encompassing persons falling
less than -2 and above -3 Z- scores.
• Monitoring - Periodic oversight of implementation of an activity which seeks to establish the
extent to which input deliveries, work schedules and targeted outputs are proceeding according
to plan
• Nutrition - study of food and its nutrients; its functions, actions, interactions and balance in
relation to health and disease
• Nutrition Education - process of imparting knowledge, designed to improve people’s attitude,
habits, behaviour, customs and beliefs that are related to food intake
• Nutrition Emergency - There is no universally acceptable term for the term but classify the
severity of an emergency using acute malnutrition or wasting in the population as an one
indicator of stress
• Nutritional index - compares a child’s body measurement with expected values. Nutritional
indices are calculated by comparing an individual’s measurements with that of a reference
population. The nutritional indices commonly calculated for young children are:
o Height for Age - a measure of stunting or chronic malnutrition;
o Mid upper arm circumference (MUAC) - also a measure of wasting or acute malnutrition
o Weight for Age - a measure of underweight or wasting and stunting combined.
o Weight for height - a measure of wasting or acute malnutrition;
• Nutritional/bilateral oedema - Swelling from excess fluid in tissues, it must appear on both feet.
• Oedema is the retention of water and sodium in the extra-cellular spaces.
• Out-patient Nutrition Care - treatment of malnutrition in the community set-up.
• Ready to Use Therapeutic Food (RUTF) - an energy dense, mineral vitamin enriched food
equivalent of F100 with added iron, specifically developed for the recovery of severe malnutrition
at home.
• Severe Acute Malnutrition - description of malnutrition level encompassing persons falling less
than -3 Z- scores.
• Standard deviation (SD) or Z-score - The deviation of the anthropometric value (weight, height
etc.) for an individual person from the median value of the reference population
• Supplementary Feeding Program ( SFP) - A feeding program designed to rehabilitate persons
affected by moderate acute malnutrition or at risk of becoming malnourished by providing a
supplementary food ration which is highly nutritious
• Triage of acute malnutrition - refers to the selection/ sorting/classification of cases of acute
malnutrition presented to fast track treatment and increase survival rates
Table of Contents
Preface
Acknowledgement
Glossary of words
Table of Contents
7
Important information for Trainers
9
Purpose
9
Core clients
9
Mission Statement
9
Planning and Organising the Training
9
Content of training Sessions
12
Introduction: Course orientation
13
Section 1: Pathophysiology, Diagnosis and Triage
17
Section 2: Management of severe acute malnutrition in the in-patient setting
21
Section 3: Management of Acute Malnutrition for infants less than 6 months
25
Section 4: Management of severe acute malnutrition in the out-patient setting
29
Section 5: Management of Moderate Acute Malnutrition in non-emergency settings
33
Section 6: Management of Acute Malnutrition in the context of HIV/AIDS and
other chronic infections
39
Section 7: Emergency Nutrition Response
43
Section 8: Community Mobilization for Nutrition services
47
Section 9: Nutrition Information, Education and Communication
51
7
Complementary Topics
55
1. Monitoring and Evaluation of IMAM programs
2. Supplies and stock control
3. Work plans
55
56
56
Organising Field events
59
Post test and Final Evaluation
59
Appendices
60
8
Important information for Trainers
This section is aimed at assisting trainers in implementing the steps for planning, organizing and
evaluating training course for IMAM
Purpose
The guide is intended to equip trainers with technical knowledge of key messages and practices
related to understanding malnutrition, management of severe and moderate acute malnutrition,
emergency nutrition responses, community structure and strategy for the management of acute
malnutrition and related educational and counselling messages.
Core clients
The core clients are persons charged with the responsibilities of organizing and training to improve
the performance of implementers of nutrition interventions. These persons include all national and
provincial health workers from MOH and NGOs, extension educators, tutors and consultants from
related fields.
Participants and motivation
The participants are health managers, clinicians and community workers that actively perform the
acute management activities in order to deliver treatment in a safe and effective manner. Through
this training the target audience will be able to extend and develop capabilities for better job
performance because this training course involves transfer of new knowledge, skills, behaviours
and attitudes to perform specific roles in the workplace. Also, the participants may earn prestige,
get promotions and/or increase their income and therefore provide a better livelihood for themselves
and their family.
Mission Statement
To ensure that all implementing partners have comprehensive knowledge of management of acute
malnutrition and to understand their roles and responsibilities in complying with the national
guidelines on IMAM and the national food security and nutrition policy.
Planning and Organising the Training
Successful training requires careful planning by the trainer. Planning helps the trainer ensure that
the appropriate participants have been invited to the training course and that the training is designed
to meet their needs in an effective way. The following aspects must be taken into consideration
during the planning sessions;
• Identify the participants - Persons that need technical assistance may be identified by the
trainers/organisers or by other professionals at workplace. Names of these persons can be
forwarded to Division of Nutrition, MOH to be considered for training. Likewise after the training,
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a list of course participants should be forwarded to the Division of Nutrition for monitoring
purpose.
•
Set date for training course - Before setting the training dates the trainer should assess
the availability of participants and training venue. Information of the training dates should be
provided to participants well in advance to allow them adequate time to prepare for training as
well as seek for absence of leave from working station.
•
Assess training needs of participants - The training organisers should identify the gaps
between “what is the current need for participants’ and what should be” as far as management
of acute malnutrition is concerned. This information is important as it will indicate what the
training should focus on and subsequently help define the training objectives and the selection
of the training activities. A simple way is to circulate a questionnaire/checklist to participants
while still at work place to determine knowledge gaps.
•
Set training objectives - Training objectives should be defined in light of the needs and state
what will be accomplished. Training objectives may indicate that participants will display an
understanding of certain concepts, demonstrate a given skill or show a change in attitude.
Measurable training objectives are key to ensuring that learning is successfully. Introduce each
section by going over the objectives with the participants.
•
Prepare and organize training content - set objectives, course content, method of
instruction, reading material, field visits, work plan templates and forms for evaluation.
•
Select training methods - The methodology selected should describe the approaches to
training delivery that will be employed. The duration of the training and the training content
may vary depending on the needs of participants and resources available. For example; a group
of participants that need technical assistance on management of severe acute malnutrition will
require a course that only concentrates on sections 1 to 3. Alternatively, sections 1-9 may be
covered in one week or 7 days. The options of the training plan are limitless and can be varied
depending on the needs of the participants. There are several methods of delivering messages
these include lectures, group discussions, panel, role plays, symposiums, case studies and
field visits. A trainer can use a combination of these methods to impart information as well
as stimulate interest of participants. In addition a training team can be chosen to complement
styles, skills and knowledge.
•
Selecting and preparing training materials - Selection of good teaching aids can improve
learning ability of the participant. The type of training materials selected can be based on the
topics selected as well as the overall objective of the training. To develop effective teaching
aids, the trainer must think through their message from the receivers’ viewpoint. Visual aids are
useful in reinforcing oral presentations. Prepare handouts or other materials before the sessions
begin. Visual aids available for this training include, wall charts, food dummies, anthropometric
equipment, vitamin supplements, RUTFs, Therapeutic milks – F-100, F-75,
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•
Organize the training venue - The training venue should be appropriate in terms of space,
accessibility and conducive for learning. The target audience should be informed about the
venue, instructions on how to access the venue and reporting date and time should also be
provided. Courses that are intense and require maximum participation should be institutionalised
and adequate funds set aside to cater for them. Where participants have to commute to training
venue, transport itinerary can come in handy. Arrange the room in advance to suit the activities.
The sitting arrangement is more suitable if in a semi-circle in front of the board. Provide table
and comfortable chairs for participants.
•
Organize the Training Course - For the training to be successful, the trainer should have a
training program in place. The more the trainer can visualize the format of the training course,
the more prepared he/she is for any questions or problems that may arise. A prepared trainer
is relaxed and more effective. Determine a time frame, the time allocated for each activity
is only a guide. Where guest speakers are invited ensure that they are well prepared and
have been properly briefed on the program. Participants should be well informed regarding the
schedule for field visits and practical sessions. Where possible share the training program with
the participants before the training starts- this can be done by sending it together with the
invitation letters.
•
Encourage participations - Throughout the training period ensure that participants are
actively engaged in all activities by involving them in group discussions, role plays, classroom
exercises and asking questions. Place a parking lot, question box or suggestion box at the
corner of training room where participants can ask questions or give suggestions regarding the
sections. Pay attention to suggestions given and/or questions asked and provide appropriate
feedback. Put up a sign up sheet for volunteers to undertake tasks such as recording of training
proceedings, daily prayers, role plays, class representative, organisation of group energizers and
other administrative issues.
•
Develop evaluation strategy – It is important that the training course is evaluated because
evaluation of the training gives a measure of the extent to which the training has been successful
in accomplishing the training objectives. In addition, proper evaluation allows for continual
improvement of the training program. The IMAM evaluation tools (available in CD-ROM) capture
all aspects of the training. One way of doing an overall evaluation is to allow the participant
to indicate whether the information was relevant, adequate and satisfactorily delivered. The
participants can place answers for each factor for a scale of 1(best) to 3 (poorest) points is
then tallied and discussed. Evaluations can be conducted after every training session or at the
end of the training duration.
•
Post training activities – After the training, it is important that the lead trainer convene all
the trainers to discuss challenges and successes of the training. Administration issues such as
paying final bills, compiling notes for training proceedings, preparing final report for the training
and disseminating it to the stakeholders are essential activities that must be undertaken.
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Content of training Sessions
Every section has topics and activities that address specified objectives. Each activity specifies
the purpose, materials and equipment needed, approximate time required and the steps to follow in
each session. Some activities require early preparation prior to the training session. Accompanying
handouts, power point presentations, case studies, classroom exercises and additional technical
notes for trainers are indicated. The different sections are divided as follows;
Section
Content
Introduction
Gives an overview of the training program, introduction of participants, expectations,
overall objective of training and description of evaluation process.
1
Covers Pathophysiology, malnutrition, diagnosis and triage. Also explains the
principles of management of Severe and moderate Acute Malnutrition.
2
Provides training guidelines on management of severe acute malnutrition in patients
older than 6 months in the in-patient setting.
3
Provides training guidelines on management of acute malnutrition for infants less
than 6 months
4
Provides training guidelines on management of severe acute malnutrition in patients older than 6 months in the out-patient setting.
5
Guidelines on management of moderate acute malnutrition for children, adolescents and adults in the non-emergency context through the MoH infrastructure.
6
Guidelines on management for malnourished children in the context of HIV and
AIDS
7
Outlines the Emergency Nutrition response to increased levels of acute malnutrition addressing moderate malnutrition.
8
Present training guidelines on the community structure and the strategy for the
management of acute malnutrition.
9
Present training guidelines on Nutrition Information, Education and Communication
Complementary
Presents guidelines on organising field visits and work plans
Appendices
Available in CD ROM enclosed
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Introduction
Introduction: Course orientation
Aim of Section is to provide an overview of the training processes including identification of
participants’ expectations as well as determining the level of participants’ understanding
of integrated management of acute malnutrition.
Learning Objectives
Overview of the section
By the end of the orientation session, the
participants will be able to;
• Name their fellow participants and give
their working experiences and project area
• Discuss the expectations and concerns of
the training
• Undertake a knowledge test to gauge level
of understanding for management of acute
malnutrition
• Explain the objectives and purpose of the
workshop
• Explain the workshop instructional
methodology
• Discuss training etiquettes, administration
and housekeeping
• Define malnutrition and explain current
nutritional situation in Kenya
Time: 1 hour 40 minutes
Sessions:
1. Word of welcome
2. Introduction of participants
3. Training expectations and concerns
4. Knowledge test
5. Training objectives
6. Training agenda
7. Training etiquettes and housekeeping
8. Basic introduction to cute malnutrition and
current Kenyan situation
Main training techniques
1.
2.
3.
4.
5.
Power point presentation 1: Introduction
Guest speaker – official opening
Group Discussions
Brain storming
Knowledge test papers and answer sheet
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Nutritional Assessment
Introduction
Materials/equipment
Advance Preparation
Prepare all material and equipment in advance,
make sure that the LCD is compatible with
the computer and the PowerPoint presentation
slides are available. Ensure that you have
adequate index cards, marking pens and flip
charts. Use Blue tac or masking tape to stick
the cards and charts on the wall
• Training Agenda for participants
• Training Agenda for trainer
• Pre-test Sheet
• National guidelines for IMAM
• Handbook
• Suggestion/question box
• Flip charts
• Blue tac / Masking tape
• Marker pens (assorted colours)
• Index cards
• PowerPoint presentation I: Introduction
• Laptop computer and LCD
• Pins
• Participants folders ( training agenda,
writing pad, handouts, wordlist and
resource list)
• Pens, pencils and rubbers
• Calculators- where possible
Prepare all training materials and equipment at
least 1-2 days before the training day.
1. Read through the introduction part of the
IMAM guidelines
2. Read through the procedure outlined below
on how to conduct this training.
3. Mount ppt presentations, rehearse and
familiarise yourself with the use of the
IT equipment. Where need be, make
the necessary adjustments to suit your
audience.
4. Ensure that you have obtained and read
through the knowledge test paper and
answer sheet. Make adequate copies.
5. Using the list of names create participants
code numbers
6. Liaise with the workshop administrator to
ensure that the training venue, food and
accommodation are available and provided
as planned.
7. Check whether all the writing pads,
flipcharts, pens, marker pens, index
cards, LCD, laptop computer, PowerPoint
presentations, suggestion box are available
and in good condition.
8. Contact the guest speaker, remind and
confirm his/her participation.
Procedures
Word of welcome
5 minutes
Begin the session by officially welcoming the participants to the training venue. Where possible,
you may engage a government official (MOH) to preside over the session. Make sure that you
inform the official well in advance and share with him/her the training objectives and agenda before
the starting day.
Introduction of participants
10 minutes
It is very important that at the onset of the training, the participant get to know each other as well
their trainers. Ask the participants to pair up. Each person should find out the following about their
partner;
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• Names/ preferred name for the workshop
• Agency/ organisation
• Project area/working station
• Experience (s) in management of Acute malnutrition–( work done, where and how long)
• Likes and dislikes
Each partner should write the information on an index card. Ask them to introduce each other, one
at a time. Get a volunteer to write down the dislikes and likes on a flip chart and use the appropriate
ones to build group norms. Encourage participants to know more about each other during break.
Collect all the index cards and stick them on the wall.
10 minutes
Training expectations and concern
Hang up three cards to display the participants’ expectations and concerns. The three cards should
be read: Professional expectations, Personal expectation and Concerns. Participants should write
their expectations and concerns on index cards and categorise them according to the three cards
as shown below. The participants’ handwriting should be legible and few words as possible be
written on each card. Participants can use as many cards as possible.
Professional Expectations
1.
2.
Personal Expectations
1.
2.
Concerns
1.
2.
A volunteer can read aloud the expectations and concerns and pull out cards that repeat what has
already been written. Encourage participants to question or seek for clarifications where need be.
Training objectives
5 minutes
Display slides to show the overall workshop objectives. Compare the objective with the participants’
professional expectations and point out any possible links between the two. It is important to point
out that not all expectations will be met. Ask participants if there are any objectives that are not
clear or do not meet their expectations and discuss and/or seek for clarification.
Training agenda
5 minutes
Distribute the workshop agenda to participants or refer them to their folders if agenda is already in
the folder. Explain to them that the objectives will be achieved through the topics covered in the
agenda. Read through the topics, activities and respective timings for each day as outlined in the
agenda. Also inform the participants that there will be some evening exercises and this will require
them to set time aside in the evening for the assignments. Emphasise the fact that punctuality
must be observed so that the training agenda can be met. It is important to agree on how to spend
time during the training period.
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Introduction
Introduction
Training etiquettes and housekeeping
10 minutes
Inform the participants that this is their training and therefore must make maximum use of their
time to reap the best outcome. Based on the group norms and expectations, formulate training
etiquettes, give the participants opportunities to discuss and agree on rules to be followed and
possible consequences of not adhering to the stated rules. Details regarding housekeeping
should be explained. The workshop administrator should take up the major role of explaining the
different issues regarding food and accommodation, transport, allowances and medical assistance.
Participants should be encouraged to choose class representatives or committee that will oversee
the welfare issues. Remind the participants to make use of the suggestion box.
Testing Knowledge (Pre-test)
10 minutes
This activity contains a pre-test. Before issuing out the test paper, give every participant a code
number that will remain secret. The code number must be written on the test paper and no names
or any other identification mark should be on the test paper. After completion of the test, mark the
test and award points, converts the marks to percentage. Plot the individual percentages on a bar
graph, where the X-axis is the participants’ code number and the Y-axis is the percentage mark.
This graph can be displayed in class.
Introduction to malnutrition
30 minutes
Present to the participants the slides that comprise of, the key definitions, background information
of malnutrition and current nutritional situation in Kenya. Inform the participants that all key
definitions are in the word list in their folders. Encourage participants to ask questions after the
presentation. Point out that detailed information will be provided in sections 1-9 of the training.
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Section 1:
Pathophysiology, Diagnosis
and Triage
Aim of this Section is to familiarise the participants with the biological and chemical
malfunction of the body during malnutrition and link these to the purpose behind each
step of treatment. Also to enable them to understand the various forms of malnutrition
and accurately identify, classify and select appropriate action in order to increase
survival rates of the vulnerable population.
Learning Objectives
By the end of the session, the participants will
be able to;
• Be familiar with technical terms that
describe malnutrition
• Relate Pathophysiology and medical/
nutrition treatment
• Be aware of the metabolic and the
physiological changes that occur to the
whole anatomy.
• Identify various forms of malnutrition
• Understand the links between nutrition,
health and mortality
• Recognise the clinical symptoms
associated with moderate and severe acute
malnutrition
• Understand diagnosis and triage of acute
malnutrition
Time: 3 hours
Sessions:
1. Pathophysiology
2. Definition of terms and categories of
malnutrition
3. Components of nutrition and causes of
malnutrition
4. Diagnosis of acute malnutrition
5. Triage for acute malnutrition
1.
2.
3.
4.
5.
6.
Power point presentation
Case study
Classroom group Discussions
Evening tasks (Home work)
Brain storming
Demonstration (anthropometric
measurement)
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Section One
Section One
Materials/equipment
the cards on the wall. Handouts for these
sessions must be ready and photocopied in
advance.
• National guidelines for IMAM
• Handout 1a: How to conduct the Appetite
Test
• Handout 1b: Criteria to identify acute
malnutrition
• Handout 1c: Calculating anthropometric
measurements
• Handout 3e: WHO references value charts
for boys and girls
• Resource lists
• Anthropometric equipments ( height
boards, Salter scales, MUAC tapes, Ropes,
Hanging pants)
• Calculators
• Photos
• Wall charts
• PowerPoint presentations: Pathophysiology,
Diagnosis and Triage
•
•
Laptop computer and LCD
Caregiver Brochure
Advance Preparation
1. Read through section 1 of the IMAM
guidelines
2. Read through the procedure outlined below
on how to conduct this training.
3. Mount presentation for Pathophysiology
and Section 1, rehearse and familiarise
yourself with the use of the IT equipment.
Where need be make the necessary
adjustments to suit your audience.
through all the required handouts and
exercises.
5. Where possible organise to get
underfive years old children (at least
4) for demonstration on how to take
anthropometric measurement
6. Request a volunteer to prepare the
energizer.
Procedures
Pathophysiology
40 minutes
This session enables participants to understand the meaning of Pathophysiology and outlines
the metabolic and physiological changes occurring to the whole anatomy. At the end of the
session participants are able to relate Patho-physiology and medical/nutrition treatment, while
understanding the Dos and Don’ts when managing a severely malnourished child.
Definition of terms and categories of malnutrition
10 minutes
Start the session with a Classroom exercise 1: Ask participants to define the terms Nutrition,
malnutrition, oedema, and outline the difference between the following terminologies; Chronic
and acute malnutrition, Kwashiorkor and Marasmus. Give them time to brain storm and ask a
volunteer to write down the answers on the flip chart. Present slides and compare the answers.
18
Components of nutrition and causes of malnutrition
10 minutes
Diagnosis of acute malnutrition
20 minutes
Explain to the participants the steps to follow when identifying malnutrition and what steps should
be followed during admission, emphasis the fact that it is important that during admission that
the health workers understands the causes of malnutrition as well as conduct the appetite test.
Demonstrate how to take anthropometric measurements. This will include, MUAC, Height, Length
and weight. Explain to the participants the use of anthropometric equipment. The practical exercise
should enable participants to acquire skills as well as identify simple mistakes likely to occur during
measurements.
Demonstration: How to conduct anthropometric measurements
40 minutes
Divide the participants into groups; the number of groups will depend on the number of children
available for the exercise. Each group should record the measurement of height, weight and MUAC
in their note books. This information will be compared at end of practical session to determine
accuracy and errors. Mention to the participants that every child must be measured twice before
recording.
Continue the session by focusing on correcting mistakes and errors that occur during
measurements and recording. Also explain how to check oedema.
Triage of acute malnutrition
30 minutes
In this session, the participants should learn how to classify the patients into various levels of
malnutrition based on reference cut-off points for W/H, BMI or MUAC. Refer to handout 1b;
criteria to identify acute malnutrition. It is important to explain to them that a triage process must
be established so that the acutely ill are examined and admitted quickly to the in-patient facility
to start treatment immediately. Poor diagnosis may lead to delayed treatment or incorrect referrals
leading to condition deteriorating even further.
Take the participants through the process of
triaging.
End Sessions: Give a brief summary of the section and issue out handout 1c to participants
as evening task- this can be done individually or as group tasks. Issue out the end of session
evaluation forms and ask participants to fill it and submit before leaving class. Remind them to slot
in the box their suggestions/comments on the day’s sessions/activities. Ask the repertoires to hand
in their notes to enable you compile the day’s activities
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Section One
This session outlines the categories of nutrition. It describes the differences between macronutrients
and micronutrients. Present the causal model slide and ask participants to differentiate between
immediate, underlying and basic causes of malnutrition. Ask the participants to brainstorm and
give answers to exercises 1a, 1b and 1c. Discuss the answers.
Notes
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Section Two
Section 2:
Management of severe acute
malnutrition in the in-patient setting
Aim of Section is to equip health workers with practical and technical knowledge
necessary to manage Severe Acute Malnutrition in an In-patient setting.
Learning Objectives
By the end of this session, participants should:
• Be aware of basic principles of
therapeutic care and its role in emergency
interventions.
• Understand the main protocols for
management of severe malnutrition and
how they are implemented in the In-Patient
Care facilities.
• Be able to identify the key points in
planning and implementing a therapeutic
care programme.
• Be aware of the main dangers and
complications during treatment of severe
malnutrition, and the main principles of
their management.
• Be aware of special treatment for infants
with medical complications.
Time: 4 hours 15 minutes. Additional 2
hours for practical field visits
Sessions:
1.
2.
3.
4.
5.
6.
7.
Brief introduction and definition
Requirement for in-patient setting
Phase 1 treatment
Transition phase treatment
Phase 2 treatment
Treatment of medical complications
Practical sessions: Visit to In-Patient Care
facility
8. Practical sessions: Milk Preparations
1. Power point presentations
2. Classroom group Discussions
3. Practical: Field visit to In-Patient Care
facility
4. Cookery demonstration
5. Evening tasks ( Home work)
6. Brain storming
21
Section Two
Materials/equipment
advance.
• National guidelines for IMAM section 2
• Handbook
• PowerPoint presentation 2: In-patient
management and treatment of severe acute
malnutrition,
• Power Point Presentation : Practical field
visit
• Demonstration Kit for preparing F-75,
F-100, ReSoMal ( appendix 2.2 of IMAM
guidelines)
• Samples of Vitamin A, Iron/folic acid, RUTF
• Handout 2a: Multi-chart, Handout 2b:
Quantity of F75/ prepared Milk to give in
Phase 1, per kg body weight , Handout
2c: Summary of routine medication for
in-patient treatment of severe acute
malnutrition, Handout 2d: Phase 2 Inpatient: Ml of F100 per kg body weight ,
Handout 2e: Treatment of Dehydration (i)
transfer form from in-patient to outpatient,
Handout 2f: Treatment of Dehydration
(ii), Handout 2g: Differentiating Heart
Failure from Anemia, Handout 2h: Heart
Failure and Oedema , Handout 2i: Survival
•
•
•
exercise: Management of a patient with
complications in inpatient care.
Instruction sheets for field visits plus
questionnaires and checklists
Caregiver Brochures
Advance Preparation
1. Prepare all training materials and equipment
at least 1-2 days before the training day.
2. Read carefully through section 2 of the
IMAM guidelines ( see session outlined
above) and section on organising practical
field visits (page 45)
3. Read through the procedure section
outlined below on how to conduct this
training.
4. Mount power point presentations, rehearse
and familiarise yourself with the use of
the IT equipment. Where need be make
audience.
5. Organise for the in-patient ward visit.
Inform the in-charge the purpose of the
visit, time and no. of participants. Agree
with the in-charge on modalities of
visit and time allocated to interview the
caretakers.
through all the required handouts, case
studies and exercises. Make adequate
copies.
energizer.
Procedures
Overview of In-Patient Care
10 minutes
In this session, give the participant an overview of management of severe malnutrition and explain
different ways of managing severe acute malnutrition and the treatment processes.
Phase 1 treatment
1 hour
In this session, explain to the participants that the first thing is to assess a patient in order
to determine treatment, use the ten essential steps approach for treatment, stabilization and
22
Transition phase treatment
20 minutes
To attain this phase, the criteria of transition must be followed strictly. Transition Phase prepares
the patient for Phase 2 treatment or for transfer to the Out- patient care where an out-patient
facility for treatment of severe acute malnutrition exists. The transition phase may take one to
two days. Here the child is transitioned from F-75 to F-100 and /or RUTF. Show participants the
different sachets of the therapeutic milks and RUTF; let them outline the differences in terms of
content, size, weight, colour and use. Explain clearly the criteria for discharge to Phase 2. In the
transition phase a patient whose condition deteriorates must be referred to phase 1.
Phase 2 treatment
30 minutes
In this phase, the patient can only be admitted if he/she has an appetite, reduced oedema and
medical complications are treated or controlled. Main objective of phase 2 is to achieve catch-up
growth as well as resolve micronutrient deficiencies. Explain to participants the components of
nutrition support, routine medication and surveillance. Take participants through the preparation
steps before discharge, this is important as it will ensure full recovery as well as reduce relapse.
Treatment of medical complications
3 hours
In this session, take the participants through the management of patients experiencing medical
complications such as Hypoglycemia, Hypothermia, Dehydration, and Septic (Toxic) shock, Absent
Bowel Sounds, Gastric Dilatation, Abdominal Distension, Heart Failure and Severe Anemia. For
each complication, give a brief description, clinical signs, management, treatment, monitoring
and prevention. To complete the session, explain to the participants that great care must be
taken when prescribing drugs to severely malnourished patients because the severely malnourished
patients have abnormal liver and kidney functions.
Requirement for in-patient setting
10 minutes
Explain to the participants that it is important that they know and understand the requirements
for setting up an in-patient unit. Take them through the slide presentations, explaining the
treatment area, staffing position, individual roles and responsibilities, materials and equipment and
documentation. Make print out of multi-chart and go through the different sections. The filling out
of the multi-chart form will come in handy when during the practical field visits to the in-patient
23
Section Two
rehabilitation. Refer them to section 1 for more details on diagnosis and triage. Present slide
on criteria for admission and explain the cut- off points. Point out the importance of stabilizing
and rehabilitating severely malnourished patients immediately admitted in the facility. Explain to
the participants the need to give nutrition support alongside medication. More attention should
be given to the type of diet; in this case F-75, frequency and appropriate feeding techniques
and routine medication. Issue out Handout 2b and discuss the routine medication. Ensure that
participants understand the need for a patient to be monitored.
Section Two
Visits to in-patient ward
3 hours
Present the PowerPoint presentation on practical field visit to familiarise the participants on preactivities, actual-activities and post activities of the field visit. Arrange a visit to the district hospital
or nearest health facility with an in-patient unit - where severe acute malnourished patients are
admitted. Prior to the visit, ensure that the in-patient ward has varying complication cases. Divide
the participants in groups, each group should visit a patient and determine the type of medical
complication, treatment and management. They should interview the clinician, nurse or nutritionist
and at least one caretaker. Use questionnaires and checklist for in-patient visit. On return to class,
each group should share information with the rest and discuss whether the patients received
adequate treatment, if not, inform them what should be done to ensure that the patient recovers.
Note down their points and compare with what was taught in class, see whether there are new or
different ways of treatment contrary to the guidelines, discuss with class the way forward. Arrange
to share information with program staff at the health facility.
Milk preparation sessions
1 hour
This is a cookery demonstration session. It is important that you familiarise yourself with the
milk feed preparations procedures prior to classroom demonstration. First present the auxiliary
slides on milk preparation. Gather all the therapeutic materials and equipment required (see list of
demonstration kits in appendix 10), ensure that there is adequate space for participants to prepare
the milk feeds. Make prior arrangements to have boiled and cooled water (to save on time). Divide
the participants into groups. Each group must prepare F-100 and F-75 milk feeds. Instruct the
participants to follow all the necessary steps including hygiene requirements during preparation.
Let the groups follow the steps as outlined in the presentations. Monitor the practical sessions
and assist the participants where need be. At the end of the practical session, let the participants
compare the milk feeds. Give room for questions and answers.
End Sessions: Give a brief summary of the section and issue out handout 2i to participants as
evening task- this can be done individually or as group tasks. Issue out the end of session evaluation
forms and ask participants to fill and hand it in before leaving the class. Remind them to slot in the
box their suggestions/comments on the day’s sessions/activities. Ask the repertoires to hand in
their notes to enable you compile the day’s activities and where possible discuss points that may
not be clear.
24
Section Three
Section 3:
Management of Acute Malnutrition
for infants less than 6 months
Aim of this Section is to train health workers on the management for malnourished
children under 6 months with and without prospect of being breastfed
Learning Objectives
By the end of this Session, learners should be
able to:
• Identify and admit malnourished infants
less than 6 months and special babies less
than 3kg
• Understand the criteria for discharge of
infants less that 6 months and babies less
than 3 kg
• Manage malnourished infants less than 6
months in the In-Patient Care (for infants
with and without prospects of being
breastfed)
• Implement Supplementary feeding if
breastfeeding is an option
• Know how to care for a mother of
malnourished infants less than 6 months
Time: 2 hours
infants less than six weeks with prospect of
being breastfed
Two: Management of acute malnutrition in
infants less than six weeks with prospect of
not being breastfed
The following contents shall be applied on
both sessions
• Overview
• Admission and discharge criteria
• Nutrition support
• Routine medicine
• Surveillance
• Care for mothers
• Follow-up
1. Power point presentation
2. Photos of supplementary suckling
technique
3. Evening tasks ( Home work)
4. Brain storming
Sessions:
There are two major sessions in this section,
One: Management of acute malnutrition in
25
Section Three
Materials/equipment
Advance Preparation
advance.
• PowerPoint presentation 3: Management
for acute malnutrition in infants less than
six weeks
• Handout 4a: Amount of F100 Diluted for
body weight,
• Handout 4b: Amounts of F100 Diluted or
F75 to give infants who are not breast-fed
in phase 1
• Handout 4c: Case study
• Handbook
• Caregivers brochures
1. Prepare all training materials and equipment
above)
training.
4. Mount presentation for section 3, rehearse
audience.
5. Ensure that you have obtained and
read through all the required handouts,
instruction materials and exercises. Make
adequate copies.
energizer
Procedures
Overview
10 minutes
Introduce the topic by explaining to the participants that there are two major sessions of this topic.
The topic discusses children under 6 months that are malnourished with or without prospects of
being breastfed. Participants should understand that both cases will be handled in these sessions,
first discuss the management of malnourished children under 6 months with a prospect of being
breast fed followed by the management of malnourished children under 6 months without a prospect
of being breast fed. Inform the participants the importance of focusing on malnourished under six
months children, these children must be treated in an in-patient setting. Using the word list let the
participants define exclusive breastfeeding and myths surrounding exclusive breastfeeding.
Admission and discharge criteria
10 minutes
Outline the admission and discharge criteria for malnourished children under six months. Clear
indicators of admission include medical complications, lack of breastfeeding either because the
infant is sick or the mother is incapable of breastfeeding, loss of weight and even presence of
26
oedema. Emphasise the importance of weight gain, resumption on breastfeeding and/or lack of
medical complications as clear indicators for discharge.
50 minutes
Nutrition support is key to managing malnourished children under six months. In this session
discuss the key components of nutritional support for children with prospects of being breastfed.
These should include; Supplementing breast milk, preparation of F100 diluted, regulating quantity
of F100 diluted and supplementary suckling technique. In addition explain to the participants the
three phases of treatment crucial for managing children with no prospects of being breastfed.
Remind the participants of the steps for preparing F-100 dilute. Emphasis the fact that quantity of
therapeutic milks depends on body weight and therefore care must be taken to ensure that child’s
weight is accurately taken. Case study 4c is handy for group discussions, divide the class into
groups and allocate 20 minutes for discussions and 10 minutes for feedback.
Routine medicine
20 minutes
In this session, emphasis the importance of treating illnesses and/or medical complications
immediately infant is admitted in health facility. Treatment of diseases should go alongside nutrition
therapy and counseling to care giver on prevention of illnesses. Mention to the participants, that the
first line anti-biotic treatment is most recommended, unless in very severe infections where 2nd line
antibiotics are used. Children should also receive micronutrients such as vitamin A on admission
and folic acid in one single dose. It is important that national IMCI guidelines are followed during
routine medication. The routine medications for malnourished children with or without prospects
of being breastfed are the same.
Surveillance
10 minutes
This session explains the daily activities for the management of malnourished child. Emphasis
is on the roles of the health workers and what they must do each day to ensure proper care of
the infant and mother. The child must be weighed daily, measured body temperature and where
necessary checked for oedema. Proper recording must be done, checked and maintained in order
to determine progress of child’s health. Information should be filled into the multi-chart. Show the
participants a sample of the multi-chart and let them point out areas where they can fill in some of
this information - weight, body temperature, dehydration, cough, number of stools etc.
Care for mothers
10 minutes
Care for mother is very important. Mothers require nutritional care so that the amount of breast
milk can be increased. The nutritional status of the mother should also be checked this can be
done by using MUAC. Oedema can also be checked and treatment given accordingly. Explain to the
participants that it is important that she must consume meals that offer required amounts of kcals
(2, 500kcals) in a day and enough drinking water (at least 2 litres). Micronutrient supplementation is
recommended because the quality of the mother’s breast milk depends on the mother’s nutritional
27
Section Three
Nutrition support
status. Health worker should be attentive to her nutritional needs and reassure her that all is well.
Where possible introduce her to other mothers for Psycho-socio support.
Section Three
Follow-up
10 minutes
Inform the participants that it is important to follow-up all children and their mothers. The nutritional
status of the mother must be maintained by ensuring that she is admitted in an existing SFP.
Mother must be informed that complementary feeding can only be introduced after the child has
been exclusively breastfed for 6 months. Also the infant’s growth must be monitored to ensure
that he/she is growing well.
End Sessions: Give a brief summary of the section. Ask participants to read through the handouts
provided as take home assignments. Issue out the end of session evaluation forms and ask
participants to fill and hand it in before leaving the class Remind them to slot in the box their
suggestions/comments on the day’s sessions/activities. Ask the repertoires to hand in their notes
to enable you compile the day’s activities and where possible discuss points that may not be clear.
28
Section Four
Section 4:
Management of severe acute
malnutrition in the Out-Patient
setting
Aim of this Section is to provide health workers with information about Out-Patient
Therapeutic Care and its place in the health care system.
Learning Objectives
By the end of this session, participants should
be able to:
• Know the admission and discharge
procedures
• Beware of the role of health workers in OutPatient setting
• Understand management and treatment
procedures
• Understand principles of home care in
Out- Patient setting
• Know the procedures for surveillance and
follow-up of patients in Out-Patient Care
Time: 3 hours. Additional 2 hours for
practical field visits
Sessions:
•
•
•
•
•
•
•
Brief introduction and definitions
Admission and discharge processes
Requirements for Out-Patient Care
Treatment and management procedures in
Out-Patient Care
Home care for the malnourished patient
Role of health workers
Criteria for transfer: Out-Patient to InPatient Phase 1
1.
2.
3.
4.
Case studies
Brain storming
29
Section Four
Materials/equipment
advance.
• Handbook
• PowerPoint presentation 4: Management of
severe acute malnutrition for patients > 6
months out-patient setting
• Handout 1a:How to conduct appetite test
• Handout 3a: Out-Patient Care treatment
card
• Handout 3b: Out-Patient Care ration card
• Handout 3c: Checklist: possible causes of
failure to respond
• Handout 3d: Medical examination Checklist
• Handout 3e: WHO reference value charts
for boys and girls
• Samples of RUTF, Fortified blended foods
• Food dummies or pictures for counselling
(vegetables, meats, cereals, milk, oil,
legumes, fruits)
•
•
•
Caregiver brochure
Practical field visit instruction sheet
Advance Preparation
IMAM guidelines (see session outlined
above)
training.
3. Mount presentation for section 4 and
practical field visits; rehearse and
familiarise yourself with the use of the
IT equipment. Where need be make
audience.
through all the required handouts, case
studies and exercises. Make adequate
copies.
5. Set a table and a chair aside to create a
scenario for counselling
energizer.
Procedures
Brief introduction and definitions
10 minutes
Start the session by asking the participants if any of them is familiar with the concept of OutPatient Care, this can be done by simply asking them what is Out-Patient Care? How is it different
from In-Patient Care? After that, clearly state the objectives of Out-Patient Care and explain the
differences between In-Patient and Out-Patient Care.
Admission and discharge processes
30 minutes
Explain to the participants that the admission and discharge criteria for the Out-Patient Care
are very important to ensure proper targeting and efficient management of the program. It is
important to note that patients admitted in the Out- Patient Care are only malnourished and do
30
Treatment and management procedures in Out-Patient Care
50 minutes
Similar to In-Patient Care, the patient admitted in the Out-Patient Care requires a lot of attention.
The procedures must be followed carefully to ensure that the patient receives all medication and
nutritional support as well as parental care. Ready to use therapeutic food is commonly used in OutPatient Care as it is equivalent to F-100, highly fortified and does not require any preparation. The
contents of RUTF must be explained explicitly, show sachets of RUTFs. It is important to inform the
participants that a protection ration should be given to the severely malnourished patient’s family
to minimize risk of RUTF being shared. Health workers should ensure that the family members
are registered for general food ration. Also routine medication and surveillance should be adhered
to very strictly to enable the patient recover aptly. Participants ought to understand that the
prescription and daily dose of recommended drugs should be in-line with the national guidelines.
Clearly explain to the caregiver the importance of bringing the patient to the site on the appointed
day, any delays may lead to deterioration of the health situation of the patient.
Requirements for Out-Patient Care
20 minutes
In this session, it is important to outline the requirements of the outpatient and compare with
those required at in-patient. This comparison will enable the participants understand the resources
required for setting up the out-patient nutrition care. A list of requirements for in-patient requirement
and outpatient is provided
In appendix 10.
Home care and Role of Health workers
50 minutes
In this session explain to the participant that care of the patient is a continuous process and does
not end with the nurse at the health facility. The care taker must understand her/his role so that the
patient can receive good care at home. Explain to the participants the important role of the health
workers, this can be demonstrated through Role Play (handout 8a, Role play 2) let the classroom
divide into groups and allocate 20 minute for discussion and 10 minutes to report back on the type
of poor care and actual causes and how to improve the care.
Criteria for transfer: out-patient to in-patient Phase 1
20 minutes
Sometimes a patient fails to respond to treatment, in such a case, remedial action must be applied
immediately. Failure to respond is categorised into two, either as primary or secondary, explain
to the participants the two criteria and issue out handout 3c and give them the several remedial
actions. It is important that you outline the criteria for referral for in-patients phase 1, inform
31
Section Four
not have medical complication. Describe the steps for admission and discharge criteria; here refer
the participants to section 1 on importance of diagnosis and triage. Appetite test is a very good
criterion for admission; ensure that the participants understand how to conduct the appetite test
by taking them through the steps of conducting the appetite test (see handout 1a). Inform the
participants that during discharge, caretakers must be notified of the patient’s final outcome and
more or so the importance of follow up care, Immunization and growth monitoring.
the participants that referral to phase 1 can only be done after a medical examination. Show
participants how to use transfer form for out-patient to in-patient.
Section Four
Practical Field visits to an OTP program
2 hours
Inform the participants that they will be visiting an Out- Patient Care Program in order to
acquire hands on experience on management of a severely malnourished patient that has no
medical complications. Divide participants in groups and give them copies of the checklists and
questionnaires. Details of the field visits are presented in auxiliary slides for Practical field visits.
participants to fill and hand it in before leaving the class Remind them to slot in the box their
32
Section Five
Section 5:
Management of Moderate Acute
Malnutrition in non-emergency
settings
Aim of this section is to enable health workers design and manage programmes targeting
those with Moderate Acute Malnutrition (MAM)
Learning Objectives
By the end of this session participants should:
• State the aim of management of Moderate
Acute Malnutrition ( MAM)
• Identify patients affected by moderate
acute malnutrition
• Manage moderate acute malnutrition by
applying standard protocols
• Know the requirements and procedure
in setting up a programme to manage
moderate acute malnutrition
Time: 3 hours. Additional 2 hours for
practical field visits
Sessions:
•
•
•
•
•
•
•
Overview
Admission and discharge procedure
Decision matrix
Management process
Data collection and reporting
Requirements for setting up a MAM
programme
Monitoring and Follow-up
1.
2.
3.
4.
5.
6.
Power point presentations
Group discussion –case studies
Demonstrations
Role play- Decision Matrix
Brain storming
33
Section Five
Materials/equipment
advance.
• PowerPoint presentation 5: Management
of MAM, supplies and stock control,
Monitoring an Evaluation and Practical field
visit
• A table and 3 chairs - set scenario for a
health facility
• Organise the participants into working
groups (the size of each group will depend
on the amount of material and equipment
available for practical)
• Demonstration materials/equipment
 Ingredients for preparation of CSB, local
porridge and premix ( see appendix 5.2
and 5.3 of IMAM guidelines)
 2 large basins for preparing premix
 A large plastic sheet
 4 small bowl
 2 jugs of clean water
 Paraffin stove or charcoal jiko
 2 Sufurias with lids
 2 wooden spoons
 4 cups or plates
 Soap for washing hands
 Handouts on Wordlist
• Handout 5a: Exercise: Anthropometry
Calculation and case study
• Handout 5b: Decision matrix table
• Handout 5c: Summary of Routine medical
treatment for Children under five
• Handout 5d: Summary of Routine medical
treatment for pregnant and lactating
mothers
34
•
•
•
•
•
Handout 5e: Case study: Nutritional
support Rations
Handout 9b: reporting format
Handbook
Caregivers brochures
Practical field visit instruction sheet
Advance Preparation
•
•
•
•
•
•
•
•
Prepare all training materials and equipment
Read carefully through section 5 of the
above)
Read through the procedure section
training.
Ask 4 participants to volunteer and role
play ( a health worker, a pregnant mother
with her husband, a mother with < 5
years old child with her husband)
Prepare the cookery demonstration kits
for preparation of CSB, local porridge and
premix. Ensure that you have adequate
portions of each. You may divide the
classroom into three groups and each group
may handle one demonstration. Check and
be sure that you have all materials and
ingredients required for the demonstrations,
read through appendix 5.2 and 5.3.
Mount presentation for section 5 and the
practical field visits, rehearse and familiarise
yourself with the use of the IT equipment.
Where need be make the necessary
adjustments to suit your audience.
Ensure that you have obtained and
instructional materials and exercises. Make
adequate copies.
Request a volunteer to prepare the
energizer.
Procedures
5 minutes
In this session explain to the participants the objectives of the section, point out that the aim of
managing moderately malnourished patients is to meet the additional nutritional needs as well
as prevent deterioration of nutritional status of those at risk. It is important that the participants
understand the difference between the management of moderate acute malnutrition in an
emergency and a non-emergency setting. The overview should include definition of MAM, brief
introduction of the current situation in Kenya and the different components for the management of
moderately malnourished patients. Ask participants to give examples of interventions that manage
moderately malnourished individuals. Discuss the answers.
Admission and Discharge procedure
5 minutes
Inform the participants that the admission and discharge criteria for the MAM are essential for
efficient management of the program. Describe the steps for admission and discharge criteria
and refer them to section 1 on importance of diagnosis and triage. Explain to the participants that
there are three major steps of admission procedures; namely anthropometric measurement, causal
analysis and determining treatment.
Decision matrix
30 minutes
In this session, explain to the participants the steps a health worker needs to take in order to
correctly admit a patient into the program. The steps outlined in the decision matrix (handout 5c)
are simple yet act as a guide to determine the nutritional status of a patient as well as establish
possible causes of malnutrition necessitating the need for treatment and counseling.
Role Play
•
•
•
•
•
•
Each role play should take approximately 10 minutes.
Ask the volunteers to role play
First the pregnant women and husband and next the mother with a malnourished under five
years.
The health worker in the role play should use the information in the decision matrix to
determine the treatment and key nutritional messages for patient and caregivers.
Allow the participants to discuss the flow of information and how best to present the result
to the patient. For instant if the health worker takes the anthropometric measurement of the
patient and find he/she is severely malnourished and requires in-patient treatment, how best
can he/she present the information to the caregiver?
Let the participants agree on the best approaches to counsel mothers in the presence of their
husbands
35
Section Five
Overview
Section Five
Processes of managing MAM
1 hour
The management process includes nutrition support, routine medicines, counselling and followup. The participants need to understand that it is important to register a patient and provide the
patient with a ration card so that the health worker can monitor the progress of the patient. All
information regarding the patient must be recorded. Show the participants a copy of the register,
ration cards (handout 5f) and reporting formats (handout 9b). It is important to emphasise that
the type of food rations and food baskets designed must take into considerations the tastes and
preferences of the local community. Ask the participants to brainstorm on the different tastes and
preferences of local food based on the communities they represent and for each local community,
ask them to design the most appropriate food basket. Take the participants through table on the
recommended amounts of food commodities for take home dry rations. Explain to the participants
the importance of premix. Nutrition counselling is also an important part of managing MAM and
enables the caregiver to understand the causes and prevention of malnutrition.
DEMONSTRATION procedures
•
•
•
Divide the class into groups, each group should carry out two demonstrations.
Allocate 20 minutes for demonstrations and 10 minutes for discussions
Share copies of Appendices 5.2 and 5.3 from IMAM guidelines.
1. How to make pre-mix ( table 5.4 in IMAM Guidelines)
2. How to cook CSB (Appendix 5.2 recipe 1 in IMAM Guidelines)
3. How to cook local porridge (Appendix 5.2 in IMAM guidelines can choose any, substitutions
can be made depending on the tastes and preference of the local community)
4. After cooking, let the group members’ review and taste the cooked food items and give
constructive comments.
Setting up a programme
2 hours
In this session, carefully explain to the participants that it is important that every health facility has
a solid plan to establish an intervention program for the effective allocation of resources as well as
ensure good performance of the program. Using the PowerPoint slides, inform the participants about
the different components of setting up a MAM program, data collection, procurement of supplies
and documentation, recruitment and allocation of staff, determining case loads, supply handling
and management, distribution of foods and drugs and determining the patient load. It is important
to note that detailed information on supply handling and management will be handled in section
of supplies and stock control (see auxiliary slide on supply ordering and stock control). Allow
participants to ask questions and discuss any comments and suggestions raised by participants.
36
Practical Field visits to a MAM program
20 minutes
End Sessions: Give a brief summary of the section and issue out handout 5a to participants as
evening task- this can be done individually or as group tasks. Ask participants to read through the
handouts provided as take home assignments. Issue out the end of session evaluation forms and
ask participants to fill and hand it in before leaving the class Ask the repertoires to hand in their
notes to enable you compile the day’s activities and where possible discuss points that may not
be clear.
37
Section Five
Inform the participants that they will be visiting a supplementary feeding program for hands on
experience on management of MAM patients. Divide participants in groups and give them copies
of the checklists and questionnaires. Details of the field visits are presented in auxiliary slides and
instructional sheets for Practical field visits.
Notes
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_________________________________________________________________________________
Section 6:
Management of Acute Malnutrition
in the context of HIV/AIDS and other
chronic infections
Aim of Section is to enable health workers quickly and accurately identify, classify and
select appropriate treatment for malnutrition persons living with HIV and AIDS
Learning Objectives
By the end of this session participants should
be able to:
• Know the magnitude of HIV and AIDS in
Kenya
• Understand the link between malnutrition
and HIV/AIDS
• Understand the mode of transmission and
diseases progression
• Know the admission and discharge criteria
for malnourished PLHIV
• Be conversant with the nutritional support
and care for PLHIV
• Understand reasons for growth disorders
and growth failure
Time: 1 hour
Sessions:
1.
2.
3.
4.
5.
6.
7.
Overview
Links between HIV and Nutrition
Admission criteria and discharge criteria
Nutritional assessment, support and care
Routine medication
Monitoring
Follow-up
Main Training Techniques:
•
•
•
•
•
Case study
Evening tasks ( Home work)
Brain storming
Group discussions
39
Section Six
Section Six
Materials/equipment
Advance Preparation
advance.
• PowerPoint presentation 6
• Handout 8b:
• Handout 8c:
• Handbook
• National guidelines for Nutrition and HIV/
AIDs
• Infant and Young child Feeding in the
context of HIV and AIDS ( Counselling
Cards)
•
•
•
•
•
•
above)
training.
Mount presentation for section 6, rehearse
audience.
adequate copies.
energizer.
Procedures
Overview
10 minutes
Start off this session by giving participants an overview of the current HIV situation in Kenya
including that of children and HIV and AIDS. Explain to them that HIV and AIDS is strongly linked
to malnutrition and therefore care should be taken to ensure that all infected patients with HIV
and AIDS are managed appropriately. For additional reading, refer the participants to the national
guidelines for nutrition and HIV/AIDS, and infant and young child feeding in the context of HIV
and AIDS
Admission criteria and discharge criteria
10 minutes
Explain to the participants that admission and discharge criteria for malnourished persons living
with HIV are strictly observed to ensure proper targeting and efficient management of the program.
Describe the steps for admission and discharge criteria; here refer the participants to section 1 on
importance of diagnosis and triage and take them through the flow chart of nutritional assessment
(handout 8c). Inform the participants that during discharge, caretakers must be notified of the
patient’s final outcome and more or so the importance of counseling and follow up care.
40
30 minutes
In this session, inform the participants about the critical nutritional practices for PLHIV (Handout
8d). Explain to them the benefits of nutritional intervention in HIV and AIDS and nutrient
requirements for PLHIV. Note that detailed information on the amounts and quantities of nutrients
is available in the national guidelines for nutrition and HIV and AIDS. Routine medication for
children is essential to reduce chances of opportunistic infections. All patients and caregiver of
children should participate in nutrition counselling session. Provide caregivers brochures for take
home messages.
Monitoring and follow-up
10 minutes
Explain to the participants that monitoring and close follow-up of patients is very essential in
managing malnourished PLHIV. Part of monitoring is regularly assessing and identifying HIV related
symptoms and managing common infections. Also it is essential that children’s weight is monitored
periodically to determine growth and development.
End Session: Give a brief summary of the section. Ask participants to read through the handouts
participants to fill and hand it in before leaving the class. Ask the repertoires to hand in their notes
41
Section Six
Nutritional support and care and Routine medication
Notes
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Section Seven
Section 7:
Emergency Nutrition Response
Aim of Section is to prepare health workers for prompt and effective response for
Nutrition in Emergency setting
Learning Objectives
be able to:
• Understand what causes nutrition
emergencies
• Identify which groups are most nutritionally
vulnerable in an emergency
• Be aware of the different types of
malnutrition that arise in emergencies
• Identify steps in Emergency Response
• Be aware of the range of food related to
emergency nutrition responses and when
they are appropriate
• Identify requirements for emergency
nutrition interventions
• Understand the coordination mechanism in
emergency response
Time: 3 hours 20 minutes
Sessions:
•
•
•
•
•
•
Overview
Steps for Emergency Response
Types of emergency Nutrition Interventions
Requirements of an Emergency Nutrition
Intervention
Linking Nutrition Programmes and Other
Interventions
Steps in Community Mobilization
•
•
•
•
Brain storming
Group discussions
43
Section Seven
Materials/equipment
advance.
• Handbook
• PowerPoint presentation 7: Emergency
Nutrition Response
• Power Point Presentation auxiliary slides:
Supplies ordering and stock control and
• Power Point Presentation auxiliary slides:
Monitoring and Evaluation
• Report forms
• Registers
• ration cards
• Calculator
• Handout 6a: Stakeholders’ Role in
Emergency Response
• Handout 6b: Estimating target population
for SFP
• Handout 6c: Calculating amount of food to
procure
• Handout 6d: Reference supply procurement
figures
•
•
•
Handout 6e: Performance Indicators for
Nutrition Interventions
Caregivers brochures
Advance Preparation
•
•
•
•
•
•
•
above)
training.
Invite the guest speaker from ALRMP
- Special program and ask him/her to
give a talk on coordination process of
humanitarian response programs in Kenya.
audience.
adequate copies.
energizer.
Procedures
Overview
20 minutes
Start the session by defining emergency nutrition response and emphasising the fact that emergency
nutrition response primarily protects the nutritional status of vulnerable groups. Describe the
different categories of vulnerable groups, taking time to ask the participants to name specific
individuals in each of these groups. Give a brief of the situation in Kenya and issue out handout
6a. It is important to emphasise that all emergency nutrition responses are conducted under the
umbrella of the Health and Nutrition Sector Working Group chaired by the MoH. The sector is
charged with various responsibilities such as preparedness, prevention, mitigation, response and
relief.
44
40 minutes
Inform the participants of the three major steps for emergency response. Explain to them that
Coordination of all the emergency activities is the key to success of any response and that well
coordinated programs perform very well, to have a good coordination there must be good coordination
forums that enable healthy exchange of information between stakeholders. Issue out handout 6a
and ask each participant in turn to outline the responsibilities of each key stakeholder. Continue
the session by informing participants that an initial assessment using the standard procedures
is essential in order to determine the health and nutritional status of the affected population; In
relation to this, explain to the participants’ factors that yield a successful assessment. In addition
let the participants know that setting up a good response program requires good planning and
selecting an appropriate program site.
Guest speaker
20 minutes
End the session by inviting a guest speaker from Arid lands resource management program to
discuss the emergency response coordination structure in Kenya.
Types of emergency Nutrition Interventions
40 minutes
Describe the components of the emergency nutrition interventions and conditions or justification
for setting up the type of each program. Show the participants how to calculate the beneficiary
load for a targeted SFP and Issue out handout 6b for classroom exercise. Give the participants 10
minutes to calculate the answer and discuss the answers.
Requirements of an Emergency Nutrition Intervention
1 hour
There are several requirements for successful interventions, discuss each of the requirement, this
should include; Personnel, Supervision and Management, Office space, Supply Chain Management,
Transportation, Storage, Monitoring and Evaluation. It is worth mentioning that these are minimum
requirements for setting up a program, the quantity of each component will depend on the
magnitude of the problem as well as the resources available. Also the component of coordination is
very useful when determining program requirements as the program implementers may source for
additional support from another agency to fill in the gaps. Discuss the procurement process of the
Kenya MoH supply system- present in the supply and stock control slides. For section on program
performance – take the patients through the slides on monitoring and Evaluation.
Issue out handout 6c so that participants can learn how to calculate amount of food supplies
needed for a nutrition program. Handout 6 d is useful for providing additional information on
estimates of food quantities required.
45
Section Seven
Steps for Emergency Response
Section Seven
Classroom exercise: (Brainstorming)
Group discussions
10 minutes
Presentations
5 minutes
Divide classroom into groups and ask each group to discuss the current MoH supply systems and
recommend appropriate ways of making the system be more efficient. Use some of the problems
identified for workplan
Linking Nutrition Programmes and other Interventions
In this session inform the participants that emergency nutrition interventions are more effective
when all basic needs of the vulnerable population are met. This can only happen if the nutrition
intervention is linked to other programs that will provide needs such as water and sanitation, shelter,
security, disease control and prevention. In addition the existing program must be connected to a
community health services to ease referrals for the malnourished and sick beneficiaries.
participants to fill and hand it in before leaving the class Remind them to slot into the box their
46
Section Eight
Section 8:
Community Mobilization for
Nutrition Services
Aim of this Section is to enable health workers establish and maintain effective community
mobilization activities to support Nutrition services
Learning Objectives
be able to:
• Appreciate the importance of community
mobilization in IMAM services
• Understand the goals of community
mobilization
• Understand process of community
mobilization
• Understand the process of setting up a
referral system between the health facility
and the community
Time: 1 hour 40 minutes
Sessions:
•
•
•
•
Overview
Community Mobilization Goals
Community Mobilization Process
 Planning phase
 Implementation Phase
•
•
•
•
Brain storming
Group discussions
47
Section Eight
Materials/equipment
Advance Preparation
advance.
• PowerPoint presentation 8: Community
Mobilization for Nutrition services
• Handbook
• Handout 7a: Home visit Check list
• Handout 8a:Role play 2: Counseling
session during home visits
•
•
•
•
•
•
•
above)
training.
audience.
Make arrangement with 2 or 3 participants
to role play/ dramatise Role play 2 in
handout 8a
adequate copies.
energizer.
Procedures
Overview
20 minutes
In this session, emphasis the fact that the Out-Patient Care deals with nutritional care and support
for severely malnourished patients without medical complications, moderately malnourished
patients and those at risk. Outline the important players in the care support and effort made by
the ministry of health to strengthen the community health care through the essential packages.
Community Mobilization Goals and Processes
30 minutes
Explain the purpose of community mobilisation to the participants mentioning that community
mobilisation is key to success in management of a nutrition intervention. Inform the participant
that while setting up the community nutrition care it is important that the goals of community
mobilization are well understood by all players. Explain to them the two major processes of
community mobilization and how they are linked. The planning phase involves assessment of
48
community capacity to determine the gaps and levels of participation, whereas the implementation
phase is the actual participation and sensitizing of the community members on the importance of
nutritional care. Discuss the flow chart of community mobilization processes.
1 hour
In this session, discuss the various steps required to implement an effective community nutrition
care. These steps are; Assessing community capacity, community sensitization, case finding,
follow-up and on-going sensitization. The outreach team that includes the Health workers and
Community workers ought to pay attention as well as adhere to these steps. At the end of this
session, issue out handout 7a and discuss the checking lists for supervisors and community health
workers. Inform the participants that the checklist and report forms are sure way of monitoring
the community program.
Discuss the counselling points raised in role play 2 in Handout 8a (refer to section 4 above).
Inform the participants that close monitoring of the CMNS program guarantees efficiency and
share the reporting formats for home visits and supervisors.
End Sessions: Give a brief summary of the section and issue out handout list of resources. Ask
participants to read through the handouts. Issue out the end of session evaluation forms and ask
participants to fill and hand it in before leaving the class. Ask the repertoires to hand in their notes
to enable you compile the sessions activities and where possible discuss points that may not be
clear.
49
Section Eight
Notes
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Section Nine
Section 9:
Nutrition Information,
Education and Communication
Aim of this section is to provide a framework for health workers and Community Health
Workers to deliver nutrition-related information more effectively and enhance successful
management of acute malnutrition
Learning Objectives
be:
• Conversant with considerations for
successful nutrition education
• Able to identify steps in planning a nutrition
education activity
• Knowledgeable on vital messages that
should be relayed on specific nutrition
subjects
• Able to conduct effective nutrition
counseling
Time: 1 hour
Sessions:
•
•
•
•
•
•
•
Overview
Conducting a Nutrition Education Session
Nutrition promotion, enhancement,
protection and avoidance
Channels of Communication
Nutrition Topic and Message Content
Nutrition Counseling
Monitoring and Evaluation
•
•
•
•
•
•
Role play
Brain storming
Group discussions
Brain storming
Group discussions
51
Section Nine
Materials/equipment
Advance Preparation
advance.
• PowerPoint presentation 9:
• Handout : Word list
• Handout 8a: Role play- counseling a
caretaker
• Handbook
•
•
•
•
•
•
above)
training.
audience.
adequate copies.
energizer.
Procedures
Overview
5 minutes
Start the session by informing the participants of the importance of IEC in nutrition interventions.
Explain to them that behavior change depends on a successful nutrition education. A successful
nutrition education takes into consideration factors such as motivation of target population, beliefs
about their food and care for the sick. A participatory approach that is targeting a specific group
with a clear message is most appropriate.
Conducting a Nutrition Education Session
15 minutes
Outline and discuss the eight steps essential for conducting a nutrition education session. Emphasis
that before an education session takes place, the educator must first identify the prevailing training
needs; the most pressing need should be given priority. The best way to unravel such a need is to
identify the right group to train as well as use the right channel and resources to communicate the
information. Feedback is very important and a determinant of a good education session.
52
Classroom exercise: (Brainstorming)
Continue the session by informing the participants that the right channel of communication must
be identified and used appropriately so that the message can be relayed without distortions.
Discuss the two common channels of communication and indicate when each can be used.
Nutrition Topic and Message Content
15 minutes
This session provides information that will assist the health worker counsel the caregiver effectively.
The health worker needs to understand the subject matter as well as be able to relay the same
information t o the patients or caretakers. The topics for discussion are; Optimal breastfeeding,
complementary feeding,
Feeding sick and/or malnourished children, Maternal nutrition,
micronutrient deficiency, Protein - energy malnutrition, Growth monitoring, Immunization, Hygiene
and sanitation, De-worming and Nutrition and HIV/AIDS . In each topic, explain the message
content to the participants.
Nutrition counseling
20 minutes
Nutrition counseling is an integral part of managing acute malnutrition. While conducting the
counseling session familiarize yourself with the GATHER Approach recommended by the MoH. A
patient that is discharged from the nutrition program requires counseling to prevent relapse. The
topic of counseling is very much linked to the causes of malnutrition. In this session outline the
general guidance on counseling. Also inform the participants that counseling is an on-going activity
and community health workers should be conversant with the nutrition topics so as to assist
caretakers during follow-up and home visits. After every counseling session provide the patient
with a take home message brochure as a reminder of the topics discussed during counseling
sessions.
Role Play
•
•
•
•
•
Issue handout 8a
Role play should take approximately 10 minutes
Ask the volunteers to counsel the caregivers appropriately using the GATHER method.
The volunteers should use as much as possible the information in the heath workers note
book
At the end of each counseling session, health worker should give the caretaker a take home
message brochure.
53
Section Nine
Divide classroom into groups and allocate 10 minutes for discussion and 5 minutes for feedback.
ASK THE QUESTION: What factors should one consider when communicating a message?
Section Nine
Monitoring and Evaluation of training sessions
10 minutes
It is essential to monitor nutrition education processes so as to determine whether the set
objectives are achieved or not. Plans and Tools for monitoring and evaluating a nutrition education
program must be developed at the onset of the program. Out line to the participants the indicators
for monitoring and evaluation and the reasons for conducting an evaluation or monitoring exercise.
Mention to them that it is important that information obtained during monitoring and evaluation
of a nutrition education program is shared with partners so as to improve practices, scale-up
interventions, revise guidelines and reform policy.
End Sessions: Give a brief summary of the section and issue out list of resources and ask participants
to read through the reference materials for details information on counselling. Issue out the end of
session evaluation forms and ask participants to fill and hand it in before leaving the class. Ask the
repertoires to hand in their notes to enable you compile the sessions activities and where possible
discuss points that may not be clear.
54
Complimentary Topics
Complementary Topics
Topic 1:
Monitoring and Evaluation of IMAM programs
Aim of Section is to enable health workers to adequately monitor and evaluate IMAM
activities
Learning Objectives
be able to:
• Understand the meaning and difference
between monitoring and evaluation
• Understand the importance of monitoring
and evaluation nutrition interventions
• Correctly fill all reporting tools properly
• Gather, analyze data and compile monthly
reports
• Understands evaluation parameters
• Understand how to calculate and interpret
the different performance indicators
Time: 1 hour
Procedure
Content:
•
•
•
•
•
Definitions
Importance of Monitoring interventions
Monitoring tools and reporting formats
Importance of Evaluation
Parameters of Evaluation
1 hour
Mount the auxiliary slides for Monitoring and Evaluation. Explain to the participants the differences
between the two and explain that the impact of any program can be determined through putting
in place acceptable M&E tools and indicators. Continuous data collections and reporting is crucial
during program implementation, therefore each facility should keep records of basic information.
The information should also be shared with stakeholders. Explain to the participants the meaning
of the essential evaluation parameters. It is important to mention to the participants that details of
how to conduct monitoring and evaluation can be obtained from reference materials in the resource
list.
55
Topic 2:
Supplies and stock control
Aim of Section is to enable health workers adequately procure and manage
supplies for IMAM activities
Learning Objectives
be able to:
• Understand the importance of appropriate
supply requests and stock control
• Understand supply chain management for
IMAM
• Order supplies and monitor utilization of
supplies
Time: 40 minutes
Content:
•
•
•
•
Procedure
Types of food supplies ( commercial and
locally produced)
Non- food supplies
Estimating supplies needs
Supply chain for MOH
1 hour
Mount auxiliary slides for supplies ordering and stock control. Start the session by explaining
to the participants the importance of appropriate supply request and stock control for planning
and accountability purposes. Prepare and show samples of both commercial and locally produced
supplies to the participants. Practice how to calculate supply needs and discuss the supply chain
of MOH. Encourage the participants to identify any loops that hinder the smooth flow of supplies
and let them give suggestions what should be done to ease the flow.
Topic 3:
Work Plans
3.1 Workplan For Improving Service Delivery
Overview
The purpose of this section is to enable participants assimilate information obtained from training
and apply it in context. In this session, categorise the participants either by geographical zones
or by working group; whereby participants coming from the same geographical or administrative
areas are grouped together. Alternatively group participants based on working areas, for example
health workers working at In-Patient facility, Out- Patient Care and MAM centres can be grouped
together.
56
1. Outline the main challenges for effectively managing acute malnutrition in your working area.
Choose from the Focus areas stated below:
• Identification of malnutrition
• Processes of medical treatment and nutritional support and care
• Program Performance (low coverage, high deaths, high defaulters, high re-admission etc)
• Supply chain management (supply procurement, storage capacities, reporting formats/
registrar etc)
• Training of program staff (refresher courses) and on job training for other HW/CHW
• Monitoring and Evaluation (Reporting, stock taking and control, timeliness,
• Coordination /partnership for IMAM
• Community mobilisation for nutrition services (case finding, Follow-up/home visits)
• Counselling and nutrition education - dissemination of IEC materials and BCC
2. Prioritize the challenges
3. Agree on the means to solve the problems/challenges at your working area.
4. Develop a work plan indicating the following information
 Area (geographical area/ site)
 Focus area of management of acute malnutrition ( In-patient, OTP, MAM etc)
 Target group (<5 years, Pregnant and lactating mothers)
 Identified problem/challenge (e.g. Poor nutritional counselling by health workers)
 Formulate the Overall Objective and specific objective (s) based on the identified problems
 Recommend solutions and define specific activities aimed at achieving the set objectives
 Resources( funds, documentation, food supplies etc)
 State implementation period (when do you plan to undertake the specific activity)
 Responsible persons and their specific roles in undertaking each activity. (E.g. DNO will be
in-charge of training health workers in health facilities, providing necessary materials and
equipment and supervising).
 State output indicators (e.g. how many caretakers have been reached with key messages etc)
Name of working area ____________________________________________________________________
Focus area of IMAM
____________________________________________________________________
Target Group
____________________________________________________________________
Overall objective
____________________________________________________________________
Activities
Specific
Objective
Locale
Resources
Implementation
Responsible
Output
required
period
person and
indicators
specific roles
Activity 1
Activity 2
Prepared By:
_____________________
Authorised By: _____________________ (MOPH/MOMS)
Date:
_____________________
Date:
______________________
57
Discussion Points
Working Matrix
3.2 Workplan For Training Health Workers
Overview
Time: 40 minutes
The purpose of developing this work plan is to enable trainers to effectively plan an IMAM training
for health workers. In this session, categorise the participants based on geographical zones. Each
group will decide on;
1. Type of training (e.g. training for In-Patient Care or training for community health workers)
2. Content of training
3. Objective of training
4. Specific objective ( s)
5. Target audience (Nurses, paediatricians, nutritionists, community health workers etc) Duration for
the training ( number of days)
6. Date (s)of training
7. Venue ( indicate whether residential or non-residential)
8. Resource persons
9. Resources required for training (Funds, stationary, teaching aids, practical & demonstrations)
10. Monitoring /output indicators ( e.g. No. of trainings conducted, No. of target audience , knowledge
test results, training reports)
11. Follow-up (Persons responsible for follow-up )
Ministry/ Agency
____________________________________________________________________
Working Station
____________________________________________________________________
Overall objective
____________________________________________________________________
Content of
Specific
Target
Training
Objective
Audience
Date (s)
Resources
Resources
Practical
Output
Persons
Support
field visits/
indicators
Follow-up
demos
Complete
IMAM
Pacakge
Service Training Sessions
In-Patient
Out-Patient
Prepared By:
_____________________
Authorised By: _____________________ (MOPH/MOMS)
Date:
_____________________
Date:
58
______________________
Organising Field events
•
Pre-visit activities: Contact the officer in-charge of the health facility or Nutrition program
manager of SFP or OTP to be visited. Confirm the time of arrival, number of participants,
duration of the visit and areas of focus. If transport is needed, make sure that the training
administrator has organised for transport. Remind the participants about the visit one day in
advance and ask them to carry required materials and equipment. Break the participants into
groups and let each group choose a leader and a repertoire then provide them with a checklist
or ask the participants to develop a checklist depending on the subject matter. Inform the
various groups of the departure time ( in case they are not leaving at the same time)
•
Actual visit activities: Observe time; the participants need to understand that punctuality is
crucial for a successful visit. Participant will be introduced to centres’ contact person who
will brief them on the visit including the rules and regulation of the centre and this must be
adhered to by all participants. Participants should ensure to keep to the allocated time and as
much as possible ask questions relating to the subject matter and take notes. Also encourage
participants to interact with the patients (where need be). At the end of the visit, select a
participant to give a vote of thanks to the facility’s representative.
•
Post visit activities: Each group finalises on report and a repertoire presents feedback to the
rest of the participants. Discuss any outstanding issues and agree on way forward.
Post test and Final Evaluation
Issue out the post test sheet and allow 20 minutes to answer the questions. Remind participants
to write their respective code numbers in the space provided. After completing the test, mark
and award scores. Plot the individual percentages on the same bar graph that previously had the
pre-test results, compare the results of the two. This graph can be displayed in class. Remember
to congratulate the participants for good performance (if any). Ensure that the feedback is shared
with stakeholders. After the post test, issue out the end training evaluation form. Ask participants
to carefully read through the instructions and fill the form appropriately. Allocate 15 minutes
for the final evaluation. Collect the filled up forms and conduct an analysis to determine the
performance of the training. Share the information with your supervisors and give recommendation
on way forward.
59
Mount the Auxiliary slides on Practical field visits. Inform the participants of the importance of
the field visits to the various IMAM interventions; In-Patient Care, Out-Patient Care and MAM
programs. Provide the participants’ with the practical field visit instruction sheets for detailed
information. The participants will organise for the field visits as follows;
Appendices
All PowerPoint presentations available in CD- ROM enclosed
Sections 1-9
Auxiliary slides
Appendix 1- Handout for section 1
Available in the CD- ROM
Appendix 2- Handouts for section 1
Appendix 10- List of equipment and demonstration kits
Available in the CD Rom
Appendix 11- Resource list
Available in the CD-Rom
Appendix 12- Word list
Available in the CD- Rom
Appendix 13: National Guidelines for IMAM
Available in CD-ROM
Appendix 14: Hand Book for IMAM
Available in CD-ROM
60
Notes
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62
in partnership with

UNICEF - IMAM Trainers guide - 030210.indd

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