Facilitatorguide

FACILITATORGUIDE
C ONDUCT ICATT BASED IMCI TRAINING
DraftOctober2010

ICATTbasedIMCItraining

CONTENTS
GENERALPART..................................................................................................................................................................9 1. 2. 3. Introduction.............................................................................................................................................................11 PrepareforfacilitatingICATTbasedIMCItraining.................................................................................11 Facilitatortechniquesforanytrainingconfiguration............................................................................13 Facilitatortechniques:Workingwithacofacilitator................................................................................13 Facilitatortechniques:Motivatingparticipants...........................................................................................13 Facilitatortechniques:Coordinatingaroleplay..........................................................................................16 Facilitatortechniques:Leadingadrill..............................................................................................................16 Facilitatortechniques:Reviewingthedaywork ..........................................................................................17 ICATTCLASSROOMBASEDIMCITRAININGWITHINDIVIDUALCOMPUTERS...................................19 1. 2. Tasksofafacilitatorinclassroombasedtrainingwithindividualcomputers............................21 Facilitatortechniquesinclassroombasedtrainingwithindividualcomputers .........................22 Facilitatortechniques:Monitoringparticipantprogress..........................................................................22 Facilitatortechniques:Checkcompletedprintedcaserecordingforms............................................23 3. GuidelinesforINTRODUCTION.......................................................................................................................25 1. 2. 3. 4. Welcomeparticipants................................................................................................................................25 Presentation:IMCIstrategytoimprovehealthandoverviewofIMCIinthecountry..25 Objectivesofthetraining,trainingorganization,andyourroleasafacilitator................26 Presentation:IMCIcasemanagementprocess............................................................................27

5. Presentationanddemonstration:IMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts.........................................................................................................27 6. 4. GiveinteractivepresentationICATTHowtostart..................................................................28 GuidelinesforCAREOFCHILDAGED2MONTHSTO5YEARS..........................................................30 Part1:Assessandclassifychild...........................................................................................................................30 1. 2. 3. 4. 5. 6. 7. TrainingunitAskthemotheraboutthechildsproblems..........................................................31 TrainingunitCheckforgeneraldangersigns..................................................................................31 TrainingunitAssesscoughordifficultybreathing........................................................................32 TrainingunitAssessdiarrhoea..............................................................................................................33 TrainingunitAssessfever........................................................................................................................34 TrainingunitAssessearproblem.........................................................................................................34 TrainingunitCheckformalnutritionandanaemia.......................................................................34 3

Facilitatorguide 8. 9. 10. 11. 1. 2. 1. 2. 3. 4. 5. 6. 7. 1. 2. Checkimmunization,andvitaminAanddewormingstatus.....................................................35 TrainingunitAssessotherproblemsandreviewofassessandclassify..............................35 DrillReviewinginformationontheASSESS&CLASSIFYchart...........................................35 Summaryofthepart..............................................................................................................................35 TrainingunitIdentifytreatmentforchild.........................................................................................36 Summaryofthepart...................................................................................................................................38 TrainingunitSelectandgiveoraldrugs............................................................................................39 TrainingunitTeachthemothertogivetreatmentathome......................................................40 Drill:Practiseaskingcheckingquestions..........................................................................................40 Roleplay:TeachingamothertogiveoraldrugsDasar.............................................................40 TrainingunitGivetreatmentsandimmunizethechildattheclinic......................................40 TrainingunitGiveextrafluidfordiarrhoeaandcontinuefeeding.........................................40 Summaryofthepart...................................................................................................................................41 TrainingunitAssessfeedingandmakerecommendations.......................................................42 TrainingunitUsegoodcommunicationskills.................................................................................42

Part2:Identifytreatmentforchild.....................................................................................................................36

Part3:Treatthechild...............................................................................................................................................39

Part4:Counselthemother....................................................................................................................................41

3. Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice..........................................................................................................................................42 4. 1. 2. 5. Summaryofthepart...................................................................................................................................42 TrainingunitFollowupthechild..........................................................................................................43 Summaryofthepart...................................................................................................................................44 Part5:Followupthechild.....................................................................................................................................43

GuidelinesCAREOFYOUNGINFANTAGEDUPTO2MONTHS.........................................................45 Part1:Essentialcareforeveryyounginfant ..................................................................................................45 Part2:Assessandclassifyyounginfant...........................................................................................................45 Part3:Identifytreatmentforyounginfant,treatandcounsel...............................................................46 Part4:Followuptheyounginfant ......................................................................................................................47

ICATTCLASSROOMBASEDIMCITRAININGWITHLCDPROJECTOR.......................................................49 1. 2. TasksofafacilitatorinclassroombasedtrainingwithLCDprojector...........................................51 FacilitatortechniquesinclassroombasedtrainingwithLCDprojector........................................52 Facilitatortechniques:TeachingtheinformationinICATT.....................................................................52 Facilitatortechniques:DemonstratingICATTaudiovisualmaterials..................................................53 Facilitatortechniques:ConductingICATTexercises...................................................................................53 4

ICATTbasedIMCItraining Facilitatortechniques:PractiseusingchartbookletduringICATTsessions....................................54 Facilitatortechniques:WhenparticipantsneedabreakduringanICATTsession ........................55 3. GuidelinesforINTRODUCTION.......................................................................................................................57 1. 3. 4. Welcomeparticipants...............................................................................................................................57 Objectivesofthetraining,trainingorganization,andyourroleasafacilitator................58 Presentation:IMCIcasemanagementprocess............................................................................59 2. Presentation:IMCIstrategytoimprovehealthandoverviewofIMCIinthecountry..58

5. Presentationanddemonstration:IMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts.........................................................................................................59 4. GuidelinesforCAREOFCHILDAGED2MONTHSTO5YEARS..........................................................61 Part1:Assessandclassifychild...........................................................................................................................61 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3. 4. 1. 2. 3. 4. 5. 6. 7. 1. TrainingunitAskthemotheraboutthechildsproblems..........................................................62 TrainingunitCheckforgeneraldangersigns..................................................................................63 TrainingunitAssesscoughordifficultybreathing........................................................................63 TrainingunitAssessdiarrhoea..............................................................................................................64 TrainingunitAssessfever........................................................................................................................66 TrainingunitAssessearproblem.........................................................................................................66 TrainingunitCheckformalnutritionandanaemia.......................................................................66 Checkimmunization,vitaminAanddewormingstatus..............................................................67 TrainingunitAssessotherproblemsandreviewofassessandclassify..............................67 DrillReviewinginformationontheASSESS&CLASSIFYchart...........................................68 Summaryofthepart..............................................................................................................................68 TrainingunitIdentifytreatmentforchild.........................................................................................69 Summaryofthepart...................................................................................................................................71 TrainingunitSelectandgiveoraldrugs............................................................................................72 TrainingunitTeachthemothertogivetreatmentathome......................................................72 Drill:Practiseaskingcheckingquestions..........................................................................................73 Roleplay:TeachingamothertogiveoraldrugsDasar.............................................................73 TrainingunitGivetreatmentsandimmunizethechildattheclinic......................................73 TrainingunitGiveextrafluidfordiarrhoeaandcontinuefeeding.........................................73 Summaryofthepart...................................................................................................................................73 TrainingunitAssessfeedingandmakerecommendations.......................................................75 5

Part2:Identifytreatmentforchild.....................................................................................................................69

Part3:Treatthechild...............................................................................................................................................71

Part4:Counselthemother....................................................................................................................................75

Facilitatorguide 2. TrainingunitUsegoodcommunicationskills.................................................................................75

3. Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice..........................................................................................................................................76 4. 1. 2. 5. Summaryofthepart...................................................................................................................................76 TrainingunitFollowupthechild..........................................................................................................77 Summaryofthepart..................................................................................................................................78 Part5:Followupthechild.....................................................................................................................................77

GuidelinesforCAREOFYOUNGINFANTAGEDUPTO2MONTHS..................................................79 Part1:Essentialcareforeveryyounginfant ..................................................................................................79 Part2:Assessandclassifyyounginfant...........................................................................................................79 Part3:Identifytreatmentforyounginfant,treatandcounsel...............................................................80 Part4:Followuptheyounginfant ......................................................................................................................81

ICATTBASEDIMCIDISTANCELEARNINGTRAINING....................................................................................83 1. 2. 3. Tasksofafacilitator.............................................................................................................................................85 Trainingcalendarsequence,objectives,andlocationoftrainingevents...................................86 Initialfacilitatorparticipantencounter.......................................................................................................87 1. 2. Welcomeparticipants...............................................................................................................................87 Presentation:IMCIstrategytoimprovehealthandoverviewofIMCIinthecountry..88

3. Objectivesofthetraining,trainingorganization,agendaofthisencounter,andyour roleasafacilitator................................................................................................................................................88 4. Presentation:IMCIcasemanagementprocess...........................................................................89 5. Presentationanddemonstration:IMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts.........................................................................................................90 6. Clinicalpractice:Demonstrationoftheassessmentandclassificationofasickchild aged2monthsupto5years.............................................................................................................................90 7. 8. 4. GiveinteractivepresentationICATTHowtostart..................................................................92 ReviewParticipantworkbookandannouncepracticalarrangementsforthetraining .93

Intermediatefacilitatorparticipantencounter........................................................................................95 1. CollectingparticipantsICATTStudentprofiles,completedrecordingforms,and Individualrecordofparticipantprogressandcheckingparticipantprogress............................95 2. 3. 4. Objectivesandorganizationoftheintermediatefacilitatorparticipantencounter.....95 GroupoverviewofprogressinICATTandparticipantindividualclinicalpractice.........96 DrillReviewinginformationontheASSESS&CLASSIFYchart................................................96

5. Outpatientsession:Demonstrationofidentifyingtreatment,treatingthechildand counsellingthemother;individualpracticeinassessmentandclassificationofchildrenaged 2monthsupto5years........................................................................................................................................96 6. Groupfeedbackandproblemsolvingsession.................................................................................97 6

ICATTbasedIMCItraining 7. 8. 5. Individualfeedbackconductedinsmallgroups.............................................................................97 Summaryofworkandtasksforthe2ndselflearningphase......................................................97

Finalfacilitatorparticipantencounter.........................................................................................................99 1. CollectingparticipantsICATTStudentprofiles,completedrecordingforms,and Individualrecordofparticipantprogressandcheckingparticipantprogress............................99 2. 3. Objectivesandorganizationofthefinalfacilitatorparticipantencounter......................99 GroupoverviewofprogressinICATTandparticipantindividualclinicalpractice......100

4. Clinicalpracticeoutpatientsession:Individualpracticeincompletecasemanagement ofchildrenaged2monthsupto5years ...................................................................................................100 5. 6. Drill:Practiseaskingcheckingquestions.......................................................................................101 Groupfeedbackandproblemsolvingsession..............................................................................101

ANNEXES.........................................................................................................................................................................103 Annex1:CompletedrecordingformsforselectedICATTvideoexercises....................................105 Annex2:DrillReviewinginformationontheASSESS&CLASSIFYchart......................................110 Annex3:DrillPractiseaskingcheckingquestions...............................................................................115 Annex4:RoleplayTeachingamothertogiveoraldrugsDasar..................................................116 Annex5:RoleplayUsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice...........................................................................................................................................119 Annex6:DistancelearningtrainingParticipantsupportduringselflearningphases..........122 Annex7:DistancelearningtrainingCheckparticipantprogressandgiveindividualfeedback .........................................................................................................................................................................................124 Annex8:DistancelearningtrainingExampleIndividualrecordofparticipantprogress....127

Facilitatorguide

ICATTbasedIMCItraining

FACILITATORGUIDE
C ONDUC T ICATT BASED IMCI TR AINING

GENERALPART

Facilitatorguide

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ICATTbasedIMCItraining

1. INTRODUCTION
ThegenericFacilitatorguideconsistsofgeneralandtrainingconfigurationspecificparts.The generalpartprovidessuggestionshowtoprepareforfacilitatinganICATTbasedtrainingand describesfacilitatortechniquesthatareusedinanytypeoftraining.Inthetrainingspecific parts,therearethreesections.Eachsectionprovidesguidelinesforoneofthefollowingtraining configurations:classroombasedtrainingwithindividualcomputers,classroombasedtraining withLCDprojector,anddistancelearningtraining.Eachsectiondescribesfirstthetasksofa facilitator,thenfacilitatingtechniquesspecificforthetrainingconfigurationandlastlyit providesguidelinesforconductingthetraining. ThegenericFacilitatorguideneedsadaptationaccordingtonationalguidelines.Pedagogical adaptationisneededifthetrainingstructurewillbedifferentfromthegenericonedescribedin theDirectorguide. ToprepareforfacilitatinganICATTbasedIMCItraining,printtheGeneralpart,thetraining configurationthatyouwillconductandtheannexes. ThesectionSupportmaterialsintheICATTtrainingplayerprovidestrainingaidsforexample forteachingnavigationinICATT,conductingmoreorotherdrillsandroleplaysthanthose describedintheannexesofthisguideoraworkbookfordistancelearningtrainingparticipant.

2. PREPAREFORFACILITATINGICATTBASEDIMCITRAINING
ReadallthetrainingunitsandreviewallexercisesinICATTtrainingplayer.Trainingaid ICATTexercisesandanswersinICATTsupportmaterialsishelpfulforreviewingexercises. Italsoincludesnotesforpointstoemphasize. Thinkaboutpointsthatparticipantsmightfinddifficultandquestionstheymayask,plan waystohelpwithdifficultpointsandanswerpossiblequestions. Thinkabouttheskillstaughtineachtrainingunitandhowtheycanbeappliedinthe participants'ownsettingsorclinics.Planwhichquestionsyouwillasktheparticipants thatwillencouragethemtothinkaboutusingtheskillsintheirwork.Questionsare suggestedinappropriateplacesinthetrainingaidICATTexercisesandanswers. o Classroombasedtrainingwithindividualcomputers:Duringtheindividual learning,youwillmonitorwheretheparticipantsworkinICATT.Forthisreason itisespeciallyimportantthatyoulearntorecognizeeasilywhereinICATTthe participantsare.NotewhereinICATTyoucanfindthetitlesofvariousitems: Part,unitandsectiontitlescanbefoundrightbelowtheuppermenubar. Thetitleofanexerciseisshownoneachexercisescreen.Allexercisesin thePRACTISEsectionsarenumbered.ExercisesintheTESTsectionsare NOTnumbered.

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Facilitatorguide Anexercisequestionnumberandtotalnumberofquestionsinan exerciseareatthebottomofthescreen. o ClassroombasedtrainingwithLCDprojector: DecidehowyouwillpresenttheICATTtextcontente.g.: whichpartsofthetextcanbesummarizedandnotreadwordby word, whichpartsoftextyouwillreadyourselfandwhichshouldbe readbyaparticipant, howyouwillsummarizeeachpagewhatmajorpointsyouwill make. Bearinmindthatthedurationofworkingthrougheachofthetraining unitsshouldbeapproximatelyasindicatedinthecourseschedule. Decidewhichexerciseorexercisequestionsyouwillomitifyou arebehindthescheduleorwhichoptionalTESTexercisesor additionaldrillsorroleplaysyouwillconductifyouareaheadof schedule.Additionalroleplaysanddrillscanbefoundinthe trainingaidsConductroleplaysandLeaddrillsinICATTsupport materials. Runallthevideosandflashmoviesandreviewallthepictures.Somevideos,ifnot alreadyadapted,mayincludeinformationthatisnotcompletelyconsistentwithyour nationalIMCIguidelines.Makenotesonthesediscrepanciestoinformtheparticipants unlessthishasalreadybeendoneduringtheICATTnationaladaptation. Readtheguidelinesforeachcomponent(orfacilitatorparticipantencounterina distancelearningtraining)inthetrainingconfigurationspecificpartofthisguide. Ifyouhaveacofacilitator,planhowyouwilldividetheworkandhowyouwill collaborate. Prepareforanydemonstrations,drills,orroleplaysandcollectanynecessarysupplies. Collaboratewiththecourseorganizertoensureoptimalconditionsforprojected teaching:TheICATTtrainingplayerinstalledandrunningonthecomputeryouwilluse, thebestprojectoravailable,loudspeakers,projectionscreenifpossible(awallisless preferableaslightwillbeabsorbed),adequatelightingbutoutsidelightnotinterfering withprojection(curtains,shutters),noisenotinterfering(aircondition,fans,ambient noise),seatingarrangementspermittingcomfortablereadingdistance. IfyouwilluseIMCIwallcharts,putthemonthewallintheclassroom. Classroombasedtrainingwithindividualcomputers:Decidehowyouwilldealwith participantswho: o workmuchfasterthantherestandlearnwell(e.g.tellthemtolookatFurther readingmaterialsortotakeabreak) workmuchslowerthantherestevenafteryouhavehelpedthemtosolve obviousproblemssuchasinnavigationinICATT(e.g.optionaladditionalworkin theeveningsorskippingsomeexercisesinthePRACTISEpart).

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ICATTbasedIMCItraining Atthebeginningofthetraining,youwillgiveapresentationaboutIMCIstrategy. PresentationIMCIstrategytoimprovehealthcanbefoundintheICATTsupport materialsFacilitatorguideFacilitatoraids.Prepareyourselftodeliverthe presentation.Notethatintheagenda,thetitleofthepresentationisIMCIstrategyto improvehealthandoverviewofIMCIinthecountry.Thepartabouttheimplementationof ICATTinyourcountrymayhavealreadybeeninsertedintothepresentationduringthe nationalICATTadaptation.Ifnot,youneedtodevelopthispartofthepresentation yourself.YoumayfindtheinformationinICATTcomponentINTRODUCTIONifitwas adaptedoryoumayneedtoobtaintheinformationfromothersources.

3. FACILITATORTECHNIQUESFORANYTRAINING CONFIGURATION
FACILITATORTECHNIQUES:WORKINGWITHACOFACILITATOR
Agreewithyourcofacilitatorontherolesandresponsibilitiesandhowyoucanwork togetherasateam. Attheendofeachtrainingdayreviewtheactivitiesthatareplannedthenexttraining dayandagreewhowillbetheleadingfacilitatorinconductingeachactivity. Assistoneanotherinconductingactivities. Classroombasedtrainingwithindividualcomputers:Agreewithyourcofacilitatorhow youwillorganizethemonitoringofandassistancetotheparticipants. ClassroombasedtrainingwithLCDprojector:AssistoneanotherinpresentingICATT content,workingthroughICATTexercises.Forexample: o WhenyoupresenttheexamplecasestudiesonscreenFillinacaserecordingform intheREADsections,youmayreadthecasestudyandyourcofacilitatormaypoint onthescreentoshowhowtheinformationinthecasedescriptioniswrittenonthe recordingform. Youmayreadexercisequestions,yourcofacilitatormaygoaroundthetables,asking participantstogiveanswers,andyoumayentertheanswersintoICATT. Whentheparticipantsrecordinformationonprintedrecordingformsastheywatch thevideoincertainexercises,checktogetherwithyourcofacilitatorthatthe participantswritedowntheinformationontherecordingforms.Afterthevideoends checktogetherwithyourcofacilitatorthattheparticipantscompletedtherecording formsandclassifiedthecasecorrectlyandprovidefeedbackifneeded.

FACILITATORTECHNIQUES:MOTIVATINGPARTICIPANTS
Encourageinteraction Beavailabletotheparticipantsatalltimesinclassroombasedtrainingsandatagreed upontimesindistancelearningtraining. 13

Facilitatorguide Befriendlyandhelpfulwhenyoutalkwiththeparticipants.Bydoingthis,the participantswillovercometheirshynessandwillinteractwithyoumoreopenlyand productivelythroughoutthecourse. Checktoseeifparticipantsarehavinganyproblems,eveniftheydonotaskforhelp.If youshowinterest,theparticipantswillfeelmorecompelledtodothework.Also,ifthe participantsknowthatsomeoneisinterestedinwhattheyaredoing,theyaremore likelytoaskforhelpwhentheyneedit. Frequentlyaskquestionsofparticipantstochecktheirunderstandingandtokeepthem activelythinkingandparticipating.Questionsthatbeginwith"what,""why,"or"how" requiremorethanjustafewwordstoanswer.Avoidquestionsthatcanbeanswered withasimple"yes"or"no." o Afteraskingaquestion,PAUSE.Giveparticipantstimetothinkandvolunteera response.Ifnooneanswersyourquestion,rephrasingitcanhelptobreakthe tensionofsilence.Butdonotdothisrepeatedly.Somesilenceisproductive. Acknowledgeallparticipants'responseswithacomment,a"thankyou"ora definitenod.Thiswillmaketheparticipantsfeelvaluedandencourage participation.Ifyouthinkaparticipanthasmissedthepoint,askforclarification, oraskifanotherparticipanthasasuggestion.

Answerparticipants'questionswillingly,andencourageparticipantstoaskquestions whentheyhavethemratherthantoholdthequestionsuntilalatertime. Donotfeelcompelledtoanswereveryquestionyourself.Dependingonthesituation, youmayturnthequestionbacktotheparticipantorinviteotherparticipantstorespond. Youmayneedtodiscussthequestionwithanothertutorbeforeanswering.Beprepared tosay"Idon'tknowbutI'lltrytofindout." Usenameswhenyoucallonparticipantstospeak,andwhenyougivethemcreditor thanks.Usethespeaker'snamewhenyoureferbacktoapreviouscomment. Alwaysmaintaineyecontactwiththeparticipantssoeveryonefeelsincluded.Becareful nottoalwayslookatthesameparticipants.Lookingataparticipantforafewseconds willoftenpromptareply,evenfromashyparticipant.

Keepthesessionfocusedandlively Keepyourpresentationslively: o o o Presentinformationconversationallyratherthanreadit. Speakclearly.Varythepitchandspeedofyourvoice. Useexamplesfromyourownexperience,andaskparticipantsforexamplesfrom theirexperience.

Donotturnyourbacktothegroupforlongperiodsasyoupresent.

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ICATTbasedIMCItraining Trytoencouragequieterparticipantstotalk.Asktohearfromaparticipantinthegroup whohasnotspokenbefore,orwalktowardsomeonetofocusattentiononhimandmake himfeelheisbeingaskedtotalk. Trytoidentifyparticipantswhohavedifficultyunderstandingorspeakingthecourse language.Speakslowlyanddistinctlysoyoucanbemoreeasilyunderstoodand encouragetheparticipantinhiseffortstocommunicate.Arrangehelpfortheparticipant ifbepossible.

Reinforceparticipants'efforts Asafacilitator,youwillhaveyourownstyleofinteractingwithparticipants.However,a fewtechniquesforreinforcingparticipants'effortsinclude: o avoidinguseoffacialexpressionsorcommentsthatcouldcauseparticipantsto feelembarrassed, sittingorbendingdowntobeonthesamelevelastheparticipantwhentalking tohim, answeringquestionsthoughtfully,ratherthanhurriedly, encouragingparticipantstospeaktoyoubyallowingthemtime, appearinginterested,saying"That'sagoodquestion/suggestion."

o o o

Reinforceparticipantswho: o o o o tryhard askforanexplanationofaconfusingpoint doagoodjobonanexercise helpotherparticipants(withoutdistractingthembytalkingatlengthabout irrelevantmatters).

Relatingthetrainingcontenttoparticipants'work DiscusstheuseoftheIMCIcasemanagementproceduresintheparticipants'own professionalsettings.NotesonsomeICATTPRACTISEpartexercisesintrainingaid ICATTexercisesandanswerssuggestspecificquestionstoask.(Forexample,inIdentify treatment,asktowhichhospitalorclinictheparticipantcanreferchildrenwithsevere classifications;inTreatthechild,askwhatfluidswillberecommendedforPlanA,and askwhetherhedispenseddrugstomothers;inFollowup,askwhethermotherswill bringachildbackforfollowup.)Besuretoaskthesequestionsandlistentothe participant'sanswers.Thiswillhelpparticipantsbegintothinkabouthowtoapplywhat theyarelearning. Reinforceparticipantswhodiscussoraskquestionsaboutusingthesecasemanagement proceduresbyacknowledgingandrespondingtotheirconcerns.

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Facilitatorguide

FACILITATORTECHNIQUES:COORDINATINGAROLEPLAY
Beforetheroleplay,refertotheappropriatenotesinthisguidetoremindyourselfofthe purposeoftheroleplay,rolestobeassigned,backgroundinformation,andmajorpoints tomakeinthegroupdiscussionafterwards. Assignroles.Atfirst,selectindividualswhoareoutgoingratherthanshy,perhapsby askingforvolunteers.Ifnecessary,afacilitatormaybeamodelforthegroupbyactingin anearlyroleplay. Giveroleplayparticipantsanypropsneeded,forexample,ababydoll,anddrugs. Giveroleplayparticipantsanybackgroundinformationneeded. Suggestthatroleplayparticipantsspeakloudly. Allowpreparationtimeforroleplayparticipants. Wheneveryoneisready,arrangeseating/placementofindividualsinvolved.Havethe "mother"and"healthworker"standorsitapartfromtherestofthegroup,where everyonecanseethem. Beginbyintroducingtheplayersintheirrolesandstatingthepurposeorsituation.For example,youmayneedtodescribetheageofthechild,assessmentresults,andany treatmentalreadygiven. Interruptiftheplayersarehavingtremendousdifficultyorhavestrayedfromthe purposeoftheroleplay. Whentheroleplayisfinished,thanktheplayers.Ensurethatfeedbackofferedbythe restofthegroupissupportive.Firstdiscussthingsdonewell.Thendiscussthingsthat couldbeimproved. Trytogetallgroupmembersinvolvedindiscussionaftertheroleplay.Thereare questionsgiveninthisGuidetohelpstructurethediscussion. Askparticipantstosummarizewhattheylearnedfromtheroleplay.

FACILITATORTECHNIQUES:LEADINGADRILL
Gathertheparticipantstogetherandtellthemyouwillconductadrill.Tellthemwhattopicthey willreview. Explaintheproceduresfordoingthedrill.Tellparticipants: Thisisnotatest.Thedrillisanopportunityforparticipantstopracticewhathasbeen learned. Youwillcallonindividualparticipantsoneatatimetoanswerthequestions.Youwill usuallycallontheminorder,goingaroundthetable.Ifaparticipantcannotanswer,go tothenextpersonandaskthequestionagain.

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ICATTbasedIMCItraining Participantsshouldwaittobecalledonandshouldbepreparedtoanswerasquicklyas theycan.Thiswillhelpkeepthedrilllively.

Askifparticipantshaveanyquestionsabouthowtodothedrill. Allowparticipantstoreviewthetopicofthedrillforafewminutesbeforethedrillbegins. Ifrelevant,telltheparticipantstheymayrefertothechartbookletduringthedrill,butthey shouldtrytoanswerthequestionwithoutlookingatorreadingfromthechartbooklet. Startthedrillbyaskingthefirstquestion.Callonaparticularparticipanttoprovidetheanswer. Heshouldanswerasquicklyashecan.Thenaskthenextquestionandcallonanother participanttoanswer.Ifaparticipantgivesanincorrectanswer,askthenextparticipantifhe cananswer. Keepthedrillmovingatarapidpace.Repeatthelistofquestionsormakeupadditional questionsifyouthinkparticipantsneedextrapractice. Thedrillendswhenalltheparticipantshavehadanopportunitytoanswerandwhenyoufeel theparticipantsareansweringwithconfidence.

FACILITATORTECHNIQUES:REVIEWINGTHEDAYWORK
Forclassroombasedtrainings,attheendofeachdayreviewtheworkdone. Statewheretheparticipantsarenowandwhatpartsorunitstheyworkedthrough duringtheday. UserelevantSummariesofthepartsinthisguideand/orthetrainingunitsSpecific learningobjectivesinICATTtoreviewtheworkdone. InadditiontotheSummarycontentmentionanydifficultiesincomputerworkthatyou observed.Iftherearenavigationproblems,demonstratethedifficultitems. Answeranyquestionsthattheparticipantsmayhave. Informtheparticipantsabouttheworktobedonethenextday.

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Facilitatorguide

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ICATTbasedIMCItraining

FACILITATORGUIDESPECIFICPART
ICATTCLASSROOMBASEDIMCITRAININGWITH INDIVIDUALCOMPUTERS

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Facilitatorguide

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ICATTbasedIMCItraining

1. TASKSOFAFACILITATORINCLASSROOMBASEDTRAINING WITHINDIVIDUALCOMPUTERS
Introducethetrainingcourse,IMCI,andICATT. Deliverintroductorypresentations. TeachparticipantshowtonavigateinICATT. ExplainhowtheparticipantsshouldworkwithICATT. Monitortheprogressofparticipants.Thedurationofworkthrougheachtrainingunit shouldbeapproximatelyasindicatedinthecourseschedule. Provideassistancetoparticipantswhentheyaskforhelpandactivelyseekparticipants whomayneedhelpbutdonotaskforit. Provideindividualfeedbackoncompletedrecordingformsforselectedexercises. Conductdemonstrations,drills,androleplays. Prepareparticipantsforclinicalpracticesessionsandconducttheoutpatientsessions. Introduceandsummarizeeachdayswork. Assistthetrainingdirectorincollectingdataduringthecourse.

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Facilitatorguide

2. FACILITATORTECHNIQUESINCLASSROOMBASEDTRAINING WITHINDIVIDUALCOMPUTERS
FACILITATORTECHNIQUES:MONITORINGPARTICIPANTPROGRESS
Classroombasedtrainingwithindividualcomputersmayneedacertainamountofcoachingto helptheparticipantstocompletetheworkthroughtheICATTtrainingsetinthetimeallocated bythetraining. Atthebeginningofthetraining,telltheparticipantstoworkthroughthetrainingunits systematicallystartingfromcomponentCAREOFCHILDAGED2MONTHSUPTO5 YEARS(ICATTComponentINTRODUCTIONwillbesubstitutedbypresentationsanda demonstration). Letparticipantsworkattheirownpaceforabouttwohours.Observeiftheparticipants workapproximatelyaccordingtotheschedule.Atthebeginningtheirprogressis somewhatslowerthisisreflectedintheschedule. o Ifthemajorityofparticipantsareapproximatelyonthescheduleoraheadofit, letthemcontinueattheirownpace.Provideassistancetoindividualsasdescribed below.Ifthemajorityofparticipantsareconsistentlyaheadofschedule,consider addingadrilloraroleplay(AdditionaldrillsandroleplayscanbefoundinTraining aidsLeaddrillsandCoordinateroleplays)orreleasetheparticipantsearlywhen theyfinishthedaystasks. Ifthemajorityofparticipantsarebehindtheschedule: RemindthemtoworksystematicallythroughtheICATTandnottobrowse. Remindthemtoaskyouforassistancewhenevertheyhaveaproblem. AtthebeginningofeachICATTsession,writeonaflipchartthetitlesof trainingunitsscheduledforthatsessionandapproximatelyhowmuchtime shouldtheparticipantsneedtoworkthroughthem. Makearound510minutesaftertheparticipantswereexpectedtostarta newtrainingunitandcheckwhethertheystartedworkingonthescheduled unit. Ifyoudotheaboveandthemajorityofparticipantsarestillbehindthe schedule,adjusttheschedule.Oryoumayinstructparticipants10minutes beforethescheduledstartofanewtrainingunittoquitwhattheyweredoing (mostprobablyPRACTISEexercises)andtrytocompletetheTESTexercises. ThisisbecausetheparticipantsareusuallyveryeagertohavetheirProgress barindicatingunitsaspassed.

Ifaparticipantisbehindschedule,askhimorherifheorshehasaproblemandhelp theparticipanttosolvetheproblem. o Ifthefailuretopassthetrainingunit(redsquareontheprogressbar)isthe cause,reviewtheTESTexerciseswiththeparticipantandhelphimorherto 22

ICATTbasedIMCItraining correctthewronganswer(s).UsethetrainingaidICATTexercisesandanswers tochecktheanswers.DoNOTshowtheparticipanthowthecorrectanswerscan befoundintheCheckprogress,whichisaccessiblefromtheParticipantprofile. o Ifaparticipantisconsistentlyslowdespiteyourassistance,dependingonthe situation,offerhimorhereithertoworklongerhoursthanscheduledorsuggest whichexercisesinthePRACTISEpartheorshecanskipinthenextunits.

Ifaparticipantistoofaradvanced,checkifheorshehascompletedallexercisesand whetherheorsheunderstandstheprocess.Askhimorherhowheproceededtogetthe answers.UsenotesintheguidelinesfortheICATTcomponentsinthenextchaptersorin trainingaidICATTexercisesandanswers. o Iftheparticipanthascompletedallexercisesandunderstandstheprocess,praise himorherforworkingwellandtellhimorhertolookatFurtherreading materialsortotakeabreak. IftheparticipanthascompletedallexercisesbutdoesNOTunderstandthe process,explainwhatisneeded.Emphasisethatheorsheshouldreadalltext andtrytocompletetheexercisesonhisorherown.Heorsheshouldnotjust copytheanswersprovidedbyICATT. Iftheparticipanthasnotdoneallexercises,tellhimorhertoworkthroughthe exercises.

Periodicallymakeroundsandcheckif: o o ParticipantshaveproblemswithICATTnavigation.Ifyes,providehelpneeded. Participantsarecompletingtheprintedcaserecordingformsforselected exercises(checktheforms). Participantsareworkinginthetrainingunitinwhichtheyaresupposedtowork. Ifnot,findthereasonandprovidehelpwhenneeded.

FACILITATORTECHNIQUES:CHECKCOMPLETEDPRINTEDCASERECORDINGFORMS
CompletingaprintedcaserecordingformisrequiredinseveralICATTvideoexercises. DistributerecordingformstotheparticipantsatthebeginningofanICATTsession duringwhichtheyareexpectedtoworkthroughavideoexerciserequiringaprinted recordingform. Telltheparticipantstofilltheformastheywatchtheexercisevideo.Tellthemthat fillingtheformwillhelpthemtoanswertheexercisequestionsinICATTanditisalsoa usefulpracticefortheclinicalsessions. Observeparticipantsiftheyarewritinginformationintotherecordingformswhenthey runthevideointherelevantexerciseandremindthemtodosoifnot.Whenyouseethat

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Facilitatorguide aparticipanthasfinishedtheexercise,askhimorhertoshowyoutherecordingform. Checkifhecompletedtheformandifitwascompletedcorrectly. o o Iftheformhasbeencompletedcorrectly,praisetheparticipant. Iftheformhasbeencompletedbutnotcorrectly,gothroughtheexercisewiththe participantandhelphimorhertocompletetheformcorrectly.Completedrecording formscanbefoundinAnnex1ofthisguide. Iftheparticipanthasnotcompletedtheform,askhimorhertocompleteit(the participantcanusehisanswerstypedintoICATTtodoso).Thencheckiftheform hasbeencompletedcorrectly.Providefeedbackasneeded.

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ICATTbasedIMCItraining

3. GUIDELINESFORINTRODUCTION
PREPARETOFACILITATETHECOMPONENT TheICATTcomponentINTRODUCTIONisdoneinagroupintheformofpresentations.Prepare fordeliveringthesepresentations. PresentationIMCIstrategytoimprovehealthandICATTHowtostartandICATTHowto startcanbefoundintheICATTsupportmaterialsTrainingaids. ICATTINTRODUCTIONchaptersareusedforpresentationsIMCIcasemanagementprocess andIMCIcasemanagementchartsandrecordingforms. Participantswillbeintroducedtothechartbookletandcaserecordingformsinthiscomponent. Makesureyouhaveenoughprintedcopiesforalltheparticipants. ACTIVITIES 1.Welcomeparticipants.Introduceyourselfandaskparticipantstointroducethemselves. Participantstellwheretheyworkandtellbrieflytheirresponsibilityforcareofsickchildren. 2.GivepresentationIMCIstrategytoimprovehealthandoverviewofIMCIinthecountry 3.Describeobjectivesofthetraining,trainingorganization,andyourroleasafacilitator 4.PresentICATTchapterIMCIcasemanagementprocess. 5.PresentfromICATTanddemonstrate:IMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts(ifused).

1.

WELCOMEPARTICIPANTS Welcometheparticipants.
Ifparticipantsdonotknowyouordonotknoweachother,introduceyourselfasafacilitatorof thistrainingandwriteyournameontheflipchart. Asktheparticipantstointroducethemselvesandwritetheirnamesontheflipchart. Explaintoparticipantsthatyouwouldliketolearnmoreabouttheirresponsibilitiesforcaring forsickchildren.Thiswillhelpyouunderstandtheirsituationsandbeabetterfacilitatorfor them.Astheyintroducethemselves,askthemtotell: Whatisthenameofandsomecharacteristicofyourplaceofwork? Whatisyourpreviousandcurrentposition? HaveyoualreadybeentrainedinIMCIorpracticedIMCI? Leavethelistofnamesinaplacewhereeveryonecanseeittohelpyouandtheparticipants learneachother'snames.

2.

PRESENTATION:IMCISTRATEGYTOIMPROVEHEALTHANDOVERVIEWOFIMCIIN THE COUNTRY

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Facilitatorguide GivethepresentationIMCIstrategytoimprovehealthcomplementedbyanoverviewofIMCI implementationinyourcountry. ThispresentationisgiveninsteadofgoingthroughtheICATTchapterWhatisIMCIinthe ICATTcomponentINTRODUCTION.

3.

OBJECTIVESOFTHETRAINING,TRAININGORGANIZATION,ANDYOURROLEASA FACILITATOR

OpentheICATTtrainingplayerontheIntroductionpageanddescribetheobjectivesofthe trainingbasedonitscontent: IMCIstandsforIntegratedManagementofChildhoodIllness.Youwilllearnmoreabout IMCIlaterinthissession.Duringthetraining,youwilllearnhowtomanagesickchildren andhowtoaddressallthechildsproblemsandneedstogether,inanintegratedway.You willalsolearnhowtoprovideessentialcaretoallnewbornchildren,toensuretheirquick andsafeadaptationtothenewenvironment. Thiscomputerprogram,theIMCIComputerizedAdaptationandTrainingTool(ICATT)will helpyoulearnhowtomanagemajorchildhoodproblemsusingtheIMCIclinical managementguidelines.WithICATT,youwillbeabletolearnnewinformation,seevideos andphotographs,andtestyournewknowledge. Pointattheuppermenu: Yourtraininghasthreecomponents:INTRODUCTION,CAREOFSICKCHILDAGED2 MONTHSUPTO5YEARS,andCAREOFSICKYOUNGINFANTAGEDUPTOTW OMONTHS. OpentheCAREOFSICKCHILDAGED2MONTHSUPTO5YEARSscrolldownmenu:The componenthasseveralparts(readthetitles).OpenPart1Assessandclassify:Eachcomponent hasatleastonebutusuallymoretrainingunits.Openthefirsttrainingunitandpointatthe puzzleicons:Eachtrainingunithasfourparts:READ,SEE,PRACTISE,andTEST.OpentheREAD introductorypage:IntheREADpartyouwillreadthenecessaryinformation.OpentheSEEpart: intheSEEpartyouwillseevideosandpictures.OpenthePRACTISEpart:InthePRACTISEpart youwilldoexercisestopracticewhatyouhavelearned.Youwillgetanimmediatefeedbackifyour answerwascorrect.EverythingyoulearnaboutIMCIintheICATTmustbesupportedbyclinical practice.Youwillpracticeinarealclinicalsettinginordertolearnhowtoapplyyournewskillsin themanagementofsickyounginfantsandchildren.InthePRACTISEpartyouwillalwaysfind whichskillsyouneedtopracticeinaclinicalsession.OpentheTESTpart:IntheTESTpartyouwill doexercisestocheckyourprogress.Animmediatefeedbackifyouranswerwascorrectisnot providedimmediatelyasinthePRATISEpartbutyoucanseewhetheryouranswerswerecorrect ornotontheProgressbarlocatedatthebottomofeachscreen(showtheProgressbar). Mentionthefollowupvisitforaninservicetrainingifapplicable: Afteryoureturnhome,youwillbevisitedinyourclinicstohelpyouapplyyournewskillsin yourownsetting. Makeannouncementsaboutscheduleandpracticalorganizationofthetraining.Performany necessaryadministrativetasks.

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ICATTbasedIMCItraining Explaintoparticipantsthatasafacilitator,youwill: guidethemthroughthetrainingactivities, teachthemhowtonavigateintheICATT, helpthemwithnavigationinICATTifneeded, clarifyinformationtheyfindconfusingandanswerquestionsthattheymighthave, leaddrills,androleplays, summarizethedailywork,and preparethemforeachclinicalsession(explainwhattheywilldoandwhattotake)and assistsinthem.

Answeranyquestionsthattheparticipantsmayhave. Tellparticipantsthatthetraininghasthreecomponents: INTRODUCTION, CAREOFSICKYOUNGINFANTAGEDUPTO2MONTHS,and CAREOFSICKCHILDAGED2MONTHSTO5YEARS.

NowtheyarereadytolearnabouttheIMCIcasemanagementprocessandtheIMCIclinical guidelinesdescribedintheIntroduction.

4.

PRESENTATION:IMCICASEMANAGEMENTPROCESS
Brieflyintroducethefirstscreen. Wherepossible,summarizethepartsofthetextonthescreenreadingtheimportanttext (notreadingitwordbyword). Summarizethecontentofthescreenhighlightingthemainpoints. Movetothenextscreen. Attheendofthepresentationsummarize: TheIMCIcasemanagementprocessconsistsofsixsteps: ASSESS CLASSIFY IDENTIFYTREATMENT TREATTHECHILD COUNSELTHEMOTHER FOLLOWUP (Ifwallchartsareused,pointtoorwalktoeachofthechartsonthewallasyousay itstitle.)TheIMCIcasemanagementprocessisdescribedonchartsthathavealsobeen transformedintoachartbooklet.Nowyouaregoingtolearnmoreaboutthecase managementchartsandthechartbooklet.

PresentchapterIMCIcasemanagementprocessintheICATTIntroductioncomponent:

5. PRESENTATIONANDDEMONSTRATION:IMCICASEMANAGEMENTCHARTSAND RECORDINGFORMS,PRINTEDCHARTBOOKLET,ANDWALLCHARTS.
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Facilitatorguide GiveoneIMCIchartbooklet,onecopyoftherecordingformforsickchildaged2monthsupto5 years,andonecopyoftherecordingformforyounginfanttoeachparticipantbeforethe presentation. UseprojectedpagesofICATTchapterIMCIcasemanagementchartsandrecordingformsfor yourguidanceandtheguidanceofparticipantsbutdoNOTreadthescreens.Demonstratewhat isdescribedoneachscreeninthechartbookletorontherecordingforms. Afterdemonstratingeachitem,asktheparticipantstofinditinthechartbookletorinthe recordingform.Ifyouusewallcharts,demonstratetheitemonthewallchart.Yourcofacilitator checksthattheparticipantshavefoundeachdemonstrateditem. WhenyoufinishpresentingtheICATTchapterIMCIcasemanagementchartsandrecording forms,telltheparticipants:AsyouworkthroughICATTpages,youwillseealinktothechart bookletSeeIMCIchart.Italwaysdisplaysonlyapartofthechartrelevantforwhatisonthe screen.Demonstrate,forexample,thelinkinCareofchildaged2monthsupto5years,Part1 Assessandclassify,Assesscoughordifficultybreathing. Askparticipantsiftheyhaveanyquestionsaboutwhattheyreadorheard.Answertheir questions,butdonotexplainindetailhowtousethecasemanagementcharts.Thiswillbe taughtintherestofthetraining. Note: Participantsmayaskwhetherthecasemanagementchartscanbeusedforchildrenwho areolderthantheagegroupsspecifiedonthecharts.Iftheyaskthisquestionnow,explainas simplyaspossible,suchasbyusingonlytheexplanationinbolditalicsbelow.Iftheyasklaterin thetraining,aftertheyhavelearnedhowtoassessandclassify,theycouldunderstandtheentire explanationintheboxbelow.
Whynotusethisprocessforchildrenage5yearsormore? Thecasemanagementprocessisdesignedforchildrenlessthan5yearsofage.Althoughmuchoftheadviceon treatmentofpneumonia,diarrhoea,malaria,measlesandmalnutritionisapplicabletoolderchildren,theassessment andclassificationofolderchildrenwoulddiffer.Forexample,thecutoffratesfordeterminingfastbreathingwouldbe different,becausenormalbreathingratesareslowerinolderchildren.Chestindrawingisnotareliablesignofsevere pneumoniaaschildrengetolderandthebonesofthechestbecomemorefirm.Olderchildrencantalkandsoareable toreportadditionalsymptomswhicharenotinthesecharts,suchaschestpainandheadache,whichmaybeusefulin decidingwhetherpneumoniaormalariaispresent. Inaddition,certaintreatmentrecommendationsoradvicetothemotheronfeedingwoulddifferforchildrenover5 yearsofage.Thedrugdosingtablesonlyapplytochildrenupto5years.Thefeedingadviceforolderchildrenmay differandtheymayhavedifferentfeedingproblems. Tosummarize:Muchofthetreatmentadvicemaybehelpfulforachildage5yearsormore.However,becauseof differencesintheclinicalsignsofolderandyoungerchildrenwhohavetheseillnesses,thisassessmentand classificationprocessusingtheseclinicalsignsisnotrecommendedforolderchildren.

6. GIVEINTERACTIVEPRESENTATIONICATTHOWTOSTART.
Iftheparticipantshavenoorverylimitedcomputerskills,runflashmovieHowtousea computerbeforeyougivethepresentation.YouwillfindthisflashmovieinICATTsupport materialsTrainingaids.Itexplainsthemaincomponentsofacomputer. FollowthestepsinthepresentationICATTHowtostart.Describeanddemonstrateandthe navigationstepsswitchingbetweenthepresentationandICATTplayer[usingtheAltTabkeys] 28

ICATTbasedIMCItraining asneeded.Asktheparticipantsaftereachsteptoperformthesameactionasyoudid.Other facilitator(s)checkthattheparticipantshavedoneit. Important:Donotoverwhelmtheparticipantswithnavigationdetailssuchasdifferentways howtogettoaparticularplaceinICATT.Demonstrateonlythemainstepsneededfor navigationthemostimportantbeingtheNext/Backbuttons.Participantsofaclassroombased trainingneedtolearnonlythebasicsatthebeginningtheywillhavetheopportunitytoaskyou forhelpwheneverneededandmostlylearnbydoingitthemselves. Tellparticipantsthattheyshouldaskyouforhelpanytimeduringthetrainingtheyhavea questionconcerningthenavigationinICATTorthecontentofthetraining.Askifthereareany questionsandprovideanswersasneeded. Whentherearenomorequestions,tellparticipantsthattheyarereadytobeginwiththefirst stepofcasemanagement,assessingandclassifyingasickchildaged2monthsupto5years.Tell themtostartnow.

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Facilitatorguide

4. GUIDELINESFORCAREOFCHILDAGED2MONTHSTO 5YEARS
NOTE: Participantswillworkthroughthetrainingunitsindividually.Theseguidelinesprovide onlyadditionalinstructionswhereneeded. Forsomeexercises,therearepointstoemphasise.Duringthetrainingyouwillcheck howparticipantsareworkingthroughtheexercisesandprovideassistancewhen needed.Whenyouprovideassistancewithanexercisetoaparticipant,makesureto emphasisethepointsmentionedintheseguidelines.

PART1:ASSESSANDCLASSIFYCHILD
PREPARETOFACILITATETHEPART Eachparticipantwillneed8copiesofrecordingformsforthefollowingvideoexercises: ACTIVITIES 1. ParticipantsworkthroughtrainingunitAskthemotheraboutthechildsproblem. 2. ParticipantsworkthroughtrainingunitCheckforgeneraldangersigns. 3. ParticipantsworkthroughtrainingunitAssesscoughordifficultybreathing. 4. ParticipantsworkthroughtrainingunitAssessdiarrhoea. 5. ParticipantsworkthroughtrainingunitAssessfever. 6. ParticipantsworkthroughtrainingunitAssessearproblem. 30 Assesscoughordifficultybreathing:Exercise6Classifycoughordifficultybreathing casestudyGyatsu Assesscoughordifficultybreathing:Exercise7Classifycoughordifficultybreathing casestudyWambui Assesscoughordifficultybreathing:Exercise5CasestudyBen Assessdiarrhoea:Exercise5CasestudyJosh Assessfever:Exercise7CasestudyPu Checkformalnutritionandanaemia:Exercise6CasestudyJenny Assessotherproblemsandreviewofassessandclassify:Exercise7CasestudyFaduma Assessotherproblemsandreviewofassessandclassify:Exercise8CasestudyMartha

ICATTbasedIMCItraining 7. ParticipantsworkthroughtrainingunitCheckformalnutritionandanaemia. 8. ParticipantsworkthroughtrainingunitCheckimmunization,vitaminAanddeworming status. 9. ParticipantsworkthroughtrainingunitAssessotherproblemsandreviewofassessand classify. 10. LeaddrillReviewinginformationontheASSESS&CLASSIFYchart 11. Summarizethepart.

1.

TRAININGUNITASKTHEMOTHERABOUTTHECHILDSPROBLEMS
DotheyusetheNextbutton? DotheyknowhowtorunthevideoCommunicationwithmother? DotheyknowhowtoworkthroughtheflashmovieRulesofgoodcommunicationand quiz? DotheyticktheanswersinExercise1Maincausesofchildhooddeathbeforetheyclick OKtorevealthecorrectanswers? DotheytypetheiranswerforExercise2Goodcommunicationskillsbeforetheyclick OKtorevealthepossiblecorrectanswer?Canallparticipantstypewithoutdifficulties? WhenparticipantsmovetothenexttrainingunitCheckforgeneraldangersignsis theirProgressbarsquarefortrainingunitAskthemotheraboutthechildsproblems green?

Whiletheparticipantsareworking,observehowtheywork:

Provideassistancetoparticipantswhohavedifficulties.

2. TRAININGUNITCHECKFORGENERALDANGERSIGNS
Whiletheparticipantsareworkingthroughthisandthenexttrainingunits,continueobserving thepointsdescribedintheprevioustrainingunituntilyouseethatallparticipantsknowhowto workthroughtheICATTcorrectly. Ifneeded,remindparticipantsthattheyshouldnotspendtimewithFurtherreadingmaterials unlesstheyhavesufficienttime. PRACTISEsection Exercise1Lethargicorunconsciouschild(video) Emphasizepointssuchas:

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Facilitatorguide Noticethatachildwhoislethargicmayhavehiseyesopenbutisnotalertorpayingattentionto whatishappeningaroundhim. Somenormalyoungchildrensleepverysoundlyandneedconsiderableshakingoraloudnoise towakethem.Whentheyareawake,however,theyarealert.

3. TRAININGUNITASSESSCOUGHORDIFFICULTYBREATHING
Whiletheparticipantsareworkingcontinueobservingtheitemsdescribedpreviously. Inadditioncheckthatparticipants: UsethelinkSeeIMCIcharttothechartbooklet. Knowhowtoenlargeapicture. Knowhowtoscrolldownthepage.

PRACTISEsection Exercise2CountWumbi'srespiratoryrate(video) Emphasizethatcountingbreathingrequirescloseattentiontoonespotonthechestorabdomen. Exercise4AssessforchestindrawingII(video)Tellparticipantsthattheymayskipthis exercise. Exercise5Stridororwheezing(video) Note:Chestindrawing,stridor,andwheezingrequireknowingwhenthechildisbreathingin andout.Remindtheparticipantstopracticethiswhentheyseechildrenintheclinic. Videoexercises6,7,and8 Giveeachparticipantrecordingformsfortheseexercisesandaskthemtofilltheformsasthey watchthevideosand,aftereachvideohasfinished,toclassifythechild.Checkthatthe participantsfilledtherecordingformsandclassifiedthecasescorrectly.(Completedrecording formsareinAnnex1ofthisguide.)Providefeedbackifneeded. Exercise6ClassifycoughordifficultybreathingcasestudyGyatsu Note: Thisisthefirsttimeparticipantspracticeclassifyingamainsymptom.Askquestionstoconfirm thattheparticipantunderstandshowtousetheclassificationtable.Forexample: HowdidyoudecidethatGyatsudoesnothaveageneraldangersign? Howdidyoudecidethatthechildhasfastbreathing? Whereonthechartdidyoulooktodecideiffastbreathingispresent?

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ICATTbasedIMCItraining Whereonthechartdidyoulookwhenselectingaclassificationforcoughordifficult breathing? Howdidyoufinallyselectthischild'sclassification? Thisisalsothefirsttimeparticipantspracticewritingonarecordingform.Makesurethatthe participantrecordsinformationcorrectlyontherecordingform.Remindtheparticipantto alwaysstartfromthepink(ortop)row.

4.

TRAININGUNITASSESSDIARRHOEA

PRACTISEsection Exercise2Sunkeneyes(photoandvideo) Note:Ifyouarenotsurethatthechildeyesaresunken,askthemotherifthechildseyeslook unusualtoher. Exercise3Skinpinch(video) Emphasizefollowing: Ifyoucanseethetentedskinevenbrieflyafteryoureleasetheskin,thisisaslowskin pinch.Askinpinchwhichreturnsimmediatelyissoquickthatyoucannotseethetented skinatallafterreleasingit. Repeattheskinpinchifyouarenotsure.Makesureyouaredoingitintherightposition. Exercise4Classifydiarrhoea Note: Whenparticipantsusetheclassificationtablefordehydrationtheywilluseaprocessslightly differentthanwhattheyuseforassessingcough.Theymayhavequestionsorbeconfusedabout whytwoormoresignsareneededtoclassifydehydrationandonlyonesigntoclassifycoughor difficultbreathing,orpersistentdiarrhoeaanddysentery.Also,whenclassifyingdiarrhoea,the childmayhaveone,twoorthreeclassificationsrelatedtodiarrhoea.Explainthatyes,thisisa differentprocessandthateachmainsymptomisclassifiedinslightlydifferentways. Askaparticipanttoshowyouontheclassificationtablehows/heselectedtheclassification. Reinforcetheprocessofstartingwiththepinkrow,thenyellowandthengreenrow. Exercise5CasestudyJosh(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideoand,afterthevideoends,toclassifythechild.Checkthattheparticipantscompleted therecordingformandclassifiedthecasecorrectlyandprovidefeedbackifneeded.(The completedrecordingformisinAnnex1ofthisguide.) 33

Facilitatorguide Note: Thisisthefirsttimeparticipantspracticeclassifyingmorethanonemainsymptom.Makesure thattheparticipantrecordsinformationcorrectlyontherecordingform.Asyoutalkthrough eachcasewiththeparticipant,askhimorhertodescribehowheorsheselectedthechild's classifications.Reinforcepointssuchas: alwaysstartfromthepink(ortop)row toselectaclassificationfordehydration,theremustbetwosignspresenttoselecteither SEVEREorSOMEDEHYDRATION onlyclassifyPersistentdiarrhoeaifthechildhashaddiarrhoeafor14daysormore. onlyclassifyDysenteryifthechildhasbloodinthestool.

Sometimeschildrenwhoaresickortiredareverystillintheclinicbuttheyrespondtotouchor voice.Joshisanexampleofthis.Theyshouldnotbeconsideredlethargic.Itcanbehardtotell thisonthevideobecauseyouonlyseeafewminutesofthechild.Ifyouinitiallythinkachildis lethargicbutthenheorsheawakensandbecomesalertlaterintheexam,donotconsiderthis childtohavethegeneraldangersign"lethargicorunconscious".

5.

TRAININGUNITASSESSFEVER

PRACTISEsection Exercise7CasestudyPu(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideoand,afterthevideoends,toclassifythechild.Checkthattheparticipantscompleted therecordingformandclassifiedthecasecorrectlyandprovidefeedbackifneeded.(The completedrecordingformisinAnnex1ofthisguide.)

6. 7.

TRAININGUNITASSESSEARPROBLEM TRAININGUNITCHECKFORMALNUTRITIONANDANAEMIA

Therearenospecialinstructions.

PRACTISEsection Exercise5ClassifymalnutritionandanaemiaCasestudyKalisa Note:Thisisthefirsttimeparticipantsusetheweightforagechart.Tomakesurethatthe participantunderstandshowtodetermineweightforage,askhimorhertoshowyouonthe weightforagecharthowheorshedeterminedweightforageforeachcase. Exercise6CasestudyJenny(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideoand,afterthevideoends,toclassifythechild.Checkthattheparticipantsfilledthe

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ICATTbasedIMCItraining recordingformandclassifiedthecasecorrectlyandprovidefeedbackifneeded.(Completed recordingformisinAnnex1ofthisguide.)

8.

CHECKIMMUNIZATION,ANDVITAMINAANDDEWORMINGSTATUS

PRACTISEsection Exercise3ImmunizationsandvitaminAprophylaxisforMarco Note: Emphasizethatthereareveryfewcontraindicationsforimmunizations.Evenwhena contraindicationispresentforonevaccine,othervaccinesmaybesafelygiven. Checktoseethattheparticipantunderstandshowtousetherecommendedimmunization schedulewhendecidingifthechildneedsanyimmunizationsduringthisvisit.Forexample: Howdoyoudecidethatachildneededanimmunizationtoday? Whatwouldyousaytothemotherfirsttofindoutthischild'simmunizationhistory? Ifshesays,"Yes,Ibroughtanimmunizationcardtoday,"whatshouldyoudonext? Ifshedidnotbringthecardtoday,whatwouldyoudo?

9.

TRAININGUNITASSESSOTHERPROBLEMSANDREVIEWOFASSESSANDCLASSIFY

SEEsection Checkthatparticipantsdonotspendmuchtimestudyingthesectiontherearemanyother conditionsachildmayhaveandthoseincludedinICATTarejustafewexamples. PRACTISEsection Iftheparticipantsarebehindschedule,tellthemtoskipexercisesinthePRACTISEpart. Exercise7CasestudyFaduma(video)andExercise8CasestudyMartha(video) Giveeachparticipanttwocopiesofarecordingformandaskthemtofilltheformastheywatch thevideoand,afterthevideoends,toclassifythechild.Checkthattheparticipantsfilledthe recordingformsandclassifiedthecasecorrectlyandprovidefeedbackifneeded.

10. DRILLREVIEWINGINFORMATIONONTHEASSESS&CLASSIFYCHART
YouwillfindthedrillinAnnex2ofthisguide. LeadthisdrillanytimeafterparticipantshavefinishedASSESS&CLASSIFY.Thedrillconsistsof fourparts.Youmayconductthepartsseparatelywhenparticipantsneedabreakfromwork withICATT.

11. SUMMARYOFTHEPART
Toreviewthemainskillscoveredinthispart,readthelearningobjectiveslistedbelow.Asyou stateeachobjective,point(oraskaparticipantoryourcofacilitatortopoint)towherethe relevantstepislocatedonthechart.UsethewallchartoropenthelinkSeeIMCIchartinthe

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Facilitatorguide READpartofthetrainingunitAssessotherproblemsandreviewofassessandclassifyit displayscompleteASSESS&CLASSIFYpartofthechartbooklet. Nowyoushouldknowandhavetheknowledgeandskillsto: Askthemotheraboutthechild'sproblem. Checkforgeneraldangersigns. Askthemotheraboutthefourmainsymptoms: o coughordifficultbreathing o diarrhoea o fever o earproblem. Whenamainsymptomispresent: o assessthechildfurtherforsignsrelatedtothemainsymptom o classifytheillnessaccordingtothesignswhicharepresentorabsent. Checkforsignsofmalnutritionandanaemiaandclassifyingthechild'snutritionalstatus. Checkthechild'simmunizationstatusanddecideifthechildneedsanyimmunizations today. Assessanyotherproblems. Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants,suchas recognizingaparticularsign.Tellparticipantsthatseveralpointsinthispartwillbereinforced infutureclinicalsessions.Theywillalsobereviewedthroughouttherestofthepartsthat describehowtoidentifytreatment,treatsickchildrenandcounselmothers. Answeranyquestionsthattheparticipantsmayhave.

PART2:IDENTIFYTREATMENTFORCHILD
ACTIVITIES 1. ParticipantsworkthroughtrainingunitIdentifytreatmentforchild. 2. Summarizethepart.

1. TRAININGUNITIDENTIFYTREATMENTFORCHILD
Atsometimewhenparticipantsworkthroughthistrainingunit,interrupttheirworkinICATT andmakeademonstrationofthereversesideofrecordingform. Demonstrationofthereversesideofrecordingform Askparticipantstotakeoutoneoftherecordingformsthattheyusedfortheassessmentand classificationintheirclinicalpracticesession. Showhowtofoldthe"Classify"columnofthecaserecordingformsothatitcanbeseenwhile lookingatthebackoftheform.Thenmakethefollowingpoints: LookattheASSESS&CLASSIFYcharttofindthetreatmentsneededforeachclassification. 36

ICATTbasedIMCItraining Listtreatmentsneededonthebackoftheform,acrossfromtheclassification. Writeonlytherelevanttreatments. Shortenthewordingoftreatmentsifdesired.Forexample,ahealthworkerwrote:Fluid andfood(PlanB)insteadof"Givefluidandfoodforsomedehydration(PlanB)." Followuptimesarelistedinthetreatments.Thesemeantotellthemothertoreturnina certainnumberofdays.Youmayabbreviate"Followup"as"F/up."Ifyoulistseveral followuptimes,youwilltellthemothertheearliest,definitetime.Thisisthetimetorecord inthedesignatedspaceontherecordingform. (Note:youmayalsoneedtotellthemotheraboutearlierfollowupthatmaybeneededifa problempersists.Forexample,youmayneedtosay"Returnin5daysforsure,butreturnin 2daysifthereisstillfever.") Noticethattherecordingformalreadyliststheitem,"Advisemotherwhentoreturn immediately,"becauseitisneededforeverysickchildgoinghome.Donotlistthisagain. (YouwilllearnthesignswhichindicatewhentoreturnimmediatelylaterinPart4.Counsel themother,trainingunitUsegoodcommunicationskills.) Noticethespaceonthebackoftherecordingformtorecordimmunizationsneededtoday. YouwilllearnhowtocompletethefeedingsectionsoftherecordingforminPart4.Counsel themother.Whenfeedingassessmentisneeded,itmaybedoneatanyconvenienttime duringthevisit,afterthechild'simmediateneedsaretakencareof. Ifthesametreatmentisneededformorethanoneclassification,youonlyneedtolistit once.However,sincedifferentantibioticsmaybeneededfordifferentproblems,list antibiotictreatmentseparatelyforeachproblem,forexample: o o antibioticforpneumonia antibioticforacuteearinfection

IfachildhasPNEUMONIAforwhichcotrimoxazolewillbegiven,thecotrimoxazolewill serveastreatmentfortheacuteearinfectionaswell.

Askoneparticipantwhattreatmentsheorsheidentifiedforhisorherpatient.Discussas needed.Continueaskingforthetreatmentidentifieduntilyoureviewallthetreatments identifiedforallclassificationsthattheparticipantspatientshave. SEEsection Picture2ImportantdecisionsfortreatmentplanC ExplaindecisionsfortreatmentplanCtothewholegroup: EnlargethepictureandreadthesimplifiedPlanCoutloudasparticipantsfollowonthescreen. TellparticipantsthatplanCwillbetaughtindetailinthenextpart.Fornowyouwillfocuson thequestionsontheleftside.ExplainwhathappensforeachNOorYESanswer. 37

Facilitatorguide DiscusswhethertheparticipantsclinicshaveIVtherapyavailable,whetherIVtherapyis availablenearby(within30minutes),andwhetherNGtubescanbeused.Thesituationatthe participantsclinicwilldeterminewhatheorshecandoforachildwhoneedsPlanC. PRACTISEsection Exercise1Decidewhetherornoturgentreferralisneeded Note:Question5(Habib)involvescasewithdiarrhoeawithSEVEREDEHYDRATION.Besurethe participantunderstandswhentokeeporrefersuchacase: Ifthechildalsohasanothersevereclassification,refer.Specialexpertiseisrequiredto rehydratethischild,astoomuchfluidgiventooquicklycouldendangerhislife. Ifthechildhasnoothersevereclassification,usePlanCtodecideifyoushould rehydratethechildatyourclinicorreferthechild.

Exercise4IdentifytreatmentsforAina Note:Pointoutthedifferencebetweenurgentandnonurgentreferral.Ainaneedstobereferred forfevermorethan7days,butitisnotanurgentreferral.Thereistimefortheothertreatments neededbeforeAinagoestothehospital. Exercise7Identifyurgentprereferraltreatmentneeded Note:Remindparticipantsthaturgent,prereferraltreatmentsareinboldprintontheASSESS andCLASSIFYchart.

2. SUMMARYOFTHEPART
AskparticipantstobrieflysummarizewhattopicshavebeencoveredbypartandunitIDENTIFY TREATMENT.Participantsshouldcalloutwhatthisparthastaughtthemandyouwilllisttheir responsesonaflipchart. Showthespecificlearningobjectivesinthetrainingunit.Askparticipantstoprovidefeedbackas towhethertheyfeelthattheseobjectiveshavebeenmet. Participantsshouldhighlightanydifficultareas,wheretheyneedfurtherclarificationandask finalquestions. Asktheparticipantstowhathospitalorclinictheyreferchildrenwhoneedurgentreferral. Discussbrieflyhowfarawaythatisandhowmotherscantravelthere. Thanktheparticipantsfortheirgoodwork.Tellthemthattheyhavesuccessfullycompletedthe IDENTIFYTREATMENTstepandtheyarenowreadytoproceedtothenextpartTREAT,where theywilllearnhowtodothenecessarytreatments. 38

ICATTbasedIMCItraining

PART3:TREATTHECHILD
PREPARETOFACILITATETHEPART Thereisoneroleplayinthispart.Assigntheroleofamother(orfather)intheroleplaytoone participantandtheroleofahealthworkertoanotherone.Gatherallsupplieslistedintherole playdescription.Youwillalsoneedonehandoutperparticipantfortheroleplay. ACTIVITIES 1. ParticipantsworkthroughtrainingunitSelectandgiveoraldrugs. 2. ParticipantsworkthroughtrainingunitTeachthemothertogivetreatmentathome. 3. Leaddrilloncheckingquestions. 4. Coordinateroleplay:TeachingamothertogiveoraldrugsDasar. 5. ParticipantsworkthroughtrainingunitGivetreatmentandimmunizethechildatthe clinic. 6. ParticipantsworkthroughtrainingunitGiveextrafluidfordiarrhoeaandcontinue feeding. 7. Summarizethepart.

1. TRAININGUNITSELECTANDGIVEORALDRUGS
SEEsection Video:Useofrapidactingbronchodilator RemindtheparticipantsthattheyhaveseenthevideointhetrainingunitCoughordifficulty breathing.Theydonotneedtorunthe12minutesvideoagain.(Alsoitscontentistosome extentbeyondthescopeofthisIMCItraining.) Video:CoughManagementofwheezeinsmallhospital CommentappropriatelyonthedifferencebetweentheIMCIguidelinesandhospitaltreatment describedinthevideo(oxygen,rapidactingbronchodilator,andprednisolone). PRACTISEsection Checkthattheparticipantsunderstandthattheyshouldenterthedrugdosesindecimal numbers(e.g.0.5,1.5)andnotfractions(e.g.(1/2). Checkthattheparticipantsunderstandcorrectlytheageranges.Forexampleagerange2 monthsupto12monthsreferstoachildwhois2monthsoldorolderbutnotyet12monthsold.

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Facilitatorguide Makesuretheparticipantsunderstandwhenachildcanbetreatedwithasingleantibioticand whentwoantibioticsareneeded. Exercise2SelectanappropriateoralantibioticforPNEUMONIAandACUTEEAR INFECTION Note:TherecommendeddurationoftreatmentforPNEUMONIAis3daysandforACUTEEAR INFECTION5days.Asthechildhasbothclassifications,heorsheshouldreceivecotrimoxazole for5days.

2. TRAININGUNITTEACHTHEMOTHERTOGIVETREATMENTATHOME
Sothatyouwillbetterunderstandtheparticipantssituation,asktheparticipantsifthey dispensedrugstomothersathisclinic.Ifsomeoneelsegivesthetablets,capsulesorsyrupto motherstotakehome,tellparticipantsthattheyshouldstillteachthemotherhowtogivethe drugsathome. Allexercisesinthisunitrequirewrittenanswers.Iffeasible,comparetheparticipant'sanswers withanswersgivenhere.Itisacceptableiftheparticipant'sanswersarewordedsomewhat differentlybutreflecttheteachingstepscoveredintheunit. Iftheparticipant'sanswersdonotreflectthestepstaughtintheunitorifhisorheranswersare exactlythesameasinICATT,havetheparticipantlocatetherelevantstepsintheunit.

3. DRILL:PRACTISEASKINGCHECKINGQUESTIONS
ThedrillisinAnnex3ofthisguide. LeadthisdrillatanyconvenienttimeafteryouworkedthroughthetrainingunitTeachthe mothertogivetreatmentathome.Youmaywishtodoitwhentheparticipantsneedabreak fromICATTwork,orafteralunchorteabreak.

4.

ROLEPLAY:TEACHINGAMOTHERTOGIVEORALDRUGSDASAR FollowtheinstructionsfortheroleplayinAnnex4ofthisguide.
ConducttheroleplayatanysuitabletimeafterworkingthroughtrainingunitTeachthemother togivetreatmentathome.

5.

TRAININGUNITGIVETREATMENTSANDIMMUNIZETHECHILDATTHECLINIC

Therearenospecialinstructionsforthistrainingunit.

6.

TRAININGUNITGIVEEXTRAFLUIDFORDIARRHOEAANDCONTINUEFEEDING PRACTISEsection
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ICATTbasedIMCItraining Exercise3TreatmentplanC(text) TellparticipantstoworkthroughtheexerciseonlyiftheyareallowedandcangiveIVfluidin theirhealthfacility.

7.

SUMMARYOFTHEPART Toreviewthemainskillscoveredinthispart,readthelearningobjectiveslistedbelow.
Nowyoushouldknowandhavetheskillsto: Determineappropriateoraldrugsanddosagesforasickchild. Giveoraldrugs(includingantibiotics,antimalarials,paracetamol,vitaminA,ironand mebendazole),andteachingthemotherhowandwhentogiveoraldrugsathome. Treatlocalinfections(suchaseyeinfections,eardrainage,mouthulcers,sorethroatand cough),andteachthemotherhowandwhentogivethetreatmentsathome. Checkamother'sunderstanding. Givedrugsadministeredinthecliniconly(intramuscularinjectionsofampicillin, gentamicin,andquinine). Preventlowbloodsugar. Treatdifferentclassificationsofdehydration,andteachingthemotheraboutextrafluidto giveathome. Immunizechildren.

Tellparticipantswhatwasdonewellduringtheirworkthroughthispart.Alsomentionany pointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave. Thanktheparticipantsfortheirgoodwork.Tellthemthattheyhavesuccessfullycompletedthe TREATMENTstepandtheyarenowreadytoproceedtothenextpartCOUNSELTHEMOTHER.

PART4:COUNSELTHEMOTHER
PREPARETOFACILITATETHEPART Thereisoneroleplayinthispart.Assigntheroleofamother(orfather)intheroleplaytoone participantandtheroleofahealthworkertoanotherone.Collectallsupplieslistedintherole playdescription.Youwillalsoneedonehandoutperparticipantfortheroleplay,onehandout forthemother,andacopyoftheMother'scardforthehealthworker. 41

Facilitatorguide ACTIVITIES 1. ParticipantsworkthroughtrainingunitAssessfeedingandmakerecommendations. 2. ParticipantsworkthroughtrainingunitUsegoodcommunicationskills. 3. Conductroleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice. 4. Summarizethepart.

1. TRAININGUNITASSESSFEEDINGANDMAKERECOMMENDATIONS PRACTISEpart
Exercise1Feedingrecommendations(text) Note: ThemainpointofExercise1istoidentifyrelevantfeedingadviceandlimitadvicetothat.Be surethattheparticipantsunderstandthatitisnotnecessarytogiveallthefeedingadviceto everymother.Ifcertainrecommendationsarenotbeingfollowed,adviceshouldbelimitedto thoserecommendations.Thishelpsthemotherfocusonwhatisimportantinhersituation. Ifthechildisbeingfedcorrectlyforhisorheragegroup,thenthemothermaynotneedany feedingadvicenow.(Ifthechildisabouttoenteranewagegroupwithdifferentfeeding recommendations,however,explainthesenewrecommendationstoher.)Remembertopraise themotherforfeedingpracticesthatarecorrect. Stresstheimportanceofteachingthemotheraboutwhentoreturn,especiallytheimportanceof teachingherthesignstoreturnimmediately.

2.

TRAININGUNITUSEGOODCOMMUNICATIONSKILLS

Therearenospecialinstructionsforthistrainingunit.

3.

ROLEPLAY:USINGGOODCOMMUNICATIONSKILLSANDTHEENTIRECOUNSELCHART ANDMOTHERS CARDFELICE

FollowtheinstructionsfortheroleplayinAnnex5ofthisguide. ConducttheroleplayatanysuitabletimeafterworkingthroughtrainingunitUsegood communicationskills.

4. SUMMARYOFTHEPART
Leadabriefdiscussiontoreviewwiththeparticipantsthemainskillscoveredinthispart: Assessthechild'sfeeding Identifyfeedingproblems Counselthemotheraboutfeedingproblems 42

ICATTbasedIMCItraining Advisethemothertoincreasefluidduringillness Advisethemother: o whentoreturnforfollowupvisits, o whentoreturnimmediatelyforfurthercare, o whentoreturnforimmunizations Giverelevantadvicetoeachmother Usegoodcommunicationskills UseaMother'scardasacommunicationstool. Leadagroupdiscussionoflocalfeedingproblemsandrecommendedadvicefortheseproblems. Relatethediscussiontothefeedingproblemsofchildrenseenduringtheclinicalsessions.(If participantshavenotyetpractisedcounsellingaboutfeedingduringaclinicalsession,delaythis discussionuntilafterthatclinicalsession.) Askparticipantswhatcommonlocalfeedingproblemstheyfoundduringtheirclinicalsessions. ForproblemscoveredontheCOUNSELchart,pointoutwhatadviceshouldbegiven.Forany additionallocalproblemsidentifiedbyparticipants,askwhatwouldbesuitableadvice. Askparticipantsiftherecommendedadviceforlocalfeedingproblemsispractical.Askif mothersarelikelytofollowthisadvice.Ifnot,askforalternativesuggestionsthatwould improvefeeding,bepractical,andbefollowedbymothers. Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmaystillhave.

PART5:FOLLOWUPTHECHILD
ACTIVITIES 1.ParticipantsworkthroughsectionandtrainingunitFollowupthechild. 2.Summarizethepart.

1. TRAININGUNITFOLLOWUPTHECHILD
PRACTISEsection Makesurethateachparticipantlearns: WheretofindinstructionsforafollowupvisitontheTREATchart. Howtoassessachildwhocomesforfollowup. Howtoselecttreatmentbasedonresultsofthefollowupassessment. Torefertohospitalanychildwhohasmultipleproblemsandisgettingworse.Also referanychildwhoneedsasecondlinedrugwhichisnotavailable,andanychild youareworriedaboutordonotknowhowtotreat.

Asyoudiscusstheanswerswithparticipants,askthemtoshowyouwheretheylookedonthe chartforinformationaboutconductingthefollowupvisitforPNEUMONIA:Followupboxfor 43

Facilitatorguide PNEUMONIAontheTREATchart,theASSESS&CLASSIFYchartforhowtoassessdangersigns andcoughanddifficultbreathing,andtheantibioticboxontheTREATchart. Asktheparticipantsifmotherswhocometotheirclinicswillbringachildbackforfollowup.If theysaythatmothersusuallywillnot,discusshowtheycouldmakefollowupvisitsmore convenientforthem.Alsodiscusshowtheycouldexplaintothemtheimportanceoffollowup.

2. SUMMARYOFTHEPART Reviewwithparticipantstheskillscoveredinthispartwithonetrainingunitaslistedinthe ICATTspecificlearningobjectives.

Theparticipantsshouldknownow: Decideiffollowupisrequired Assessthesickchildduringfollowupvisit Selectappropriatetreatmentbasedontheresultsoftheassessmentduringfollowup visit Checkwhetherthechildhasanynewproblems Assessandclassifyanynewproblemsthechildmayhave.

Discusswithparticipantswhatchangeswouldbeneededintheirclinicstoencouragemothers tobringtheirsickchildrenandinfantsforfollowupcare.e.g.notchargingforfollowupvisitsor reducingthewaitingtimespentinthequeue. Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsstillmayhave.

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ICATTbasedIMCItraining

5. GUIDELINESCAREOFYOUNGINFANTAGEDUPTO2 MONTHS
PART1:ESSENTIALCAREFOREVERYYOUNGINFANT
ACTIVITIES 1. ParticipantsworkthroughsectionandtrainingunitEssentialcareforeveryyoung infant. 2. Summarizethepart. Therearenospecialinstructionsforthistrainingpart. Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsshouldknownow: howtopreparethedeliveryareaforthemotherandnewbaby theessentialneedsofallnewbornsimmediatelyafterbirth howtoprepareasafeandwarmenvironmentforeachnewborn whatawarmchainmeansanditsroleinthethermalprotectionofeverynewborn howtoensuretheearlyinitiationofbreastfeeding howtoensureskintoskincontactbetweenthemotherandnewborn themainstepsforroutinecareofthebaby'seyesandumbilicalcord thebasicrulesofgoodcommunicationwiththemotherandotherfamilymembers.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsstillmayhave.

PART2:ASSESSANDCLASSIFYYOUNGINFANT
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Facilitatorguide ACTIVITITES 1. ParticipantsworkthroughtrainingunitCheckyounginfantforveryseverediseaseand localbacterialinfection. 2. ParticipantsworkthroughtrainingunitCheckyounginfantforjaundice. 3. ParticipantsworkthroughtrainingunitAssessyounginfantsdiarrhoea. 4. ParticipantsworkthroughtrainingunitCheckyounginfantforfeedingproblemorlow weight. 5. ParticipantsworkthroughtrainingunitCheckimmunizationandassessotherproblems oftheyounginfant. 6. Summarizethepart. Therearenospecialinstructionsforthispart. Tosummarizethepart,leadabriefdiscussiontoreviewwiththeparticipantsthemainskills coveredinthispart: Provideessentialcareforeveryyounginfant Checkayounginfantforveryseverediseaseandlocalbacterialinfection Checkayounginfantforjaundice Assessandclassifyayounginfantwithdiarrhoea Checkforafeedingproblemorlowweight,assessbreastfeedingandclassifyfeeding

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficult. Answeranyquestionsthattheparticipantsmayhave.

PART3:IDENTIFYTREATMENTFORYOUNGINFANT,TREATANDCOUNSEL
ACTIVITIES 1.ParticipantsworkthroughsectionandtrainingunitIdentifytreatmentforyounginfant,treat andcounsel. 2.Summarizethepart. Therearenospecialinstructionsforthispart.

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ICATTbasedIMCItraining Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsnowshouldknowhowto: identifytreatmentsneeded,includingurgentprereferraltreatments treatayounginfantwithoralorintramuscularantibiotics givefluidfortreatmentofdiarrhoea teachthemothertotreatlocalinfectionsathome teachthemotherthecorrectbreastfeedingtechnique teachthemotherhowtoexpressbreastmilkandfeedtheinfantusingacup advisethemotherhowtotreatheryounginfantathome.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave.

PART4:FOLLOWUPTHEYOUNGINFANT
ACTIVITIES 1. ParticipantsworkthroughsectionandtrainingunitFollowuptheyounginfant. 2. Summarizethepart. Therearenospecialinstructionsforthispart. Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsshouldnowknowhowto: decidewhethertheyounginfant'svisitisforfollowup assessthesignsspecifiedinthefollowupboxfortheyounginfant'sprevious classification selecttreatmentsbasedontheyounginfant'ssignsandsymptoms decidewhethertheyounginfanthasanynewproblemsandifso,howtoassessand classifythem.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave. 47

Facilitatorguide

48

ICATTbasedIMCItraining

FACILITATORGUIDESPECIFICPART
ICATTCLASSROOMBASEDIMCITRAININGWITHLCD PROJECTOR

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Facilitatorguide

50

ICATTbasedIMCItraining

1. TASKSOFAFACILITATORINCLASSROOMBASEDTRAININGWITH LCDPROJECTOR
IntroducethetrainingcourseandICATT. WorkthroughallICATTunitsandsectionstogetherwiththeparticipantsasan interactiveactivity: o o Readand/orsummarizeallthetextscreenstogetherwiththeparticipants, Runthevideosandflashmoviesandshowthepicturesanddiscussthemas needed, WorkthroughthePRACTISEpartexercises(TESTexercisesarenotworked throughunlesstheparticipantsneedmorepracticeandthereissufficienttime).

Checktheparticipantsunderstanding. Conductdemonstrations,drills,androleplays. Prepareparticipantsforclinicalpracticesessionsandassistinthem. Keeptheschedule.Thedurationofworkthrougheachtrainingunitshouldbe approximatelyasindicatedinthecourseschedule. Assistthetrainingdirectorincollectingdataduringthecourse.

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Facilitatorguide

2. FACILITATORTECHNIQUESINCLASSROOMBASEDTRAINING WITHLCDPROJECTOR
FACILITATORTECHNIQUES:TEACHINGTHEINFORMATIONINICATT
ICATTcomponent,partorunitintroductionandKeyinformationintheREADpart Whenyoustart,brieflyintroducethefirstscreen. Giveparticipantssometimetoreadthetext.(Readsilentlyapproximatelyonehalfofthe textonthescreenyourself,thenstartsummarizingseenextpoint.) Thensummarizethetextonthescreenhighlightingthemainpoints(usuallyinbluebold font)withoutreadingitwordbyword(Averygoodpreparationofthefacilitatoris neededinadvance). UsethelinkSeeIMCIcharttoopentherelevantpageofthechartbooklet(where applicable)andaskparticipantstofindthepageintheirprintedcopiesofthechart booklet.ReinforcetheinformationontheKeystepspage. Movetothenextscreen. Alternativelyaskaparticipanttoreadapartofimportanttextaloudandthenask anotherparticipanttoreadthenextpartofthetext.Donotaskparticipantstoread aloudthewholetextinICATTitwouldtaketoolong.

Fillinacaserecordingformpage Readthecasestudyandpointoraskyourcofacilitatortopointonthescreentoshow howtheinformationinthecasedescriptionisrecordedontherecordingform. InthecomponentCAREOFCHILDAGED2MONTHSUPTO5YEARS,Part1:Assessand classify,thereisanexamplecaseFatimathatcontinuesthroughthefirstfivetraining units.AsktheparticipantstofillarecordingformforFatima.Checkoraskyouco facilitatortocheckthattheparticipantsfilltheformscorrectly.

Furtherreadingpage WhenyoucometotheFurtherreadingpageinthefirsttrainingunit,explainto participantsthatmanyreferencematerialsareavailableintheICATTlibrary.Herethey seelinkstothesematerials.ThesematerialshoweverareNOTincludedintothetraining course.Skipthesepagesinnexttrainingunits.

WhatNOTtodo DonotrepeatedlyreadaloudforparticipantsthefacilitatinginstructionsinICATTe.g. READorSEEpartintroductorypage. 52

ICATTbasedIMCItraining

FACILITATORTECHNIQUES:DEMONSTRATINGICATTAUDIOVISUALMATERIALS
Videoandsoundsdemonstration Runthevideos. Askparticipantsiftheyhaveanyquestions.Answertheirquestions. ExplaindiscrepanciesbetweenthevideocontentandyournationalIMCIguidelinesif thereareany.

Pictures Showtheenlargedpictures. Reinforcetheinformationillustratedanddiscussasneeded.

Flashmovies Runtheflashmovies. Askparticipantsiftheyhaveanyquestions.Answertheirquestions.

FACILITATORTECHNIQUES:CONDUCTINGICATTEXERCISES
UsethetrainingaidICATTexercisesandanswersto: Prepareyourselfforconductingtheexercises,includinginformationthatneedstobe emphasisedincertainexercises, Decidewhichexercisesorwhichexercisequestionsyouwillskipiftimeisshort, Checkthecorrectanswerswhenyouconductanexerciseandyouarenotsurewhatis thecorrectanswer, Checkparticipantsanswersonrecordingforms(whenused).

Conductexercises Tellparticipantswhattheywilldointheexercise.Thisinformationisontheexercise introductionpage.Ifthereisalsoacasedescription,readitaloudandtellparticipants thatthesametextinitalicswillappearoneachquestionscreenoftheexercise,sothey donotneedtorememberalltheinformation,theywillseeitagain. o Whererelevant,tellparticipantsthattheyshouldusetheirprintedcopiesofthe chartbooklet. Whererelevant,instructparticipantstouserecordingforms.

Gothefirstquestionandreadit. Giveparticipantstimetopreparetheiranswer. Dependingonthequestion,alternatethefollowingtogetanswersfromtheparticipants: 53

Facilitatorguide o Askparticipantsasagroupfortheanswer.Whenyoureceiveananswerfromone participant,askifotherparticipantshaveanotheropinionandcommentifneeded. Callonindividualparticipantsoneatatimeintheorderthattheysittoanswerthe question.Ifaparticipantcannotanswer,ordoesnotanswerthequestioncorrectly, gotothenextpersonandaskthequestionagain.Participantsshouldwaittobe called.(Yourcofacilitatormaygoaroundthetablesandcallparticipantsandyou entertheanswersintoICATT.) Selectalessactiveparticipantandaskhimorhertoanswerthequestion.Askif otherparticipantshaveanotheropinionandcommentifneeded. EnterthecorrectanswerintoICATT,andgotothenextquestion.

Exercisesthatrequirewriting Callonindividualparticipantstogiveyouoneanswereach.Continueaskingparticipants untilyouwillgetacompleteanswer(ChecktheanswersinICATTexercisesandanswers ifneeded). TypeparticipantsanswersintoICATTor,fordiversity,askyourcofacilitatortowrite themonaflipchart. Whenyoucollectallanswers,clickOKtorevealthepossibleansweranddiscussif needed.

ExercisesintheTESTpartareoptionalforLCDprojectedteaching.Donotconductthese exercisesunlessyouhaveasparetimeandfeelthatparticipantsneedmorepractice.Exercises intheTESTpartreviewthemostimportantitemsalreadypractisedinthePRACTISEsection. IfyoutoconducttheTESTexercisesconductthemsimilarlyasthePRACTISEpart exercises. NotethattheanswersforTESTexercisesdonotappearonscreenusethetrainingaid ICATTexercisesandanswerstochecktheanswersifneeded.

WhatNOTtodo DoNOTinsertwronganswerstoquestionsintoICATT.Ifyouarenotsure,refertothe trainingaidICATTexercisesandanswersforthecorrectanswer. Whenyoufinishanexercise,doNOTreadthesummarythatjustrepeatsthecorrect answers.Readonlysummariesthatreinforcewhatwaspractised.

FACILITATORTECHNIQUES:PRACTISEUSINGCHARTBOOKLETDURINGICATTSESSIONS
Useeveryopportunitytorefertothechartbookletandtolettheparticipantspractisewiththe printedchartbookletduringICATTsessions. WhenyouworkthroughICATTREADsection,demonstratetherelevantchartbooklet pagesfrequently(openthelinktothechartbooklet)andalwaysasktheparticipantsto findtherelevantpageintheircopyoftheprintedchartbooklet. 54

ICATTbasedIMCItraining Whenyouconductexercises,askparticipantstorefertotheirchartbooklets. Askyourcofacilitatortocheckthatparticipantshavefoundintheircopyoftheprinted chartbookleteachitemthatyoutalkabout.

PossibleuseofthechartbookletpagesinICATT(LinkSeeIMCIchart)inpartAssessand classifychildandpartAssessandclassifyyounginfant:
o WorkthroughtheKeystepsuntilyougettotheClassifythechildpageas describedaboveinFacilitatortechnique:TeachingtheinformationinICATT. WhenyougettotheClassifythechildpage,openthelinktothechartbooklet. ReviewthesignsinAsk,look,listen,feelbox. ExplaintheclassificationasdescribedintheKeyinformationpointingatthe signsofeachclassificationandeachclassification.ReviewtheIdentifytreatment part.ProvidealsoanyadditionalinformationthatisattheKeyinformation pages. Involveparticipantsintheworkingthroughtheclassificationtable:e.g.askthem whatthesignsinthepinkclassificationare,whattreatmentsshouldbegiventoa childwiththeyellowclassificationetc. AfteryoufinishexplainingtheAssessandclassifytable,gostraighttotheSEE sectionskippingtheremainingKeyinformationpages.

o o o

PossibleuseofthechartbookletpagesinICATT(LinkSeeIMCIchart)inpartFollowup: o Teachpage1oftheKeystepsasdescribedaboveinFacilitatortechniques: TeachingtheinformationinICATT. OpentheSeeIMCIchartlinkatpage1.ItdisplaysthewholeFollowuppartofthe chartbooklet. ExplaintheFollowupboxesasdescribedintheKeyinformation.Alsoprovide anyadditionalinformationthatisintheKeyinformationpagestitledConducta followupvisitforeachclassification. Involveparticipantsintheworkingthroughthefollowupvisitinstructions:e.g. askthemwhattheywillassessatthefollowupvisit,whattheywilldoifthe conditionisthesame,better,orworseetc.

FACILITATORTECHNIQUES:WHENPARTICIPANTSNEEDABREAKDURINGANICATT SESSION
Whenyouseethatyouarelosingyourparticipantsattentionandtheylooksleepyor tired,givethemashort(35minutebreak)ordosomestretchingexercises. Youmayalsouseashortbreaktocreateanaturalbreakbetweentrainingunits.

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Facilitatorguide Youmayconductadrilloraroleplayscheduledforthedayoranadditionalone(Refer totrainingaidsLeaddrillsandCoordinateroleplays)whenyouseethattheparticipants needachangeofactivity.

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ICATTbasedIMCItraining

3. GUIDELINESFORINTRODUCTION
PREPARETOTEACHTHECOMPONENT PreparetoteachthecomponentasdescribedinPrepareforfacilitatingICATTbasedIMCI trainingintheGeneralpartofthisguideandinFacilitatortechnique:Teachingtheinformationin ICATT. PresentationIMCIstrategytoimprovehealthandICATTHowtostartcanbefoundinthe ICATTsupportmaterialsTrainingaids.YoumayneedtodevelopthepartaboutICATT implementationinyourcountry. Participantswillbeintroducedtothechartbookletandcaserecordingformsinthiscomponent. Makesureyouhaveenoughprintedcopiesforalltheparticipants. ACTIVITIES 1.Welcomeparticipants.Introduceyourselfandaskparticipantstointroducethemselves. Participantstellwheretheyworkandtellbrieflytheirresponsibilityforcareofsickchildren. 2.GivepresentationIMCIstrategytoimprovehealthandoverviewofIMCIinthecountry 3.Describeobjectivesofthetraining,trainingorganization,andyourroleasafacilitator 4.PresentICATTchapterIMCIcasemanagementprocess. 5.PresentfromICATTanddemonstrate:IMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts.

1.

WELCOMEPARTICIPANTS Welcometheparticipants.

Ifparticipantsdonotknowyouordonotknoweachother,introduceyourselfasafacilitatorof thistrainingandwriteyournameontheflipchart. Asktheparticipantstointroducethemselvesandwritetheirnamesontheflipchart. Explaintoparticipantsthatyouwouldliketolearnmoreabouttheirresponsibilitiesforcaring forsickchildren.Thiswillhelpyouunderstandtheirsituationsandbeabetterfacilitatorfor them.Astheyintroducethemselves,askthemtotell: Whatarethenameofandsomecharacteristicofyourplaceofwork? Whatisyourpreviousandcurrentposition? HaveyoualreadybeentrainedinIMCIorpracticedIMCI? Leavethelistofnamesinaplacewhereeveryonecanseeittohelpyouandtheparticipants learneachother'snames.

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Facilitatorguide

2.

PRESENTATION:IMCISTRATEGYTOIMPROVEHEALTHANDOVERVIEWOFIMCIIN THE COUNTRY

GivethepresentationIMCIstrategytoimprovehealthcomplementedbyanoverviewofIMCI implementationinyourcountry. ThispresentationisgiveninsteadofgoingthroughtheICATTchapterWhatisIMCIinthe ICATTcomponentINTRODUCTION.

OBJECTIVESOFTHETRAINING,TRAININGORGANIZATION,ANDYOURROLEASA FACILITATO R
Objectives: OpentheICATTtrainingplayerontheIntroductionpageanddescribetheobjectivesofthe trainingbasedonitscontent: IMCIstandsforIntegratedManagementofChildhoodIllness.Youwilllearnmoreabout IMCIlaterinthissession.Duringthetraining,youwilllearnhowtomanagesickchildren andhowtoaddressallthechildsproblemsandneedstogether,inanintegratedway.You willalsolearnhowtoprovideessentialcaretoallnewbornchildren,toensuretheirquick andsafeadaptationtothenewenvironment. Thiscomputerprogram,theIMCIComputerizedAdaptationandTrainingTool(ICATT)will helpyoulearnhowtomanagemajorchildhoodproblemsusingtheIMCIclinical managementguidelines.WithICATT,youwillbeabletolearnnewinformation,seevideos andphotographs,andtestyournewknowledge. Pointattheuppermenu: Yourtraininghasthreecomponents:INTRODUCTION,CAREOFSICKCHILDAGED2 MONTHSUPTO5YEARS,andCAREOFSICKYOUNGINFANTAGEDUPTOTW OMONTHS. OpentheCAREOFSICKCHILDAGED2MONTHSUPTO5YEARSscrolldownmenu:The componenthasseveralparts(readthetitles).OpenPart1Assessandclassify:Eachcomponent hasatleastonebutusuallymoretrainingunits.Openthefirsttrainingunitandpointatthe puzzleicons:Eachtrainingunithasfourparts:READ,SEE,PRACTISE,andTEST.OpentheREAD introductorypage:IntheREADpartyouwillreadthenecessaryinformation.OpentheSEEpart: intheSEEpartyouwillseevideosandpictures.OpenthePRACTISEpart:InthePRACTISEpart youwilldoexercisestopracticewhatyouhavelearned.Youwillgetanimmediatefeedbackifyour answerwascorrect.EverythingyoulearnaboutIMCIintheICATTmustbesupportedbyclinical practice.Youwillpracticeinarealclinicalsettinginordertolearnhowtoapplyyournewskillsin themanagementofsickyounginfantsandchildren.InthePRACTISEpartyouwillalwaysfind whichskillsyouneedtopracticeinaclinicalsession.OpentheTESTpart:IntheTESTpartyouwill doexercisestocheckyourprogress.Animmediatefeedbackifyouranswerwascorrectisnot providedimmediatelyasinthePRATISEpartbutyoucanseewhetheryouranswerswerecorrect ornotontheProgressbarlocatedatthebottomofeachscreen(showtheProgressbar). Mentionthefollowupvisitforaninservicetrainingifapplicable:

3.

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ICATTbasedIMCItraining Afteryoureturnhome,youwillbevisitedinyourclinicstohelpyouapplyyournewskillsin yourownsetting. Makeannouncementsaboutscheduleandpracticalorganizationofthetraining.Performany necessaryadministrativetasks. Explaintoparticipantsthatasafacilitator,youwill: worktogetherwiththemthroughallICATTcomponents, conductexercises, clarifyinformationtheyfindconfusingandanswerquestionsthattheymighthave, leadgroupdiscussions,drills,androleplays,and preparethemforeachclinicalsession(explainwhattheywilldoandwhattotake).

Answeranyquestionsthattheparticipantsmayhave. Tellparticipantsthatthetraininghasthreecomponents: INTRODUCTION, CAREOFSICKYOUNGINFANTAGEDUPTO2MONTHS,and CAREOFSICKCHILDAGED2MONTHSTO5YEARS.

NowtheyarereadytolearnabouttheIMCIcasemanagementprocessandtheIMCIclinical guidelinesdescribedintheIntroduction.

4.

PRESENTATION:IMCICASEMANAGEMENTPROCESS PresentchapterIMCIcasemanagementprocessintheICATTIntroductioncomponent:
Brieflyintroducethefirstscreen. Wherepossible,summarizethepartsofthetextonthescreenreadingtheimportanttext (notreadingitwordbyword). Summarizethecontentofthescreenhighlightingthemainpoints. Movetothenextscreen. Attheendofthepresentationsummarize: TheIMCIcasemanagementprocessconsistsofsixsteps: ASSESS CLASSIFY IDENTIFYTREATMENT TREATTHECHILD COUNSELTHEMOTHER FOLLOWUP (Ifwallchartsareused,pointtoorwalktoeachofthechartsonthewallasyousay itstitle.)TheIMCIcasemanagementprocessisdescribedonchartsthathavealsobeen transformedintoachartbooklet.Nowyouaregoingtolearnmoreaboutthecase managementchartsandthechartbooklet.

5. PRESENTATIONANDDEMONSTRATION:IMCICASEMANAGEMENTCHARTSAND RECORDINGFORMS,PRINTEDCHARTBOOKLET,ANDWALLCHARTS
GiveoneIMCIchartbooklet,onecopyoftherecordingformforsickchildaged2monthsupto5 years,andonecopyoftherecordingformforyounginfanttoeachparticipantbeforethe presentation. 59

Facilitatorguide UseprojectedpagesofICATTchapterIMCIcasemanagementchartsandrecordingformsfor yourguidanceandtheguidanceofparticipantsbutdoNOTreadthescreens.Demonstratewhat isdescribedoneachscreeninthechartbookletorontherecordingforms. Afterdemonstratingeachitem,asktheparticipantstofinditinthechartbookletorinthe recordingform.Ifyouusewallcharts,demonstratetheitemonthewallchart.Yourcofacilitator checksthattheparticipantshavefoundeachdemonstrateditem. WhenyoufinishpresentingtheICATTchapterIMCIcasemanagementchartsandrecording forms,telltheparticipants:AsyouworkthroughICATTpages,youwillseealinktothechart bookletSeeIMCIchart.Italwaysdisplaysonlyapartofthechartrelevantforwhatisonthe screen.Demonstrate,forexample,thelinkinCareofchildaged2monthsupto5years,Part1 Assessandclassify,Assesscoughordifficultybreathing. Askparticipantsiftheyhaveanyquestionsaboutwhattheyreadorheard.Answertheir questions,butdonotexplainindetailhowtousethecasemanagementcharts.Thiswillbe taughtintherestofthetraining. Note: Participantsmayaskwhetherthecasemanagementchartscanbeusedforchildrenwho areolderthantheagegroupsspecifiedonthecharts.Iftheyaskthisquestionnow,explainas simplyaspossible,suchasbyusingonlytheexplanationinbolditalicsbelow.Iftheyasklaterin thetraining,aftertheyhavelearnedhowtoassessandclassify,theycouldunderstandtheentire explanationintheboxbelow.
Whynotusethisprocessforchildrenage5yearsormore? Thecasemanagementprocessisdesignedforchildrenlessthan5yearsofage.Althoughmuchoftheadviceon treatmentofpneumonia,diarrhoea,malaria,measlesandmalnutritionisapplicabletoolderchildren,theassessment andclassificationofolderchildrenwoulddiffer.Forexample,thecutoffratesfordeterminingfastbreathingwouldbe different,becausenormalbreathingratesareslowerinolderchildren.Chestindrawingisnotareliablesignofsevere pneumoniaaschildrengetolderandthebonesofthechestbecomemorefirm.Olderchildrencantalkandsoareable toreportadditionalsymptomswhicharenotinthesecharts,suchaschestpainandheadache,whichmaybeusefulin decidingwhetherpneumoniaormalariaispresent. Inaddition,certaintreatmentrecommendationsoradvicetothemotheronfeedingwoulddifferforchildrenover5 yearsofage.Thedrugdosingtablesonlyapplytochildrenupto5years.Thefeedingadviceforolderchildrenmay differandtheymayhavedifferentfeedingproblems. Tosummarize:Muchofthetreatmentadvicemaybehelpfulforachildage5yearsormore.However,becauseof differencesintheclinicalsignsofolderandyoungerchildrenwhohavetheseillnesses,thisassessmentand classificationprocessusingtheseclinicalsignsisnotrecommendedforolderchildren.

Whentherearenomorequestions,tellparticipantsthattheyarereadytobeginwiththefirst stepofcasemanagement,assessingandclassifyingasickchildaged2monthsupto5years.

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ICATTbasedIMCItraining

4. GUIDELINESFORCAREOFCHILDAGED2MONTHSTO 5YEARS
NOTES: WorkthroughthetrainingunitsasdescribedintheFacilitatortechniques.These guidelinesprovideonlyadditionalinstructionswhereneeded. AllexercisesintheTESTpartareoptional.Donotconductthemunlessyouareaheadof scheduleorfeelthattheparticipantsneedmorepractice. SomeexercisesinthePRACTISEpartaremarkedasoptionalintheseguidelines.Donot conductthemunlessyouareaheadofscheduleorfeelthattheparticipantsneedmore practice.

PART1:ASSESSANDCLASSIFYCHILD
PREPARETOFACILITATETHEPART Eachparticipantwillneedatotalof9copiesoftherecordingformsforPart1:Assessand classifythesickchild:oneforFatimaexamplerecordingformusedinfivetrainingunits,and8 forexercises,whichrequirecompletingaprintedrecordingform: Assesscoughordifficultybreathing:Exercise6Classifycoughordifficultybreathing casestudyGyatsu Assesscoughordifficultybreathing:Exercise7Classifycoughordifficultybreathing casestudyWambui(optionalexercise) Assesscoughordifficultybreathing:Exercise5CasestudyBen Assessdiarrhoea:Exercise5CasestudyJosh Assessfever:Exercise7CasestudyPu Checkformalnutritionandanaemia:Exercise6CasestudyJenny Assessotherproblemsandreviewofassessandclassify:Exercise7CasestudyFaduma (optionalexercise) Assessotherproblemsandreviewofassessandclassify:Exercise8CasestudyMartha (optionalexercise)

Asktheparticipantstocompletearecordingformfortheexerciseandcheckiftheycompletedit correctly.DoNOTcompleteanswerstotheexercisequestionsintheICATT.

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Facilitatorguide ACTIVITIES 1. WorkthroughtrainingunitAskthemotheraboutthechildsproblem. 2. WorkthroughtrainingunitCheckforgeneraldangersigns. 3. WorkthroughtrainingunitAssesscoughordifficultybreathing. 4. WorkthroughtrainingunitAssessdiarrhoea. 5. WorkthroughtrainingunitAssessfever. 6. WorkthroughtrainingunitAssessearproblem. 7. WorkthroughtrainingunitCheckformalnutritionandanaemia. 8. WorkthroughtrainingunitCheckimmunization,vitaminAanddewormingstatus. 9. WorkthroughtrainingunitAssessotherproblemsandreviewofassessandclassify. 10. Summarizethepart. 11. LeaddrillReviewinginformationontheASSESSandCLASSIFYchart

1.

TRAININGUNITASKTHEMOTHERABOUTTHECHILDSPROBLEMS

IntroductionandREADsection Furtherreading Thisisthefirsttimethatyourparticipantsseethispage.Explaintotheparticipantsthatthey willseethispageineachofthetrainingunit.Itdisplayslinkstomanyadditionalmaterialsthat areincludedinICATT.Thesematerialswillnotbeincludedintothistraining. Fillinacaserecordingform Reviewthepurposeofrecordingforms(firstparagraphontheICATTpage) Readthecasestudyandshoworhaveyoucofacilitatorpointonthescreentoshowhow theinformationinthecasedescriptioniswrittenontherecordingform. Explaintotheparticipantsthatineachtrainingunitofthissectiontheywillseean exampleofhowtofillinacaserecordingform.Distributerecordingforms.Explainthat theparticipantsshouldfilltheinformationaboutFatimaintotheirrecordingformasitis shownonthescreen.Whentheywilllearnfurther,theywilladdinformationforFatima tothesameform.Remindthemtokeeptheform. Checkorhaveyourcofacilitatorcheckthattheparticipantscompletedtheform correctly.

Note:CasestudyFatimacontinuesinthenext4trainingunits.Thesametextisrepeatedand newinformationadded.Askingparticipantstofillgraduallythesameprintedformwill 62

ICATTbasedIMCItraining emphasizetheintegratedapproachwithouttheneedtoreadagaintheinformationusedin previousunits. TESTsection ExplainthatyouwillnotworkthroughtheTESTsectionexercises.

2. TRAININGUNITCHECKFORGENERALDANGERSIGNS
IntroductionandREADsection Fillinacaserecordingform:AskparticipantstotakeouttheformforFatimathattheystarted tofillintheprevioustrainingunit.Pointoutthattheyhavealreadyfilledintheinitial informationaboutFatimaandtellthemthatnowtheywillfillthepartforgeneraldangersigns. Reviewthepageandasktheparticipantstofilltheform.Remindthemtokeeptheform. PRACTISEsection Exercise1Lethargicorunconsciouschild(video) Emphasizepointssuchas: Noticethatachildwhoislethargicmayhavehiseyesopenbutisnotalertorpayingattentionto whatishappeningaroundhim. Somenormalyoungchildrensleepverysoundlyandneedconsiderableshakingoraloudnoise towakethem.Whentheyareawake,however,theyarealert.

3.

TRAININGUNITASSESSCOUGHORDIFFICULTYBREATHING

IntroductionandREADsection Fillinacaserecordingform:AskparticipantstotakeouttheformforFatima.Pointoutthat theyhavealreadyfilledintheinitialinformationandgeneraldangersigns.Tellthemthatnow theywillfillthepartformainsymptomcoughordifficultybreathing.Reviewthepageandask theparticipantstofilltheform.Remindthemtokeeptheform. SEEsection VideoUseofrapidactingbronchodilator: RunthevideoyourselfBEFOREthesessionanddecideifyouwishtorunthewholevideoor someofitsparts.Itisa12minutelongvideo;itscontentistosomeextentbeyondthescopeof thisIMCItraining. PRACTISEsection Exercise2CountWumbi'srespiratoryrate(video) Emphasizethatcountingbreathingrequirescloseattentiontoonespotonthechestorabdomen. Exercise4AssessforchestindrawingII(video)Optional.

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Facilitatorguide Exercise5Stridororwheezing(video) Note:Chestindrawing,stridor,andwheezingrequireknowingwhenthechildisbreathingin andout.Remindtheparticipantstopracticethiswhentheyseechildrenintheclinic. Exercise6ClassifycoughordifficultybreathingcasestudyGyatsu Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideo.Afterthevideoends,askthemtoclassifythechild.Togetherwithyourcofacilitator checkthattheparticipantscompletedtherecordingformandclassifiedthecasecorrectlyand providefeedbackifneeded.(ThecompletedrecordingformisinAnnex1ofthisguide.)Donot completethequestionsintheICATTitself. Note:Thisisthefirsttimeparticipantspracticeclassifyingamainsymptom.Askquestionsto confirmthattheparticipantunderstandshowtousetheclassificationtable.Forexample: HowdidyoudecidethatGyatsudoesnothaveageneraldangersign? Howdidyoudecidethatthechildhasfastbreathing? Whereonthechartdidyoulooktodecideiffastbreathingispresent? Whereonthechartdidyoulookwhenselectingaclassificationforcoughordifficult breathing? Howdidyoufinallyselectthischild'sclassification? Thisisalsothefirsttimeparticipantspracticewritingonarecordingform.Makesurethatthe participantrecordsinformationcorrectlyontherecordingform.Remindtheparticipantto alwaysstartfromthepink(ortop)row. Exercise7ClassifycoughordifficultybreathingWambuiOptional. Exercise8CasestudyBen(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideo.Afterthevideoends,askthemtoclassifythechild.Togetherwithyourcofacilitator checkthattheparticipantsfilledtherecordingformandclassifiedthecasecorrectlyandprovide feedbackifneeded.(CompletedrecordingformisinAnnex1ofthisguide.)Thenruntheanswer videointheexercisesummary.DonotcompletethequestionsintheICATT.

4.

TRAININGUNITASSESSDIARRHOEA

IntroductionandREADsection Fillinacaserecordingform:AskparticipantstotakeouttheformforFatima.Pointoutthat theyhavealreadyfilledintheinitialinformation,generaldangersigns,andthemainsymptom coughordifficultybreathing.Tellthemthatnowtheywillfillthepartformainsymptom diarrhoea.Reviewthepageandasktheparticipantstofilltheform.Remindthemtokeepthe form.

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ICATTbasedIMCItraining PRACTISEsection Exercise1Definitionofdiarrhoea(text)Optional. Exercise2Sunkeneyes(photoandvideo) Note:Ifyouarenotsurethatthechildeyesaresunken,askthemotherifthechildseyeslook unusualtoher. Exercise3Skinpinch(video) Emphasizefollowing: Ifyoucanseethetentedskinevenbrieflyafteryoureleasetheskin,thisisaslowskin pinch.Askinpinchwhichreturnsimmediatelyissoquickthatyoucannotseethetented skinatallafterreleasingit. Repeattheskinpinchifyouarenotsure.Makesureyouaredoingitintherightposition. Exercise4ClassifydiarrhoeaCases3Mayaand4Adeolaareoptional. Note: Whenparticipantsusetheclassificationtablefordehydrationtheywilluseaprocessslightly differentthanwhattheyuseforassessingcough.Theymayhavequestionsorbeconfusedabout whytwoormoresignsareneededtoclassifydehydrationandonlyonesigntoclassifycoughor difficultbreathing,orpersistentdiarrhoeaanddysentery.Also,whenclassifyingdiarrhoea,the childmayhaveone,twoorthreeclassificationsrelatedtodiarrhoea.Explainthatyes,thisisa differentprocessandthateachmainsymptomisclassifiedinslightlydifferentways. Askaparticipanttoshowyouontheclassificationtablehows/heselectedtheclassification. Reinforcetheprocessofstartingwiththepinkrow,thenyellowandthengreenrow. Exercise5CasestudyJosh(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideo.Afterthevideoends,askthemtoclassifythechild.Togetherwithyourcofacilitator checkthattheparticipantscompletedtherecordingformsandclassifiedthecasecorrectlyand providefeedbackifneeded.(ThecompletedrecordingformisinAnnex1ofthisguide.)Then runtheanswervideointheexercisesummary.DonotcompletethequestionsintheICATT. Note: Thisisthefirsttimeparticipantspracticeclassifyingmorethanonemainsymptom.Makesure thattheparticipantrecordstheinformationcorrectlyontherecordingform.Asyoutalkthrough eachcasewiththeparticipant,askhimorhertodescribehowheorsheselectedthechild's classifications.Reinforcepointssuchas: alwaysstartfromthepink(ortop)row toselectaclassificationfordehydration,theremustbetwosignspresenttoselecteither SEVEREorSOMEDEHYDRATION 65

Facilitatorguide onlyclassifyPersistentdiarrhoeaifthechildhashaddiarrhoeafor14daysormore. onlyclassifyDysenteryifthechildhasbloodinthestool.

Sometimeschildrenwhoaresickortiredareverystillintheclinicbuttheyrespondtotouchor voice.Joshisanexampleofthis.Theyshouldnotbeconsideredlethargic.Itcanbehardtotell thisonthevideobecauseyouonlyseeafewminutesofthechild.Ifyouinitiallythinkachildis lethargicbutthenheorsheawakensandbecomesalertlaterintheexam,donotconsiderthis childtohavethegeneraldangersign"lethargicorunconscious".

5.

TRAININGUNITASSESSFEVER

IntroductionandREADsection Fillinacaserecordingform:AskparticipantstotakeouttheformforFatima.Pointoutthat theyhavealreadyfilledintheinitialinformation,generaldangersigns,andthemainsymptoms coughordifficultybreathinganddiarrhoea.Tellthemthatnowtheywillfillthepartformain symptomfever.Reviewthepageandasktheparticipantstofilltheform.Remindthemtokeep theform. PRACTISEsection Exercise7CasestudyPu(video) Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideo.Afterthevideoends,askthemtoclassifythechild.Togetherwithyourcofacilitator checkthattheparticipantscompletedtherecordingformandclassifiedthecasecorrectlyand providefeedbackifneeded.(ThecompletedrecordingformisinAnnex1ofthisguide.)Then runtheanswervideointheexercisesummary.DonotcompletethequestionsintheICATTitself.

6.

TRAININGUNITASSESSEARPROBLEM

Therearenospecialinstructions.

7.

TRAININGUNITCHECKFORMALNUTRITIONANDANAEMIA

PRACTISEsection Exercise1Definitionofseveremalnutrition(text)Optional. Exercise4ClassifymalnutritionandanaemiaCasestudyNadiaOptional. Exercise5ClassifymalnutritionandanaemiaCasestudyKalisa Note:Thisisthefirsttimeparticipantsusetheweightforagechart.Tomakesurethatthe participantsunderstandhowtodetermineweightforage,askthemtoshowyouontheweight foragecharthowtheydeterminedweightforageforeachcase. Exercise6CasestudyJenny(video) 66

ICATTbasedIMCItraining Giveeachparticipantonecopyofarecordingformandaskthemtofilltheformastheywatch thevideo.Afterthevideoends,askthemtoclassifythechild.Togetherwithyourcofacilitator checkthattheparticipantsfilledtherecordingformandclassifiedthecasecorrectlyandprovide feedbackifneeded.(CompletedrecordingformisinAnnex1ofthisguide.)Thenruntheanswer videointheexercisesummary.DonotcompletethequestionsintheICATT.

8. CHECKIMMUNIZATION,VITAMINAANDDEWORMINGSTATUS
PRACTISEsection Exercise3ImmunizationsandvitaminAprophylaxisforMarco Note: Emphasizethatthereareveryfewcontraindicationsforimmunizations.Evenwhena contraindicationispresentforonevaccine,othervaccinesmaybesafelygiven. Checktoseethattheparticipantsunderstandhowtousetherecommendedimmunization schedulewhendecidingifthechildneedsanyimmunizationsduringthisvisit.Forexample: Howdoyoudecidethatachildneededanimmunizationtoday? Whatwouldyousaytothemotherfirsttofindoutthischild'simmunizationhistory? Ifshesays,"Yes,Ibroughtanimmunizationcardtoday,"whatshouldyoudonext? Ifshedidnotbringthecardtoday,whatwouldyoudo?

9. TRAININGUNITASSESSOTHERPROBLEMSANDREVIEWOFASSESSANDCLASSIFY
IntroductionandREADsection Emphasise:Itisimportanttoaddressthechild'sallproblems,notonlythoseincludedintoIMCI. Youshouldidentifyandtreatanyotherproblemsaccordingtoyourtraining,experienceand clinicpolicy.Referthechildforanyproblemthatyoucannotmanageintheclinic. SEEsection TellparticipantsthatyouwillnotgothroughtheSEEsection,becausetherearemanyother conditionsachildmayhaveandthoseincludedinICATTarejustafewexamples. PRACTISEsection Donotworkthroughtheexercises.Onlyifyouhavetime,workthroughExercise7Casestudy Faduma(video)andExercise8CasestudyMartha(video).Giveeachparticipanttwocopies ofarecordingformandaskthemtofilltheformsastheywatchthevideos.Afterthevideosends, askthemtoclassifythechild.Togetherwithyourcofacilitatorcheckthattheparticipantsfilled therecordingformsandclassifiedthecasecorrectlyandprovidefeedbackifneeded.(Completed recordingformisinAnnex1ofthisguide.)Thenruntheanswervideointheexercisesummary. DonotcompletethequestionsintheICATT. 67

Facilitatorguide

10. DRILLREVIEWINGINFORMATIONONTHEASSESS&CLASSIFYCHART
YouwillfindthedrillinAnnex2ofthisguide. LeadthisdrillanytimeafteryouhavefinishedASSESSANDCLASSIFY.Thedrillconsistsoffour parts.Youmayconductthepartsseparatelywhenparticipantsneedabreakfromworkwith ICATT.

11.

SUMMARYOFTHEPART

Toreviewthemainskillscoveredinthispart,readthelearningobjectiveslistedbelow.Asyou stateeachobjective,point(oraskaparticipantoryourcofacilitatortopoint)towherethe relevantstepislocatedonthechart.UsethewallchartoropenthelinkSeeIMCIchartinthe READpartofthetrainingunitAssessotherproblemsandreviewofassessandclassifyit displayscompleteASSESS&CLASSIFYpartofthechartbooklet. Nowyoushouldknowandhavetheskillsto: Askthemotheraboutthechild'sproblem. Checkforgeneraldangersigns. Askthemotheraboutthefourmainsymptoms: o o o o coughordifficultbreathing diarrhoea fever earproblem.

Whenamainsymptomispresent: o o assessthechildfurtherforsignsrelatedtothemainsymptom classifytheillnessaccordingtothesignswhicharepresentorabsent.

Checkforsignsofmalnutritionandanaemiaandclassifyingthechild'snutritionalstatus. Checkthechild'simmunizationstatusanddecidingifthechildneedsanyimmunizations today. Assessanyotherproblems.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants,suchas recognizingaparticularsign.Tellparticipantsthatseveralpointsinthispartwillbereinforced infutureclinicalsessions.Theywillalsobereviewedthroughouttherestofthepartsthat describehowtoidentifytreatment,treatsickchildrenandcounselmothers. Answeranyquestionsthattheparticipantsmayhave. 68

ICATTbasedIMCItraining

PART2:IDENTIFYTREATMENTFORCHILD
ACTIVITIES 3. WorkthroughtrainingunitIdentifytreatmentforchild. 4. Summarizethepart.

3. TRAININGUNITIDENTIFYTREATMENTFORCHILD
IntroductionandREADsection Workthroughtheintroductionpage,KeystepsandFillacaserecordingform.Thendemonstrate theuseofreversesideoftherecordingformasdescribedbelow. Demonstrationofthereversesideofrecordingform Askparticipantstotakeoutoneoftherecordingformsthattheyusedfortheassessmentand classificationintheirclinicalpracticesession.Ifparticipantsdonothavearecordingformfrom theirclinicalsession,usetherecordingformthattheparticipantscompletedforFatima,thecase describedonICATTpagesFillarecordingform. Showhowtofoldthe"Classify"columnofthecaserecordingformsothatitcanbeseenwhile lookingatthebackoftheform.Thenmakethefollowingpoints: LookattheASSESS&CLASSIFYcharttofindthetreatmentsneededforeachclassification. Listtreatmentsneededonthebackoftheform,acrossfromtheclassification. Writeonlytherelevanttreatments. Shortenthewordingoftreatmentsifdesired.Forexample,ahealthworkerwrote:Fluid andfood(PlanB)insteadof"Givefluidandfoodforsomedehydration(PlanB)." Followuptimesarelistedinthetreatments.Thesemeantotellthemothertoreturnina certainnumberofdays.Youmayabbreviate"Followup"as"F/up."Ifyoulistseveral followuptimes,youwilltellthemothertheearliest,definitetime.Thisisthetimetorecord inthedesignatedspaceontherecordingform. (Note:youmayalsoneedtotellthemotheraboutearlierfollowupthatmaybeneededifa problempersists.Forexample,youmayneedtosay"Returnin5daysforsure,butreturnin 2daysifthereisstillfever.") Noticethattherecordingformalreadyliststheitem,"Advisemotherwhentoreturn immediately,"becauseitisneededforeverysickchildgoinghome.Donotlistthisagain. (YouwilllearnthesignswhichindicatewhentoreturnimmediatelylaterinPart4.Counsel themother,trainingunitUsegoodcommunicationskills.) Noticethespaceonthebackoftherecordingformtorecordimmunizationsneededtoday.

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Facilitatorguide YouwilllearnhowtocompletethefeedingsectionsoftherecordingforminPart4.Counsel themother.Whenfeedingassessmentisneeded,itmaybedoneatanyconvenienttime duringthevisit,afterthechild'simmediateneedsaretakencareof. Ifthesametreatmentisneededformorethanoneclassification,youonlyneedtolistit once.However,sincedifferentantibioticsmaybeneededfordifferentproblems,list antibiotictreatmentseparatelyforeachproblem,forexample: o o antibioticforpneumonia antibioticforacuteearinfection

IfachildhasPNEUMONIAforwhichcotrimoxazolewillbegiven,thecotrimoxazolewill serveastreatmentfortheacuteearinfectionaswell.

Askoneparticipantwhattreatmentsheorsheidentifiedforhisorherpatient(orforFatima,if used).Discussasneeded.Continueaskingforthetreatmentidentifieduntilyoureviewallthe treatmentsidentifiedforFatimaorforallclassificationsthattheparticipantspatientshave. SEEsection Flashmovie:HowtofillinIMCIcaserecordingform Donotruntheflashmovieyouhavejustdemonstratedwhatitshows. Picture2:ImportantdecisionsfortreatmentplanC EnlargethepictureandreadthesimplifiedPlanCoutloudasparticipantsfollowonthe screen.TellparticipantsthatplanCwillbetaughtindetailinthenextpart.Fornowyouwill focusonthequestionsontheleftside.ExplainwhathappensforeachNOorYESanswer. DiscusswhethertheparticipantsclinicshaveIVtherapyavailable,whetherIVtherapyis availablenearby(within30minutes),andwhetherNGtubescanbeused.Thesituationat theparticipantsclinicwilldeterminewhatheorshecandoforachildwhoneedsPlanC. PRACTISEsection Exercise1Decidewhetherornoturgentreferralisneeded Note:Question5(Habib)involvescasewithdiarrhoeawithSEVEREDEHYDRATION.Besurethe participantunderstandswhentokeeporrefersuchacase: Ifthechildalsohasanothersevereclassification,refer.Specialexpertiseisrequiredto rehydratethischild,astoomuchfluidgiventooquicklycouldendangerhislife. Ifthechildhasnoothersevereclassification,usePlanCtodecideifyoushould rehydratethechildatyourclinicorreferthechild.

Exercise2IdentifytreatmentsforAtiya(text)Optional. Exercise4IdentifytreatmentsforAina

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ICATTbasedIMCItraining Note:Pointoutthedifferencebetweenurgentandnonurgentreferral.Ainaneedstobereferred forfevermorethan7days,butitisnotanurgentreferral.Thereistimefortheothertreatments neededbeforeAinagoestothehospital. Exercise5IdentifytreatmentsforMaya(text)Optional. Exercise7Identifyurgentprereferraltreatmentneeded Note:Remindparticipantsthaturgent,prereferraltreatmentsareinboldprintontheASSESS andCLASSIFYchart.

4. SUMMARYOFTHEPART
AskparticipantstobrieflysummarizewhattopicshavebeencoveredbypartandunitIDENTIFY TREATMENT.Participantsshouldcalloutwhatthisparthastaughtthemandyouwilllisttheir responsesonaflipchart. Showthespecificlearningobjectivesinthetrainingunit.Askparticipantstoprovidefeedbackas towhethertheyfeelthattheseobjectiveshavebeenmet. Participantsshouldhighlightanydifficultareas,wheretheyneedfurtherclarificationandask finalquestions. Asktheparticipantstowhathospitalorclinictheyreferchildrenwhoneedurgentreferral. Discussbrieflyhowfarawaythatisandhowmotherscantravelthere. Thanktheparticipantsfortheirgoodwork.Tellthemthattheyhavesuccessfullycompletedthe IDENTIFYTREATMENTstepandtheyarenowreadytoproceedtothenextpartTREAT,where theywilllearnhowtodothenecessarytreatments.

PART3:TREATTHECHILD
PREPARETOFACILITATETHEPART Thereisoneroleplayinthispart.Assigntheroleofamother(orfather)intheroleplaytoone participantandtheroleofahealthworkertoanotherone.Gatherallsupplieslistedintherole playdescription.Youwillalsoneedonehandoutperparticipantfortheroleplay. ACTIVITIES 1. WorkthroughtrainingunitSelectandgiveoraldrugs. 2. WorkthroughtrainingunitTeachthemothertogivetreatmentathome. 3. Leaddrilloncheckingquestions. 4. Coordinateroleplay:TeachingamothertogiveoraldrugsDasar. 71

Facilitatorguide 5. WorkthroughtrainingunitGivetreatmentandimmunizethechildattheclinic. 6. WorkthroughtrainingunitGiveextrafluidfordiarrhoeaandcontinuefeeding. 7. Summarizethepart.

1. TRAININGUNITSELECTANDGIVEORALDRUGS
SEEsection Video:Useofrapidactingbronchodilator.Thisisthesame12minutesvideoasinthetraining unitCoughordifficultybreathing.Seecommentsthere.Donotrunitagain. Video:CoughManagementofwheezeinsmallhospital This138optionalvideodescribestreatmentinsmallhospitals(oxygen,rapidacting bronchodilator,andprednisolone).Ifyoudecidetorunit,commentappropriatelyonthe differencesbetweentheIMCIguidelinesandhospitaltreatment. PRACTISEsection Allexercisesinthissectionmaybereplacedbydrillsonselectinganappropriateantibioticand onselectingappropriateoraldrugsavailableinthetrainingaidLeaddrills.Thetopicwillbe furtherpractisedinsomeexercisesintrainingunitsthatfollow. Notes: WhenyouinsertthedrugdosesintotheICATTexerciseanswers,donotforgetthattheymustbe insertedindecimalnumbers(e.g.0.5,1.5)andnotfractions(e.g.(1/2). Makesuretheparticipantsunderstandwhenachildcanbetreatedwithasingleantibioticand whentwoantibioticsareneeded. Checkthattheparticipantsunderstandcorrectlytheageranges.Forexampleagerange2 monthsupto12monthsreferstoachildwhois2monthsoldorolderbutnotyet12monthsold. Exercise2SelectanappropriateoralantibioticforPNEUMONIAandACUTEEAR INFECTION Note:TherecommendeddurationoftreatmentforPNEUMONIAis3daysandforACUTEEAR INFECTION5days.Asthechildhasbothclassifications,heorsheshouldreceivecotrimoxazole for5days.

TRAININGUNITTEACHTHEMOTHERTOGIVETREATMENTATHOME Sothatyouwillbetterunderstandtheparticipantssituation,asktheparticipantsifthey dispensedrugstomothersathisclinic.Ifsomeoneelsegivesthetablets,capsulesorsyrupto motherstotakehome,tellparticipantsthattheyshouldstillteachthemotherhowtogivethe drugsathome.

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2.

ICATTbasedIMCItraining Allexercisesinthisunitrequirewrittenanswers.Iffeasible,comparetheparticipant'sanswers withanswersgivenhere.Itisacceptableiftheparticipant'sanswersarewordedsomewhat differentlybutreflecttheteachingstepscoveredintheunit. Iftheparticipant'sanswersdonotreflectthestepstaughtintheunitorifhisorheranswersare exactlythesameasinICATT,havetheparticipantlocatetherelevantstepsintheunit. PRACTISEsection Exercise4DeterminepriorityofadviceCasestudyMela(text)Optional.

3.

DRILL:PRACTISEASKINGCHECKINGQUESTIONS

ThedrillisinAnnex3ofthisguide. LeadthisdrillatanyconvenienttimeafteryouworkedthroughthetrainingunitTeachthe mothertogivetreatmentathome.Youmaywishtodoitwhentheparticipantsneedabreak fromICATTwork,orafteralunchorteabreak.

4.

ROLEPLAY:TEACHING AMOTHER TOGIVEORAL DRUGSDASAR FollowtheinstructionsfortheroleplayinAnnex4ofthisguide.

ConducttheroleplayatanysuitabletimeafterworkingthroughtrainingunitTeachthemother togivetreatmentathome.

5. TRAININGUNITGIVETREATMENTSANDIMMUNIZETHECHILDATTHECLINIC
Therearenospecialinstructionsforthistrainingunit.

6. TRAININGUNITGIVEEXTRAFLUIDFORDIARRHOEAANDCONTINUEFEEDING
PRACTISEsection Exercise2TreatmentplanB(text)andExercise3TreatmentplanC(text)maybe replacedbydrillsondeterminingamountsofORSsolutiontogiveachildonPlanBandon determiningIVfluidamountsavailableintrainingaidLeaddrills.WorkthroughExercise3or leadadrilldeterminingIVfluidamountsonlyifparticipantsareallowedandcangiveIVfluidin theirhealthfacility.

7. SUMMARYOFTHEPART
Toreviewthemainskillscoveredinthispart,readthelearningobjectiveslistedbelow. Nowyoushouldknowandhavetheskillsto: Determineappropriateoraldrugsanddosagesforasickchild. 73

Facilitatorguide Giveoraldrugs(includingantibiotics,antimalarials,paracetamol,vitaminA,ironand mebendazole),andteachingthemotherhowandwhentogiveoraldrugsathome. Treatlocalinfections(suchaseyeinfections,eardrainage,mouthulcers,sorethroatand cough),andteachthemotherhowandwhentogivethetreatmentsathome. Checkamother'sunderstanding. Givedrugsadministeredinthecliniconly(intramuscularinjectionsofampicillin, gentamicin,andquinine). Preventlowbloodsugar. Treatdifferentclassificationsofdehydration,andteachingthemotheraboutextrafluidto giveathome. Immunizechildren.

Tellparticipantswhatwasdonewellduringtheirworkthroughthispart.Alsomentionany pointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave. Thanktheparticipantsfortheirgoodwork.Tellthemthattheyhavesuccessfullycompletedthe TREATMENTstepandtheyarenowreadytoproceedtothenextpartCOUNSELTHEMOTHER.

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ICATTbasedIMCItraining

PART4:COUNSELTHEMOTHER
PREPARETOFACILITATETHEPART Roleplay:Thereisoneroleplayinthispart.Assigntheroleofamother(orfather)intherole playtooneparticipantandtheroleofahealthworkertoanotherone.Collectallsupplieslisted intheroleplaydescription.Youwillalsoneedonehandoutperparticipantfortheroleplayand onehandoutforthemother. ACTIVITIES 1. WorkthroughtrainingunitAssessfeedingandmakerecommendations. 2. WorkthroughtrainingunitUsegoodcommunicationskills. 3. Conductroleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice. 4. Summarizethepart.

1.

TRAININGUNITASSESSFEEDINGANDMAKERECOMMENDATIONS

PRACTISEsection Exercise1Feedingrecommendations(text) Note: ThemainpointofExercise1istoidentifyrelevantfeedingadviceandlimitadvicetothat.Be surethattheparticipantsunderstandthatitisnotnecessarytogiveallthefeedingadviceto everymother.Ifcertainrecommendationsarenotbeingfollowed,adviceshouldbelimitedto thoserecommendations.Thishelpsthemotherfocusonwhatisimportantinhersituation. Ifthechildisbeingfedcorrectlyforhisorheragegroup,thenthemothermaynotneedany feedingadvicenow.(Ifthechildisabouttoenteranewagegroupwithdifferentfeeding recommendations,however,explainthesenewrecommendationstoher.)Remembertopraise themotherforfeedingpracticesthatarecorrect. Stresstheimportanceofteachingthemotheraboutwhentoreturn,especiallytheimportanceof teachingherthesignstoreturnimmediately. Exercise2Feedingassessment(text)Optional.

2.

TRAININGUNITUSEGOODCOMMUNICATIONSKILLS

PRACTISEsection Exercise2Usesimplelanguage(text)Optional.

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3.

ROLEPLAY:USINGGOODCOMMUNICATIONSKILLSANDTHEENTIRECOUNSELCHART ANDMOTHERS CARDFELICE

FollowtheinstructionsfortheroleplayinAnnex5ofthisguide. ConducttheroleplayatanysuitabletimeafterworkingthroughtrainingunitUsegood communicationskills.

4. SUMMARYOFTHEPART
Leadabriefdiscussiontoreviewwiththeparticipantsthemainskillscoveredinthispart: Assessthechild'sfeeding Identifyfeedingproblems Counselthemotheraboutfeedingproblems Advisethemothertoincreasefluidduringillness Advisethemother: o o o whentoreturnforfollowupvisits, whentoreturnimmediatelyforfurthercare, whentoreturnforimmunizations

Giverelevantadvicetoeachmother Usegoodcommunicationskills UseaMother'scardasacommunicationstool.

Leadagroupdiscussionoflocalfeedingproblemsandrecommendedadvicefortheseproblems. Relatethediscussiontothefeedingproblemsofchildrenseenduringtheclinicalsessions.(If participantshavenotyetpractisedcounsellingaboutfeedingduringaclinicalsession,delaythis discussionuntilafterthatclinicalsession.) Askparticipantswhatcommonlocalfeedingproblemstheyfoundduringtheirclinicalsessions. ForproblemscoveredontheCOUNSELchart,pointoutwhatadviceshouldbegiven.Forany additionallocalproblemsidentifiedbyparticipants,askwhatwouldbesuitableadvice. Askparticipantsiftherecommendedadviceforlocalfeedingproblemsispractical.Askif mothersarelikelytofollowthisadvice.Ifnot,askforalternativesuggestionsthatwould improvefeeding,bepractical,andbefollowedbymothers. Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsstillmayhave. 76

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PART5:FOLLOWUPTHECHILD
ACTIVITIES 1.WorkthroughsectionandtrainingunitFollowupthechild. 2.Summarizethepart.

1. TRAININGUNITFOLLOWUPTHECHILD
PRACTISEsection Somequestionsineachexerciserequirelengthytypedanswers.Iftimeislimited,workthrough onlyonecaseofseveralthatareineachexercise.Makesurethateachparticipantlearns: WheretofindinstructionsforafollowupvisitontheTREATchart. Howtoassessachildwhocomesforfollowup. Howtoselecttreatmentbasedonresultsofthefollowupassessment. Torefertohospitalanychildwhohasmultipleproblemsandisgettingworse.Also referanychildwhoneedsasecondlinedrugwhichisnotavailable,andanychild youareworriedaboutordonotknowhowtotreat.

Asyoudiscusstheanswerswithparticipants,askthemtoshowyouwheretheylookedonthe chartforinformationaboutconductingthefollowupvisitforPNEUMONIA:Followupboxfor PNEUMONIAontheTREATchart,theASSESS&CLASSIFYchartforhowtoassessdangersigns andcoughanddifficultbreathing,andtheantibioticboxontheTREATchart. Asneeded,askparticipantstoshowyouonthechartwheretheylookedforinformationabout reassessingandprovidingtreatmentforeachcase. Forexample: forPERSISTENTDIARRHOEA,askparticipantswhatcharttheywouldusetodoafull assessmentofachildwhosediarrhoeahadnotstopped(Answer:ASSESS&CLASSIFY chart).Askthemwheretheywouldlooktofindthefeedingrecommendations appropriateforachildwhosediarrhoeahadstopped(Answer:COUNSELchart,Feeding recommendationsbox). forDYSENTERY,besuretheparticipantsunderstandtheymustassessdiarrhoeaason theASSESS&CLASSIFYchart,plusasktheadditionalquestionslistedintheFollowup box.Asktheparticipants:Ifyouneedtogiveasecondlineantibiotic,wherewillyoulook tofindtherecommendedantibiotic?(Answer:theantibioticboxforDysenteryonthe TREATchart.) forMALARIAorFEVERMALARIAUNLIKELY,clarifywiththeparticipantswhetherthey willbegivingfollowupforchildrenwhereorwhenthereislowmalariariskandthebox toreferto. forVERYLOWWEIGHTalsoasktheparticipantstoshowyouwheretheylookedfor informationabouttherelevantfeedingrecommendations.

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Facilitatorguide Asktheparticipantsifmotherswhocometotheirclinicswillbringachildbackforfollowup.If theysaythatmothersusuallywillnot,discusshowtheycouldmakefollowupvisitsmore convenientforthem.Alsodiscusshowtheycouldexplaintothemtheimportanceoffollowup.

2.

SUMMARYOFTHE PART Reviewwithparticipantstheskillscoveredinthispartwithonetrainingunitaslistedinthe ICATTspecificlearningobjectives.

Theparticipantsshouldknownow: Decideiffollowupisrequired Assessthesickchildduringfollowupvisit Selectappropriatetreatmentbasedontheresultsoftheassessmentduringfollowup visit Checkwhetherthechildhasanynewproblems Assessandclassifyanynewproblemsthechildmayhave.

Discusswithparticipantswhatchangeswouldbeneededintheirclinicstoencouragemothers tobringtheirsickchildrenandinfantsforfollowupcare.e.g.notchargingforfollowupvisitsor reducingthewaitingtimespentinthequeue. Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave.

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5. GUIDELINESFORCAREOFYOUNGINFANTAGEDUPTO 2MONTHS
PART1:ESSENTIALCAREFOREVERYYOUNGINFANT
ACTIVITIES 1.WorkthroughsectionandtrainingunitEssentialcareforeveryyounginfant. 2.Summarizethepart. Therearenospecialinstructionsforthispart. Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsshouldknownow: howtopreparethedeliveryareaforthemotherandnewbaby theessentialneedsofallnewbornsimmediatelyafterbirth howtoprepareasafeandwarmenvironmentforeachnewborn whatawarmchainmeansanditsroleinthethermalprotectionofeverynewborn howtoensuretheearlyinitiationofbreastfeeding howtoensureskintoskincontactbetweenthemotherandnewborn themainstepsforroutinecareofthebaby'seyesandumbilicalcord thebasicrulesofgoodcommunicationwiththemotherandotherfamilymembers.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave.

PART2:ASSESSANDCLASSIFYYOUNGINFANT
ACTIVITIES 1. 2. 3. WorkthroughtrainingunitCheckyounginfantforveryseverediseaseandlocalbacterial infection. WorkthroughtrainingunitCheckyounginfantforjaundice. WorkthroughtrainingunitAssessyounginfantsdiarrhoea. 79

Facilitatorguide 4. 5. 6. Therearenospecialinstructionsforthistrainingpart. Tosummarizethepart,leadabriefdiscussiontoreviewwiththeparticipantsthemainskills coveredinthispart: Provideessentialcareforeveryyounginfant Checkayounginfantforveryseverediseaseandlocalbacterialinfection Checkayounginfantforjaundice Assessandclassifyayounginfantwithdiarrhoea Checkforafeedingproblemorlowweight,assessbreastfeedingandclassifyfeeding WorkthroughtrainingunitCheckyounginfantforfeedingproblemorlowweight. WorkthroughtrainingunitCheckimmunizationandassessotherproblemsoftheyoung infant. Summarizethepart

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficult. Answeranyquestionsthattheparticipantsmayhave.

PART3:IDENTIFYTREATMENTFORYOUNGINFANT,TREATANDCOUNSEL
ACTIVITIES 1.WorkthroughsectionandtrainingunitIdentifytreatmentforyounginfant,treatandcounsel. 2.Summarizethepart. Therearenospecialinstructionsforthispart. Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsnowshouldknowhowto: identifytreatmentsneeded,includingurgentprereferraltreatments treatayounginfantwithoralorintramuscularantibiotics givefluidfortreatmentofdiarrhoea teachthemothertotreatlocalinfectionsathome teachthemotherthecorrectbreastfeedingtechnique teachthemotherhowtoexpressbreastmilkandfeedtheinfantusingacup advisethemotherhowtotreatheryounginfantathome. 80

ICATTbasedIMCItraining Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave.

PART4:FOLLOWUPTHEYOUNGINFANT
ACTIVITIES 1. WorkthroughsectionandtrainingunitFollowuptheyounginfant. 2. Summarizethepart. Therearenospecialinstructionsforthispart. Tosummarizethepart,reviewwithparticipantstheskillscoveredinthispartwithonetraining unitaslistedinthespecificlearningobjectivesinthetrainingunit. Theparticipantsshouldnowknowhowto: decidewhethertheyounginfant'svisitisforfollowup assessthesignsspecifiedinthefollowupboxfortheyounginfant'sprevious classification selecttreatmentsbasedontheyounginfant'ssignsandsymptoms decidewhethertheyounginfanthasanynewproblemsandifso,howtoassessand classifythem.

Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir workthroughthispart.Alsomentionanypointsthatweredifficultforparticipants. Answeranyquestionsthattheparticipantsmayhave.

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FACILITATORGUIDESPECIFICPART
ICATTBASEDIMCIDISTANCELEARNINGTRAINING

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1. TASKSOFAFACILITATOR
Conductthefacilitatorparticipantencountersaccordingtotheagenda. Introducethetraining,IMCI,andICATT. TeachparticipantshowtoinstallICATTorrunitfromaDVD/USBflashdisk,howto navigateinICATT,andhowtotransfertheStudentprofile. Explainhowtheparticipantsshouldworkduringthenextselflearningphase. Checktheparticipantsprogressduringthepreviousselflearningphase. Providesupporttoparticipantsduringselflearningphasesasagreeduponwithyour trainingdirector(SeeAnnex6ofthisguide). Encourageparticipantsandhelpthemduringallfacilitatorparticipantencounters,and encouragethemtocallwhenevertheyneedhelporhaveaquestionbetweenthe encounters. Assistthetrainingdirectorincollectingdataduringthetraining. Communicatewiththetrainingdirectorduringthetrainingphaseasagreedupon,e.g. reportregularlyontheparticipanttrainingprogressandproblemsthattheparticipants mayhave...

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2. TRAININGCALENDARSEQUENCE,OBJECTIVES,AND LOCATIONOFTRAININGEVENTS
Insertthedatesandvenuesofthetrainingeventsintothetablebelowifithasnotbeenalready done.
Date(s) Teaching/learningobjectives Facilitator Explainhowthetrainingwillbeorganizedandwhatis expectedfromtheparticipant TeachtheprinciplesoftheIMCIcasemanagement processandtheuseofthechartbookletandrecording forms Clinicalpractice:DemonstrateASSESS&CLASSIFY Teachhowtorun/installICATTandnavigateinit Participant LearnPart1:AssessandclassifychildofICATT componentCareofchildaged2monthsupto5years Practicetheassessmentandclassificationofsick childrenaged2monthsupto5years Facilitator AssessparticipantprogressinICATT Solvepossibleproblems Clinicalpracticeoutpatients:Demonstrateidentifying treatment,treatingthechildandcounsellingthe mother;conductparticipantsindividualpracticeinthe assessmentandclassificationofchildrenaged2 monthsupto5years Clinicalpracticeinpatients:Conductparticipants individualpracticeintheassessmentandclassification ofchildrenaged2monthsupto5years Participant LearnpartsIdentifytreatment,Treat,Counselthe motherandFollowupofICATTcomponentCareof childaged2monthsupto5years LearnICATTcomponentCareofyounginfantagedup to2months Practicemanagingsickchildrenagedupto5years Facilitator CheckifparticipantshavefinalizedtheICATT Solvepossibleproblems Clinicalpracticeoutpatients:Conductparticipants individualpracticeincompletecasemanagementof childrenaged2monthsupto5years Clinicalpracticeinpatients:Demonstrateassessment andclassificationofayounginfant;demonstrate breastfeedingassessmentandcounselling Evaluateparticipantknowledge:Writtenposttest Facilitatororanotherdesignatedperson Conductfollowupvisits Location

Initialfacilitator participantencounter

1stselflearningphase

Participant HF

Intermediatefacilitator participantencounter

2ndselflearningphase

Participant HF

Finalfacilitator participantencounter

Followupvisit

Participant HF

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3. INITIALFACILITATORPARTICIPANTENCOUNTER
PREPARETOFACILITATETHEINITIALFACILITATORPARTICIPANTENCOUNTER TheICATTcomponentINTRODUCTIONisworkedthroughinagroupintheformof presentationsandinteractivepresentations.Preparefordeliveringthesepresentations. PresentationIMCIstrategytoimprovehealthandICATTHowtostartcanbefoundinICATT SupportmaterialsTrainingaids.YoumayneedtodevelopthepartaboutICATTimplementation inyourcountry. TheICATTINTRODUCTIONchaptersareusedforpresentationsIMCIcasemanagement processandIMCIcasemanagementchartsandrecordingforms. Makesurethatyouhaveenoughcopiesofprintedmaterialsfortheparticipants(onechart booklet,caserecordingformsforclinicalpracticeduringtheencounterandforpracticeat participantsworksites,Participantworkbooks,andICATTminimumfornavigation). ACTIVITIES 1.Welcomeparticipants.Introduceyourselfandaskparticipantstointroducethemselves. Participantstellwheretheyworkandtellbrieflytheirresponsibilityforcareofsickchildren. 2.Givepresentation:IMCIstrategytoimprovehealthandoverviewofIMCIinthecountry. 3.Describeobjectivesofthetraining,trainingorganization,agendaofthisencounter,andyour roleasafacilitator. 4.PresentICATTchapterIMCIcasemanagementprocess. 5.PresentfromICATTanddemonstrateIMCIcasemanagementchartsandrecordingforms, printedchartbooklet,andwallcharts. 6.Conductclinicalpracticesession:Demonstrationoftheassessmentandclassificationofasick childaged2monthsupto5years. 7.GiveinteractivepresentationICATTHowtostartfollowedbyindividualpracticeofICATT navigation. 8.ReviewParticipantworkbookandannouncepracticalarrangementsforthetraining. REMEMBERtokeepthetimesforactivitiesinthetrainingschedule.Theagendaoftheinitial facilitatorparticipantencounterisveryfullandifoneactivitytakeslongerthanscheduled, theremaynotbeenoughtimetogiveparticipantsallinformationtheyneed.

1.

WELCOMEPARTICIPANTS Welcometheparticipants.

Ifparticipantsdonotknowyouordonotknoweachother,introduceyourselfasafacilitatorof thistrainingandwriteyournameontheflipchart. Asktheparticipantstointroducethemselvesandwritetheirnamesontheflipchart. 87

Facilitatorguide Explaintoparticipantsthatyouwouldliketolearnmoreabouttheirresponsibilitiesforcaring forsickchildren.Thiswillhelpyouunderstandtheirsituationsandbeabetterfacilitatorfor them.Astheyintroducethemselves,askthemtotell: Whatisthenameofandsomecharacteristicofyourplaceofwork? Whatisyourpreviousandcurrentposition? HaveyoualreadybeentrainedinIMCIorpracticedIMCI? Leavethelistofnamesinaplacewhereeveryonecanseeittohelpyouandtheparticipants learneachother'snames.

2.

PRESENTATION:IMCISTRATEGYTOIMPROVEHEALTHANDOVERVIEWOFIMCIIN THE COUNTRY

GivethepresentationIMCIstrategytoimprovehealthcomplementedbyanoverviewofIMCI implementationinyourcountry. ThispresentationisgiveninsteadofgoingthroughtheICATTchapterWhatisIMCIinthe ICATTcomponentINTRODUCTION.

3.

OBJECTIVESOFTHETRAINING,TRAININGORGANIZATION,AGENDAOFTHIS ENCOUNTER,ANDYOUR ROLEASAFACILITATOR

Objectives: Trainhealthprofessionalsresponsibleformanagementsickchildrenageupto5yearsin IMCI Duringthetraining,youwilllearnhowtomanagesickchildrenandhowtoaddressallthe childsproblemsandneedstogether,inanintegratedway.Youwillalsolearnhowto provideessentialcaretoallnewbornchildren,toensuretheirquickandsafeadaptationto thenewenvironment. Allinformationthatyouneedtolearnisinthecomputerprogram,theIMCIComputerized AdaptationandTrainingTool(ICATT).WithICATT,youwillbeabletoreadnew information,seevideosandphotographs,anddosomeusefulexercises.ICATTwillalsolet youtestyourprogress,asyoulearnaboutIMCI. EverythingyoulearnaboutIMCIthroughICATTmustbesupportedbyclinicalpractice.You willpracticeinyourownclinicalsettinginordertolearnhowtoapplyyournewskillsin managementofsickyounginfantsandchildren. Trainingorganizationmentionthefollowingpoints: Threefacilitatorparticipantgroupencounters. Twoindividualselflearningphasesattheparticipantsworksites. YouwillworkthroughICATTindividuallyatyourownpaceyouwilllearnhowtowork withthecomputerprogramlaterinthisencounter.Youwillfinddetailedinstructionshow toworkthroughthecontentinICATTitself. Youwillbealsoexpectedtopractisewhatyoulearnwithchildreninyourownhealth facility. 88

ICATTbasedIMCItraining Evaluation:writtentestattheendofthefinalfacilitatorparticipantencounter. Followupvisit(inservicetraining)

Explaintoparticipantsthat,asafacilitator,yourrolethroughoutthistrainingwillbeto: guidethemthroughthefacilitatorencounteractivities, teachthemhowtonavigate(movethrough)intheICATT, demonstrateclinicalcasemanagementaccordingtotheIMCIguidelinesand,later, supervisetheirclinicalpracticeduringthefacilitatorparticipantencounters, clarifyanyinformationtheyfindconfusingandanswerquestionsthattheymighthave, providedistancesupportduringtheselflearningphasesexplainhowyouwilldothat accordingtowhatwasagreeduponduringthefacilitatortraining.

Makeannouncementsaboutthescheduleandpracticalarrangementsofthefirstfacilitator participantencounter. Answeranyquestionsthattheparticipantsmayhave. Tellparticipantsthatthetraininghasthreecomponents: INTRODUCTION, CAREOFSICKYOUNGINFANTAGEDUPTO2MONTHS,and CAREOFSICKCHILDAGED2MONTHSTO5YEARS.

NowtheyarereadytolearnabouttheIMCIcasemanagementprocessandtheIMCIclinical guidelinesdescribedintheIntroduction.

4.

PRESENTATION:IMCICASEMANAGEMENTPROCESS
Brieflyintroducethefirstscreen. Wherepossible,summarizethepartsofthetextonthescreenreadingtheimportanttext (notreadingitwordbyword). Summarizethecontentofthescreenhighlightingthemainpoints. Movetothenextscreen. Attheendofthepresentationsummarize: TheIMCIcasemanagementprocessconsistsofsixsteps: ASSESS CLASSIFY IDENTIFYTREATMENT TREATTHECHILD COUNSELTHEMOTHER FOLLOWUP (Ifwallchartsareused,pointtoorwalktoeachofthechartsonthewallasyousay itstitle.)TheIMCIcasemanagementprocessisdescribedonchartsthathavealsobeen transformedintoachartbooklet.Nowyouaregoingtolearnmoreaboutthecase managementchartsandthechartbooklet. 89

PresentchapterIMCIcasemanagementprocessintheICATTIntroductioncomponent:

Facilitatorguide

5. PRESENTATIONANDDEMONSTRATION:IMCICASEMANAGEMENTCHARTSAND RECORDINGFORMS,PRINTEDCHARTBOOKLET,ANDWALLCHARTS.
GiveoneIMCIchartbooklet,onecopyoftherecordingformforsickchildaged2monthsupto5 years,andonecopyoftherecordingformforyounginfanttoeachparticipantbeforethe presentation. UseprojectedpagesofICATTchapterIMCIcasemanagementchartsandrecordingformsfor yourguidanceandtheguidanceofparticipantsbutdoNOTreadthescreens.Demonstratewhat isdescribedoneachscreeninthechartbookletorontherecordingforms. Afterdemonstratingeachitem,asktheparticipantstofinditinthechartbookletorinthe recordingform.Ifyouusewallcharts,demonstratetheitemonthewallchart.Yourcofacilitator checksthattheparticipantshavefoundeachdemonstrateditem. WhenyoufinishpresentingtheICATTchapterIMCIcasemanagementchartsandrecording forms,telltheparticipants:AsyouworkthroughICATTpages,youwillseealinktothechart bookletSeeIMCIchart.Italwaysdisplaysonlyapartofthechartrelevantforwhatisonthe screen.Demonstrate,forexample,thelinkinCareofchildaged2monthsupto5years,Part1 Assessandclassify,Assesscoughordifficultybreathing. Askparticipantsiftheyhaveanyquestionsaboutwhattheyreadorheard.Answertheir questions,butdonotexplainindetailhowtousethecasemanagementcharts.Thiswillbe taughtintherestofthetraining. Note: Participantsmayaskwhetherthecasemanagementchartscanbeusedforchildrenwho areolderthantheagegroupsspecifiedonthecharts.Iftheyaskthisquestionnow,explainas simplyaspossible,suchasbyusingonlytheexplanationinbolditalicsbelow.Iftheyasklaterin thetraining,aftertheyhavelearnedhowtoassessandclassify,theycouldunderstandtheentire explanationintheboxbelow.
Whynotusethisprocessforchildrenage5yearsormore? Thecasemanagementprocessisdesignedforchildrenlessthan5yearsofage.Althoughmuchoftheadviceon treatmentofpneumonia,diarrhoea,malaria,measlesandmalnutritionisapplicabletoolderchildren,theassessment andclassificationofolderchildrenwoulddiffer.Forexample,thecutoffratesfordeterminingfastbreathingwould bedifferent,becausenormalbreathingratesareslowerinolderchildren.Chestindrawingisnotareliablesignof severepneumoniaaschildrengetolderandthebonesofthechestbecomemorefirm.Olderchildrencantalkandso areabletoreportadditionalsymptomswhicharenotinthesecharts,suchaschestpainandheadache,whichmaybe usefulindecidingwhetherpneumoniaormalariaispresent. Inaddition,certaintreatmentrecommendationsoradvicetothemotheronfeedingwoulddifferforchildrenover5 yearsofage.Thedrugdosingtablesonlyapplytochildrenupto5years.Thefeedingadviceforolderchildrenmay differandtheymayhavedifferentfeedingproblems. Tosummarize:Muchofthetreatmentadvicemaybehelpfulforachildage5yearsormore.However,because ofdifferencesintheclinicalsignsofolderandyoungerchildrenwhohavetheseillnesses,thisassessmentand classificationprocessusingtheseclinicalsignsisnotrecommendedforolderchildren.

6. CLINICALPRACTICE:DEMONSTRATIONOFTHEASSESSMENTANDCLASSIFICATIONOFA SICKCHILDAGED2MONTHSUPTO5 YEARS

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ICATTbasedIMCItraining Organizationofthesession Thedemonstrationsessiontakesplaceinaninpatientward. Participantsaredividedintoasmanysmallgroups(upto45peopleeach)asthereare facilitators. Dependingonthearrangementsmadebyyourtrainingdirector,oneofthefacilitatorsora clinicalinstructorwillselectwiththeassistanceoftheinpatientwardsstaff45childrenwith oneormoreIMCIsymptomsforthedemonstrationinthemorning. Eachfacilitatorisassignedtoonepatient.Forthefirstgroupofparticipants,thefacilitator demonstratestheassessmentandclassificationprocess,howtousethechartbookletandthe recordingform,andassiststheparticipantsinfindingtherelevantplacesinthechartbooklet andinenteringthefindingsintotherecordingform. Afterthedemonstration,thegroupsofparticipantsrotate.Forthenextgroup,thefacilitatortells theparticipantsthepatientshistoryandsymptomsthatthepatientDOESNOThave;the facilitatordemonstratesandclassifiesthesymptomsandsignsthatthepatientDOESHAVE.This wayeachgroupofparticipantswillseeseveralpatientswithvariousIMCIsigns. Theparticipantsshouldsee45patients.Iftherearefewerfacilitators/smallgroups,one facilitatorcandemonstratetwopatients. Toprepare ReviewtheinstructionsforconductingdemonstrationsinoutpatientsessionsChild15 inchapterSpecificinstructionsforconductingoutpatientsessionsinpartGuidelinesfor clinicalpracticeintheoutpatientclinicoftheGuideforclinicalpractice. Askparticipantstobringchartbooklet,pencils,andtimingdevices. Bring5recordingformsperparticipant.

Participantobjectives Learntheprinciplesofassessmentandclassificationofsickchildrenaged2monthsup to5years. Learntousethechartbookletandcaserecordingformintheassessmentand classificationofsickchildren.

Facilitatorprocedures Firstsmallgroupofparticipants: Demonstratehowtocheckforgeneraldangersigns,howtoassessandclassifychildfor themainsymptoms,howtousethechartbookletandtherecordingform. Assisttheparticipantsinfindingtherelevantplacesinthechartbookletandinentering thefindingsintotherecordingform. Summarizethesession. Askparticipantsiftheyhaveanyquestionsbutdonotexplainindetailhowtoassesand classifyeachsign.Theparticipantswilllearnthisduringtheselflearningphase. 91

Facilitatorguide Nextsmallgroupsofparticipants: Telltheparticipantsthepatientshistory. Gosystematicallythroughtheassessmentprocess: o TelltheparticipantsabouteachsymptomthatthepatientDOESNOThave. o DemonstrateandclassifyeachsymptomsandsignsthatthepatientDOESHAVE. Assisttheparticipantsinfindingtherelevantplacesinthechartbookletandinentering thefindingsintotherecordingform. Summarizethesession. Askparticipantsiftheyhaveanyquestionsbutdonotexplainindetailhowtoassesand classifyeachsign.Theparticipantswilllearnthisduringtheselflearningphase.

7. GIVEINTERACTIVEPRESENTATIONICATTHOWTOSTART.
Iftheparticipantshavenoorverylimitedcomputerskills,runflashmovieHowtousea computerbeforeyougivethepresentation.YouwillfindthisflashmovieinICATTinSupport materialsTrainingaids.Itexplainsthemaincomponentsofacomputer. ThenopenthepresentationICATTHowtostart.Followthestepsinthepresentation describeanddemonstrateeachnavigationstepswitchingbetweenthepresentationandICATT player[usingtheAltTabkeys]asneeded. Important:Donotoverwhelmparticipantswithnavigationdetailssuchasdifferentwayshowto gettoaparticularplaceinICATT.Demonstrateonlythemainstepsneededfornavigation. Afterthepresentation,letparticipantspracticenavigationinICATTindividually.Tellthemto opentheICATTtrainingplayerandcreatedtheirstudentprofileandstartthetraining.Assistas needed. Note:IfparticipantswillbringtheirStudentprofileonUSBflashdiskstothefacilitatorsfor checkinginsubsequentencounters,remindthemthatStudentprofilenamesshouldbethesame asthosegiveninRegistrationforms. Wheneveryonehasstartedthetraining,tellthemtoopencomponentCAREOFCHILDAGED2 MONTHSTO5YEARS,Part1:Assessandclassifythesickchild,andpracticegoingthroughits pages,enlargingpictures,runningflashmovies,videos,andinsertinganswersintoexercises. Provideassistanceasneeded. Aftertheparticipantshavepractisedforsometime,distributethetrainingaidICATTnavigation minimum.Showtotheparticipantsthatinthisdocumenttheywillfindtheinformationhowto startworkingwithICATTtrainingplayerathomeorintheiroffice,howtotransfertheirStudent profile,andhowtoopenQuickreferencefortheIMCIplayerthatprovidesdetailedinstructions aboutnavigationinICATT.Demonstrateandasktheparticipanttopracticetheitemsdescribed intheICATTnavigationminimum: ShowtheparticipantICATTinstall/runoptions.Demonstrateandletparticipants practicerunningICATTfromtheirUSBflashdiskorDVD.Assistasneeded. IfparticipantswillberequiredtobringtheirStudentprofileforcheckingbyfacilitators demonstratethetransferoftheStudentprofiletoaUSBflashdisk.Askparticipantsto 92

ICATTbasedIMCItraining practicethetransferofStudentprofile.EmphasisethattransferringtheStudentprofileis notcopyingletparticipantscheckthattheirStudentprofilehasdisappearedfromthe Documentswhereitisstoredbydefault,askthemtoimporttheStudentprofileback,run thetrainingagain. DemonstrateandhavetheparticipantspracticeopentheQuickreferencefortheIMCI trainingplayer.

Attheendofthesessionmakesurethateachparticipantknowshowto: InserttheUSB/DVDwithICATTandselectRunfromDVD CreatetheStudentprofile Startthetraining UsetheBack/Nextbuttons,enlargepictures,runflashmovies,videos,insertanswers intoexercises TransfertheStudentprofile OpenQuickreferencefortheIMCItrainingplayer.

8. REVIEWPARTICIPANTWORKBOOKANDANNOUNCEPRACTICALARRANGEMENTSFOR THE TRAINING

DistributetheParticipantworkbookandasktheparticipantstoopenit. ReviewtheTrainingcalendar.Asktheparticipantstorecordthedatesandvenuesofthe participantfacilitatorencounters(ifthishasnotbeenalreadydone). Reviewtheparticipantactivitiesduringtheselflearningphases. ReviewthechapterHowtoorganizeyourwork. ExplaintotheparticipantsthattheyshouldworkthroughtheICATTapproximatelyas indicatedintheICATTselflearningschedule;askthemtowritedowntheenddateof eachtrainingweekasthedeadlineforcompletingthetasksfortheweek. Tellparticipantstorecordeachtimethattheyindividuallypracticeandthenumberof casestheyseeintotheRecordofclinicalpracticesessions. Explaintoparticipantshowtocompletetherecordsofclassificationsseen.Askthemto recordtheclassificationsthattheyhaveseenduringthedemonstrationasanexample.

AfterreviewingeachchapteroftheParticipantworkbook,givetheparticipantsanopportunity toaskquestionsandanswerthembeforeyougotothenextchapter. Explaintoparticipantshowyouwillsupportthemduringtheselflearningphases.Announce whichofthefacilitatorstheyshouldcontactforanyproblemorquestiontheymayhaveduring selflearningphasesandencouragethemtodoso.ProvideeveryonewithTrainingdirectory (includingnamesandaddressesofallparticipants,facilitators,instructors,andtheITsupport person).Distributesufficientnumberofcopiesofrecordingformsforparticipantsclinical practiceattheirworkplace. Announceanyotherarrangementsneeded.

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4. INTERMEDIATEFACILITATORPARTICIPANTENCOUNTER
ACTIVITIES 1. CollectparticipantsICATTStudentprofilesandcompletedrecordingformsandcheck participantprogress. 2. Describeobjectivesandorganizationoftheencounter. 3. ConductgroupoverviewofprogressinICATTandparticipantindividualclinicalpractice. 4. Leaddrill:ReviewinginformationontheASSESS&CLASSIFYchart. 5. Conductoutpatientclinicalpracticesession:Demonstrationofidentifyingtreatment, treatingthechildandcounsellingthemother;individualpracticeinassessmentand classificationofchildrenaged2monthsupto5years 6. Conductgroupfeedbackandproblemsolvingsession. 7. Giveindividualfeedbackinsmallgroups. 8. Summarizetheworkandreviewtasksforthe2ndselflearningphase.

COLLECTINGPARTICIPANTSICATTSTUDENTPROFILES,COMPLETEDRECORDING FORMS,ANDINDIVIDUALRECORDOF PARTICIPANTPROGRESS ANDCHECKINGPARTICIPANT PROGRESS

Facilitator(s)designatedtocheckparticipantprogress: CollecttheUSBflashdiskswiththeStudentprofilesandcompletedrecordingformsfor casesseenduringindividualpracticefromtheparticipantsduringtheregistrationbefore thebeginningoftheencounter. Note:CheckthateachUSBhastheparticipantsnameonit.Recordingformsofeach participantshouldbeinafolderwithhisorhernameonit. ChecktheStudentprofilesandcompletedrecordingformsforcasesseenandrecordthe findingsintoIndividualrecordsofparticipantprogressasdescribedinAnnex7Check participantprogressandprovidefeedbackofthisguidewhileparticipantsgothroughthe encounteragendawithotherfacilitators.

1.

OBJECTIVESANDORGANIZATIONOFTHEINTERMEDIATEFACILITATORPARTICIPANT ENCOUNTER
Statetheobjectivesoftheintermediatefacilitatorparticipantencounter: AssessparticipantsprogressinICATT. Solvepossibleproblems. Conductindividualclinicalpracticeinassessmentandclassificationofasickchildaged2 monthsupto5years. Demonstrateidentifytreatment,treat,andcounselthemother. Describetheorganizationofthisencounter.

2.

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3. GROUPOVERVIEWOFPROGRESSINICATTANDPARTICIPANTINDIVIDUALCLINICAL PRACTICE
Tellparticipantsthattheaimofthissessionistogetgeneralinformationabouttheirworkin ICATTandindividualclinicalpracticebeforetheygototheclinic.Youwillrespondtoallthe questionstheymayhaveinalatersession. AsktheparticipantswheretheyareintheICATT(whichtrainingunitstheyhavefinalized).Ask ifthereareanyissuesconcerningtheICATTsoftwareortheIMCIcontent.Listtheissuesdo notdiscussthemnow.Tellparticipantsthatyouwilldiscusstheissueslater. Asktheparticipantshowmanyclinicalsessionstheyhavehadintheirclinicandhowmany patientstheyhaveseen.Askifthereareanyissuesconcerningtheclinicalpractice.Listthe issuesdonotdiscussthemnow.Tellparticipantsthatyouwilldiscusstheissueslater.

4. DRILLREVIEWINGINFORMATIONONTHEASSESS&CLASSIFYCHART
YouwillfindthedrillinAnnex2ofthisguide. Thepurposeofthisdrillistofindouthowparticipantlearnedtoassessandclassifychildren accordingtotheIMCIguidelinesduringtheselflearningphase.

5. OUTPATIENTSESSION:DEMONSTRATIONOFIDENTIFYINGTREATMENT,TREATING THE CHILDANDCOUNSELLINGTHEMOTHER;INDIVIDUAL PRACTICEINASSESSMENT ANDCLASSIFICATIONOFCHILDRENAGED2MONTHSUPTO5YEARS

Tellparticipantsthatuntilnowtheywereexpectedtolearnandpracticeattheirhealthfacilities howtoassessandclassifysickchildrenaged2monthsupto5years.Duringthissessionthey willpracticeassessmentandclassificationundersupervisiontoensurethattheyaredoingit correctly.Inadditionyouwilldemonstratetodayhowtoidentifytreatment,treat,andcounsel themothertheywilllearndoingthisduringthenextselflearningphase. Thesessionwillstartwithademonstrationofacompletecasemanagement.Chooseachildfor thedemonstrationwhoislessthan2yearsoldandwhohasfastbreathing,fever,oranear problem.(Thischildwouldneedafeedingcounsellingandanoraldrug.) Toprepare Reviewgeneralprocedures:Howtopreparefortheoutpatientsession,Conducting theoutpatientsession,andspecificinstructionsforoutpatientsessionsChild57inpart GuidelinesforclinicalpracticeintheoutpatientclinicoftheGuideforclinicalpractice. Askparticipantstobringchartbooklet,pencils,andtimingdevices. Bring8recordingformsperparticipant. BringsupplieslistedinAnnex1oftheGuideforclinicalpracticeforthedemonstration BringoneMother'scardforthedemonstration

Participantobjectives Assessandclassifysickchildrenaged2monthsupto5years. 96

ICATTbasedIMCItraining Observeidentifytreatment,treat,assessfeeding,andcounseltheaboutfood,fluidsand whentoreturn.

Facilitatorprocedures Choosesickchildrenwithoneormoremainsymptoms. Assessandclassifyachildand,usingchartorchartbookletandarecordingform, Demonstratehowtoidentifythechild'streatment. ReviewstepsonTREATchartanddemonstratehowtoteachmothertogiveanoraldrug athome. Demonstratehowtoassessfeedingandcounselthemotheraboutfood,fluidsandwhen toreturn. Assignpatientstoparticipants.Participantsassessandclassifythecases. Observeeachparticipanttobesurechildhasbeenassessedandclassifiedcorrectly.If youcannotobserve,askparticipanttopresentcase. Givefeedbackandguidanceasneeded. Returnchildtoclinicstaffwithnotefortreatment.

Attheendofthesession Leadadiscussiontosummarizesessionandgivefeedbackonskillspracticed. 6. GROUPFEEDBACKANDPROBLEMSOLVINGSESSION ConductthissessionforthewholegroupofparticipantsusingLCDprojectedICATTasneeded. FirstaddressissuesmentionedduringthegroupoverviewofprogressinICATT. Thenaddressthemostcommonmistakesfoundinthecompletedrecordingformsandthemost commonmistakesobservedduringtheclinicalpracticesessioninthisencounter. Thenasktheparticipantsiftheyhaveanyquestionsnotyetaddressed.

7. INDIVIDUALFEEDBACKCONDUCTEDINSMALLGROUPS.
Thissessionisconductedafterthegroupfeedbackandproblemsolvingsessionanditsaimisto provideparticipantsindividualpersonalcontactwithafacilitatorandanswerstoquestionsnot addressedinthelargegroupsession. Toconductthissession,followtheinstructionsinAnnex7,

8. SUMMARYOFWORKANDTASKSFORTHE2NDSELFLEARNINGPHASE
Thanktheparticipantsfortheirgoodwork.Tellparticipantswhatwasdonewellduringtheir individualworkandduringtheencounter.Alsomentionanypointsthatweredifficultfor participants. Remindparticipantsaboutthedateandvenueofthenextfacilitatorparticipantencounter. AskparticipantstoopentheirParticipantworkbookatpagedescribingtheSecondselflearning phaseandaskoneparticipanttoreadaloudthetasksforthe2ndselflearningphase. Asktheparticipantsiftheyhaveanyquestions.Answerthemasneeded. 97

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5. FINALFACILITATORPARTICIPANTENCOUNTER
ACTIVITIES 1. CollectparticipantsICATTStudentprofiles,completedrecordingforms,andParticipant workbooksandcheckparticipantprogress. 2. Describeobjectivesandorganizationoftheencounter. 3. ConductgroupoverviewofprogressinICATTandparticipantindividualclinicalpractice. 4. Conductclinicalpracticesession:Individualpracticeincompletecasemanagementof childrenaged2monthsupto5years 5. Leaddrilloncheckingquestions. 6. Conductgroupfeedbackandproblemsolvingsession.

COLLECTINGPARTICIPANTSICATTSTUDENTPROFILES,COMPLETEDRECORDING FORMS,ANDINDIVIDUALRECORDOF PARTICIPANTPROGRESS ANDCHECKINGPARTICIPANT PROGRESS

Facilitator(s)designatedtocheckparticipantprogress: CollecttheUSBflashdiskswiththeStudentprofilesandcompletedrecordingformsfor casesseenduringindividualpracticefromparticipantsduringtheregistrationbeforethe beginningoftheencounter. Note:CheckthateachUSBhastheparticipantsnameonit.Recordingformsofeach participantshouldbeinafolderwithhisorhernameonit. ChecktheStudentprofilesandcompletedrecordingformsforcasesseenandrecordthe findingsintoIndividualrecordsofparticipantprogressasdescribedinAnnex7Check participantprogressandprovidefeedbackofthisguidewhileparticipantsgothrough theencounteragendawithotherfacilitators.

1.

2.

OBJECTIVESANDORGANIZATIONOFTHEFINALFACILITATORPARTICIPANT ENCOUNTER
CheckifparticipantsfinalizedworkingthroughICATT. Conductindividualclinicalpracticeincompletecasemanagementofsickchildrenaged2 monthsupto5years.

Statetheobjectivesoftheencounter:

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Facilitatorguide Demonstrateacompletecasemanagementoftheyounginfantincludingfeeding assessmentandbreastfeedingcounselling. Evaluateknowledgeofparticipants.

Describetheorganizationofthisencounter.

3.

GROUPOVERVIEWOFPROGRESSINICATTANDPARTICIPANTINDIVIDUALCLINICAL PRACTICE

Tellparticipantsthattheaimofthissessionistogetgeneralinformationabouttheirworkin ICATTandindividualclinicalpractice.Youwillrespondtoallthequestionstheymayhaveina latersession. AsktheparticipantswheretheyareinICATT(whichtrainingunitstheyhavefinalized).Askif thereareanyissuesconcerningtheICATTsoftwareortheIMCIcontent.Listtheissuesdonot discussthemnow.Tellparticipantsthatyouwilldiscusstheissueslater. Asktheparticipantshowmanyclinicalsessionstheyhavehadintheirclinicandhowmany patientstheyhaveseen.Askifthereareanyissuesconcerningtheclinicalpractice.Listthe issuesdonotdiscussthemnow.Tellparticipantsthatyouwilldiscusstheissueslater.

4.

CLINICALPRACTICEOUTPATIENTSESSION:INDIVIDUALPRACTICEINCOMPLETECASE MANAGEMENTOFCHILDRENAGED2MONTHSUP TO5YEARS

Reviewgeneralprocedures:Howtopreparefortheoutpatientsession,Conducting theoutpatientsession,andspecificinstructionsforoutpatientsessionsChild57inpart GuidelinesforclinicalpracticeintheoutpatientclinicoftheGuideforclinicalpractice. Askparticipantstobringchartbooklet,pencils,andtimingdevices. Bring8recordingformsperparticipant. Bring8Mother'scardsperparticipant. BringsupplieslistedinAnnex1ofGuideforclinicalpracticeandplacethemontableor tray.

Toprepare

Participantobjectives Assessandclassifyasickchild. Practiceidentifyingthechild'streatment. Advisemotherswhentoreturnimmediately. Teachmothertogiveherchildanoraldrugathome. UseaMother'scardtoadviseandteachmothers. Usegoodcommunicationskills.

Facilitatorprocedures Choosesickchildrenwithoneormoremainsymptoms.

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ICATTbasedIMCItraining Assessandclassifyachildand,usingchartorchartbookletandarecordingform, demonstratehowtoidentifythechild'streatment,howtoteachmothertotreatthe child,andhowtocounselthemother. Assignpatientstoparticipants.Participantsassessandclassifythecases. Superviseparticipantscarefullyastheypracticeidentifyingtreatment,treatingand counsellingthemother. Observeeachparticipantasheworkswithacase.Ifyoucannotobserve,askparticipant topresentthecase. Givefeedbackandguidanceasneeded. Returnchildtoclinicwithnotefortreatment.

Attheendofthesession Leadadiscussiontosummarizesessionandgivefeedbackonskillspracticed.

5. DRILL:PRACTISEASKINGCHECKINGQUESTIONS
FollowtheinstructionsforthedrillinAnnex4ofthisguide. 6. GROUPFEEDBACKANDPROBLEMSOLVINGSESSION ConductthissessionforthewholegroupofparticipantsusingLCDprojectedICATTasneeded. FirstaddressissuesmentionedduringthegroupoverviewofprogressinICATT. Thenaddressthemostcommonmistakesfoundincompletedrecordingformsandthemost commonmistakesobservedduringtheclinicalpracticesessioninthisencounter. Thenaskparticipantsiftheyhaveanyquestionsnotyetaddressed.

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FACILITATORGUIDE
ANNEXES

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ANNEX1:COMPLETEDRECORDINGFORMSFORSELECTEDICATTVIDEOEXERCISES
AllexercisesrequiringcompletingarecordingformareinICATTcomponentCAREOFCHILD AGED2MONTHSTO5YEARSPart1:Assessandclassifychild Assesscoughordifficultybreathing:Exercise6Classifycoughordifficultybreathing casestudyGyatsu

Assesscoughordifficultybreathing:Exercise7Classifycoughordifficultybreathing casestudyWambui

Assesscoughordifficultybreathing:Exercise5CasestudyBen

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Facilitatorguide Assessdiarrhoea:Exercise5CasestudyJosh

Assessfever:Exercise7CasestudyPu

Note: Malaria test is not used in this video. Classify the child's fever as if the malaria test were not available.

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ICATTbasedIMCItraining Checkformalnutritionandanaemia:Exercise6CasestudyJenny

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Facilitatorguide Assessotherproblemsandreviewofassessandclassify:Exercise7CasestudyFaduma

IsFaduma'simmunizationstatusuptodate?YES. FinallycheckforotherproblemsdoesFadumahaveotherproblems?YES. HowwouldyouclassifyFaduma'sotherproblems?SCABIES.

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ICATTbasedIMCItraining Assessotherproblemsandreviewofassessandclassify:Exercise8CasestudyMartha

Note: Malaria test is not used in this video. Classify the child's fever as if the malaria test were not available.

NowcheckMartha'simmunizationstatus:isituptodate?YES. ThenfinallycheckforotherproblemsdoesMarthahaveanyotherproblems?NO.

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ANNEX2:DRILLREVIEWINGINFORMATIONONTHEASSESS&CLASSIFYCHART TellparticipantsthepurposeofthedrillistoreviewinformationontheASSESS&CLASSIFY chart.Allowparticipantsafewminutestoreviewassessandclassifystepsonthechartbefore thedrillbegins.Tellthemtheymayrefertothechartduringthedrill,buttheyshouldtryto answerthequestionswithoutlookingatorreadingfromthechart. Whenalltheparticipantsareready,beginthedrill.Askthefirstquestion. Part1:ReviewtheASSESS&CLASSIFYchart a. Whatarethetwoagegroupsfordeterminingthecutoffforfastbreathing? 2monthsupto12monthsand12monthsupto5years b. Does"12monthsupto5years"includea5yearoldchild? no c. Does"12monthsupto5years"includea12montholdchild? yes d. Eachmotherisaskedaboutfourmainsymptoms.Whatarethey? Coughordifficultbreathing,diarrhoea,feverandearproblem e. Besidescheckingforgeneraldangersignsandassessingforfourmainsymptoms,what elsedoyoucheckallsickchildrenfor? Checkformalnutritionandanaemia.Thencheckthechild'simmunizationstatusandany otherproblemwhichthemothermentions. f. Pleasecomeuptothechartandshowthegroupwherethestepsforassessingsick childrenarelocated. (participantpointstoboxesinAssesscolumn.) g. (Askanotherparticipanttocometothechart.)Wheredoyoulookfirstwhenyouclassify thechild'sillness? (participantpointtosigncolumninclassificationtable) h. (Askanotherparticipanttocometothechart.)Wherearetheclassificationslocated? participantpointstoClassifyascolumn.) Part2:Reviewhowtoclassifyillness Reviewhowtoclassifycoughordifficultbreathing: Alwaysstartatthetopoftheclassificationtable.Ifthechildhassignsfrommorethanonerow, alwaysselectthemoreseriousclassification.Inthiscase,thechildhasasigninthepinkortoprow andasignintheyellowormiddlerow.Selectthemoreseriousclassification,SEVEREPNEUMONIA ORVERYSEVEREDISEASE.
Answeranyquestionsparticipantsmayhaveaboutclassifyingillnessinsickchildren.Then continuewiththedrillasdescribedbelow. Part3:Reviewthecutoffsfordeterminingfastbreathing

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ICATTbasedIMCItraining Beforeyoubegin,helpparticipantsreviewthecutoffsfordeterminingfastbreathing.Askone oftheparticipantstotellthegroupthecutoffforfastbreathinginachildaged2monthsupto 12months;askanothertotellthegroupthecutoffforfastbreathinginachild12monthsupto 5years. Continuethedrilluntilyoufeelthatparticipantscanrecallthecutoffsconfidently. QUESTION ANSWER ASK:Whatisfastbreathinginachildwho is: 4monthsold 18monthsold 36monthsold 6monthsold 11monthsold 12monthsold 2monthsold

50breathsperminuteormore 40breathsperminuteormore 40breathsperminuteormore 50breathsperminuteormore 50breathsperminuteormore 40breathsperminuteormore 50breathsperminuteormore

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Facilitatorguide QUESTION ASK:Doesthechildhavefastbreathingif: Thechildis: andnumberofbreathsinaminuteis: 3monthsold 52 2yearsold 6monthsold 12monthsold 12monthsold 3yearsold 8monthsold 18monthsold 15monthsold 4monthsold 14monthsold 4yearsold 20monthsold 7monthsold 10monthsold 11monthsold 12monthsold 38 48 38 42 37 54 45 42 45 45 43 48 48 38 45 45 ANSWER Yes No No No Yes No Yes Yes Yes No Yes Yes Yes No No No Yes

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ICATTbasedIMCItraining Part4:Reviewclassifyingsignsofillness Telltheparticipantstheywillnowpracticeclassifyingsignsofillness. Youwilldescribeachild'ssignsandsymptoms.Thencallonaparticipanttoselectthe appropriateclassification.Ifyouthinkaparticipantneedsadditionalpractice,askhimto describehowheclassifiedthechild'ssignsaccordingtotheclassificationtable. Whenalltheparticipantsareready,beginthedrillbyaskingthefirstquestionbelow. QUESTION: Howwouldyouclassifya9montholdchildwhohas: CoughAND CoughAND CoughAND FeverAND Feverwithhigh malariariskAND ageneraldangersignwithchest indrawingandstridorinacalmchild 51breathsperminuteandnosignsof thesevereclassification 40breathsperminuteandnosignsof thesevereclassification ageneraldangersignandstiffneck atemperatureof37.5Cintheclinic,no signsforthesevereclassificationandno malariatest. bloodinstool. Childisfor3daysrestlessandirritable; nosunkeneyes;drinkingeagerly, thirsty;skinpinchgoesback immediately. Nobloodinstool,Childisrestless, irritable,nosunkeneyes;drinking eagerly,thirsty,skinpinchgoesback slowly. Nobloodinstool.Childisnotlethargic orunconscious;notrestlessand irritable.Nosunkeneyes,andisableto drinkbutisnotthirsty.Skinpinchgoes backimmediately. Cloudingofthecornea. Ageneraldangersign. SEVEREPNEUMONIAORVERY SEVEREDISEASE PNEUMONIA COUGHORCOLD VERYSEVEREFEBRILE DISEASE MALARIA ANSWER:

Diarrhoeafor3 daysAND

SOMEDEHYDRATIONand DYSENTERY

Diarrhoeafor14 daysAND

SOMEDEHYDRATIONand SEVEREPERSISTENT DIARRHOEA NODEHYDRATION

Diarrhoeafor2 daysAND

Signssuggesting measlesAND Signssuggesting

SEVERECOMPLICATED MEASLES SEVERECOMPLICATED

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Facilitatorguide measlesAND Signssuggesting measlesAND Anearproblem AND Anearproblem AND Anearproblem AND QUESTION: Howwouldyouclassifya9monthold childwhohas: Visibleseverewasting Oedemaofbothfeet Verylowweightforage Somepalmarpallor Severepalmarpallor ANSWER Pusdrainingfromtheeyeandnosigns forthesevereclassification. Tenderswellingbehindtheear. Pusisseendrainingfromtheearand dischargeisreportedfor7days. Pusisseendrainingfromtheearand dischargeisreportedfor3weeks. MEASLES MEASLESWITHEYEOR MOUTHCOMPLICATIONS MASTOIDITIS ACUTEEARINFECTION CHRONICEARINFECTION

SEVEREMALNUTRITION SEVEREMALNUTRITION VERYLOWWEIGHTAND/ORGROWTH FALTERING ANAEMIA SEVEREANAEMIA

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ANNEX3:DRILLPRACTISEASKINGCHECKINGQUESTIONS Tellparticipantsthatthisdrillwillreviewhowtoaskcheckingquestions. Toconductthedrill: Refertothetablebelow.Readaloudeachquestioninthefirstcolumn.Askparticipantsto rephrasethequestionasagoodcheckingquestion.Makesurethateachparticipantisgiven theopportunitytoanswer. Aparticipant'scheckingquestionmaybewordedsomewhatdifferentlythantheexamples given.Thequestionisacceptableifitasksamothertodescribehowshewilltreatherchild. Ifthequestioncanbeansweredwitha"yes"or"no",itisnotacceptable. Rephrasethefollowing ExamplesofpossibleCHECKINGQUESTIONS questionsasgoodchecking questions:
Willyougiveyourchildthe tabletsaswediscussed? Youshouldbreastfeedyour childwhenhehasdiarrhoea, correct? Doyouknowhowtogiveyour childhalfofavitaminAcapsule? Doyouknowwhattodoifyour childcannotswallowthistablet? Doyouknowhowtogivethe syrup? Whenwillyougiveyourchildthetablets? Howmanytabletswillyougiveasonedose? Howwillyoufeedyourchildwhenhehas diarrhoea? Whenshouldyoubreastfeedhim? ShowmehowyouwillgivehalfofthisvitaminA capsuletoyourchild. WhenwillyougivethevitaminAcapsule? Howwillyoupreparethistabletsothatyourchild canswallowit? Howwillyougivethesyrup? Howyouwillmeasureadoseofthesyrup?Show me. Forhowmanydayswillyougivetheironsyrupto yourchild? Howmuchsyrupwillyougiveeachday? Whowilltakeyourchildtothehospital? Howwillyoutravelwithyourchildtothe hospital? Whenwillyoureturnforafollowupvisit?

Willyougiveyourchildtheiron syrupforthenext2weeks?

Canyoutakeyourchildtothe hospital?

Willyoureturnforafollowup visit? Doyouknowwhentoreturn?

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ANNEX4:ROLEPLAYTEACHINGAMOTHERTOGIVEORALDRUGSDASAR
Purpose:ToPRACTISEteachingmotherstogiveoraldrugsathome. Highlightsofthecase:AhealthworkerhasdecidedthatababynamedDasarneeds2different drugs,artemetherlumefantrineandiron.Theironisinsyrupform.Thehealthworkerwillneed toteachthemotherhowtogiveDasarthedrugsathome. Selecttwoparticipantstoplaytherolesofthehealthworkerandmother.Explainthe rolesandgivetheparticipantstimetoprepare. Explaintotheparticipantwhowillbethehealthworkerhowtoadjustteaspoon amountswhenusingaspoonthatmotherswilllikelyuseathome(Oneteaspoonful usuallyequalsto5ml).Telltheparticipanttobesuretoexplainadoseinsuchaway thatthemothercanmeasurethedoseherself.Alsotelltheparticipantthatheshould measureandgivethemotherenoughoftabletsandsyrupforthefulltrainingoftherapy, thatis,ArtemetherLumefantrine5dosesandironfor14days. Telltheparticipantwhowillbethemothertolistencarefullytotheinstructionsthatthe healthworkergivesher.Askquestionsifshedoesnotunderstandtheinstructions. Answeranyquestionssheisaskedbythehealthworker.Encouragehertoactlikea normal,concernedmother.Suggestthatthemotherbeconfusedabouttheschedule,the dose,orbeconcernedaboutgivingmorethanoneoraldrugatatime. Gatherallofthefollowingsupplies. o Chartbookletopenedtothepagetitled"Teachthemothertogiveoraldrugsat home" Dollorother"baby" Druglabelsandapen Artemetherlumefantrinetablets Ironsyrup(ortablets,ifthereisnosyrupatyourclinic) Commonspoonformeasuringsyrup Smallbottles(ordrugenvelopes)formothertotakedrugshome

o o o o o o

Introducetheroleplaybytellingparticipantsthatthehealthworkerwillfollowthesteps forteachingamotherhowtogiveoraldrugsathome.Thisroleplaywillnotinclude assessingorclassifyingDasar,whichhasalreadybeendone.Distributecopiesofthe handoutonthenextpage. Introducethemotherandthehealthworker.Readaloudthesituationfromthehandout. Remindtheobserverstothinkaboutthequestionslistedinthehandoutastheywatch. Asktheplayerstobegintheroleplay.

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ICATTbasedIMCItraining Whentheroleplayisfinished,thanktheparticipants.Thenbeginadiscussionofthe questionslistedinthehandout.Alsoasktheparticipantstomentionthedifferentor additionalstepsthatahealthworkershoulddowhenmorethanonedrugisgiven.

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Facilitatorguide Handoutforparticipants Roleplay:TeachingamothertogiveoraldrugsDasar Dasar,an8monthold(5kg)boy,livesinaregionwheretheriskofmalariaishigh,butthereis nohookwormorwhipworm.Hismotherbroughthimtotheclinicbecausehehasfever.The feverhasbeenpresentfor4days. AhealthworkerfindsthatDasarhasnogeneraldangersigns,nocough,nodiarrhoeaandnoear problem.Hehasafeverof38C,withnostiffneck,norunnynoseormeasles.Heisverylow weightforageandhassomepalmarpallor.ThehealthworkerclassifiesDasarasMALARIAand ANAEMIAandVERYLOWWEIGHT. TotreattheMALARIA,thehealthworkerdecidestogiveartemetherlumefantrinetablets.He notesthatDasarshouldbegiven1tabletnow,1tabletathome8hourslater,andthentwice dailyforfurthertwodays. TotreattheANAEMIA,thehealthworkernotesthatDasarneedstspofironsyrup. (NOTE:ThehealthworkershouldadviseDasar'smotheraboutfeeding,butthatisnotincluded inthisroleplay.YouwilllearnhowtogivefeedingadviceinthenextpartCounselthemother.) Handoutforobservers Watchtheroleplay.Donotinterfere.Readthefollowingquestionsandanswerthemasyou watch. a. Doesthehealthworkergiveinformationtothemotheraboutwhytheoraldrugsare important,andhow/whentogivethem? b. Doesthehealthworkershowthemotherexamplesofhowtomeasureadoseofeach drug? c. d. Doesthehealthworkerobservethemother: practisemeasuringadoseofeachdrug,and practisegivingthedrugtoherchild?

Doesthehealthworkercorrectlylabelandpackagethedrugs?

e. Doesthehealthworkertellthemotherwhentoreturnimmediately?Doesthehealth workertellherwhentoreturnforfollowupcare? f. Doesthehealthworkercheckthemother'sunderstanding?

g. Whatcheckingquestionsdoesthehealthworkerask?Whatothercheckingquestions wouldyouask? WHENEVERYONEISREADY,THEREWILLBEAGROUPDISCUSSION

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ANNEX5:ROLEPLAYUSINGGOODCOMMUNICATIONSKILLSANDTHEENTIRE COUNSELCHARTANDMOTHERSCARDFELICE
ThisroleplayallowsparticipantstopractisetheentireprocesscoveredontheCOUNSELchart: feedingassessment,counsellingonfeeding,givingadviceonfluid,andteachingwhentoreturn. ParticipantsdothewholeprocessusinggoodcommunicationskillsandusingtheMother'scard. Highlightsofthecase:ChildhasVERYLOWWEIGHTandfeedingproblems.Aswellasassessing feedingandcounsellingonfeeding,thehealthworkerwillpractisegivinginstructionsonwhen toreturnforVERYLOWWEIGHTandafeedingproblem. Assignrolesandconducttheroleplaysasfollows: o Assigntheroleofhealthworker.GivetheparticipantacopyoftheMother'scard touseintheroleplay.Encouragetheparticipanttotakeseveralminutesto reviewthefeedingquestionsontheRecordingformandthefeeding recommendationsforthechild'sageontheMother'scardorinthechartbooklet. Telltheparticipantthatheorsheshouldbepreparedforthemothertobehave likearealmother,toaskquestions,etc. Assigntheroleofthemother.Givethemotheraslipofpaperdescribingthe situation,thechild'susualfeedingandfeedingduringtheillness,andher attitude.Thisslipofpaperisprovidedbelowandmaybephotocopied.Tellthe "mother"thatshemaymakeupadditionalrealisticinformationthatfitsthe situationifnecessary.Helpherpreparetoplaytherole.

Conducttheroleplay.Duringtheroleplay,observersshouldcompletetheAssesschilds feedingsectionoftherecordingformandwritedownthefeedingadvicegivenonthe handoutbelow(photocopyitfortheparticipants).Theyshouldbepreparedtoanswer anddiscussthequestionsgiveninthehandout. Aftertheroleplay,leadabriefdiscussionusingthequestionsonthehandout.Ensure thatpositivecommentsaremadeaswellassuggestionsforimprovements.

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Facilitatorguide Handoutforobservers Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartandMotherscard Felice Feliceis2yearsand2monthsold.ShehasVERYLOWWEIGHTandanACUTEEARINFECTION. Thehealthworkerhasalreadygiventhemotherinstructionsonwickingtheearandgivingan antibioticfortheearinfection.Nowthehealthworkerwillassessfeedingandcounselthe motheraboutFOOD,FLUID,andWHENTORETURN. Listenandwatchcarefully.Ontherecordingformbelowwritetheanswerstothefeeding questionsandanyfeedingproblems.Noticewhetherthefeedingquestionsareused,adviceis correctandcomplete,andgoodcommunicationskillsareused.Bepreparedtodiscussthe questionsgivenbelow.
ASSESSCHILD'SFEEDINGifchildhasANAEMIA/VERYLOWWEIGHTorislessthan2years FeedingProblems: old. Doyoubreastfeedyourchild?Yes___No___ IfYes,howmanytimesin24hours?_____times. Doyoubreastfeedduringthenight?Yes___No___ Doesthechildtakeanyotherfoodsorfluids?Yes___No___ IfYes,whatfoodsorfluids?______________________________________________________________ ___________________________________________________________________________________ Howmanytimesperday?_____times.Whatdoyouusetofeedthe child?_______________________ Ifverylowweightforage:Howlargearetheservings?_____________________________ Doesthechildreceivehisownserving?_____Whofeedsthechildandhow?___________ _____________________________________________ Duringthisillness,hasthechild'sfeedingchanged?Yes___No___ IfYes,how?_____________________________________________________________________

Feedingadvicegiven: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Aftertheroleplayyouwilldiscussthefollowingquestions: a. Wereallthenecessaryquestionsaskedaboutthechild'sfeeding?Didthehealth workerfinishthefeedingassessmentbeforeidentifyingthefeedingproblemsandgiving advice? Whatfeedingproblemswereidentified,ifany? Wasthemotherpraisedforsomethingshehasbeendoingcorrectly? WascounsellingaboutFOODcompleteandcorrectforthechild'sageandfeeding problems? WasadviceonFLUIDcompleteandcorrect? WasadviceonWHENTORETURNcompleteandcorrect?Diditincludesignstoreturn immediately? Didthehealthworkeraskappropriatecheckingquestions? Ifnotoanyoftheabove,whatcouldhavebeendonebetter?Bepreparedtomake suggestions.

b. c. d. e. f. g. h.

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ICATTbasedIMCItraining Handoutforthemother Roleplay:UsinggoodcommunicationskillsandtheentireCOUNSELchartand MotherscardFelice DescriptionforFelice'smother Youhavea2yearolddaughternamedFelicewhohasverylowweightandhasanear infection.Thehealthworkerhasalreadygivenyouinstructionsonwickingtheear andgivinganantibioticfortheearinfection.Heorshewillnowassessfeedingand counselyouaboutFOOD,FLUID,andWHENTORETURN. Youaretimidwiththehealthworkeranddonotvolunteerinformationunlessasked. Youhavecomealongwaytotheclinicandyouaretired.Youarereluctanttocome backforafollowupvisitbecausetransportationisdifficultforyou.Youarenotable toreadthewordsontheMother'sCard,butyoutrytounderstandthepictures. Feliceisnolongerbreastfed.Sheeatsfamilyfoodsabout3timesaday.Shedrinks cow'smilkwhenitisavailable.Shedoesnotuseafeedingbottle.Foodservingsare smallandFelicefinishesallofherfood.(Ifaskedaboutfamilyfoodsandfeeding practices,describefoodsandfeedingpracticesthataretypicalinyourarea.)

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ANNEX6:DISTANCELEARNINGTRAININGPARTICIPANTSUPPORTDURINGSELF LEARNINGPHASES
Dependingonthetrainingarrangements,youmaybeaskedtoprovideactiveorpassivesupport toparticipantsduringtheselflearningperiods. Activesupport Contacttheassignedparticipants(usuallybyphoneoremail)23daysaftertheinitial encountertoenquirewhethertheyareabletoruntheICATTontheircomputer Ifnot,askwhattheproblemisandsolveitifpossible. Ifyoucannotsolvetheproblem,tellparticipanttocontactthepersondesignatedtohelp participantswithcomputerproblems.

Thencontacttheassignedparticipantsonceaweektoaskiftheparticipantneedsanyadvice andtoenquireabouthisorherprogress. AsktheparticipanthowhisorherworkinICATTisgoingandwhereinICATTheorshe is(whichtrainingunitshasheorshefinalized). AsktheparticipantifheorshehasanyquestionsconcerningtheworkwithICATT?If yes,provideanswersasneeded. LookattheICATTselflearningscheduleprovidedonthenextpage:Doestheparticipant proceedapproximatelyaccordingtotheschedule? o Iftheparticipantproceedsapproximatelyaccordingtothescheduleorisahead ofit,praisehimorher. Iftheparticipantisbehindtheschedule,remindhimorherofthescheduleand askaboutthereasonfordelay.Provideadviceasneeded.

Asktheparticipanthowhisorherclinicalpracticewithpatientsisgoing.Doeshehave anyquestionsconcerninghisorherindividualclinicalpractice?Ifyes,provideanswers asneeded. Recordthedateswhenyoucommunicatedwiththeparticipantduringtheselflearning phaseintotheIndividualrecordofparticipantprogress(SeeAnnex8ofthisguide)and brieflydescribethecontentofcommunication

Passivesupport Participantswillcontactyouwhentheyneedhelporhaveaquestion.Facilitatorsthemselves willnotcontactparticipantsactively.

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ICATTbasedIMCItraining ICATTselflearningschedule Theschedulebelowindicateshowtheparticipantshouldapproximatelyproceedtowork throughtheICATTpartsandtrainingunitstocompletethetrainingin8weeks.Heorshemay progressmorequicklythanindicatedbutheorsheshouldnotlagbehindtheschedule. Insertthedateswhenthetasksshouldbefinishedintothecolumnontherightaccordingtothe datesofthetraining. ICATTsections,partsandtrainingunitstowork throughduringtheweek CAREOFCHILDAGED2 MONTHSUPTO5YEARS Part1:Assessandclassifychild,TrainingunitsAsk themotheraboutthechildsproblem,Checkfor generaldangersigns,Assesscoughordifficulty breathing Part1:Assessandclassifychild,Trainingunits Assessdiarrhoea,Assessfever,Assessearproblem Part1:Assessandclassifychild,Trainingunits Check formalnutritionandanaemia,Checkimmunization, vitaminAanddewormingstatus;Assessother problemsandreviewofassessandclassify Part2:Identifytreatmentforchild, Part3:Treatthechild:Selectandgiveoraldrugs, Teachthemothertogivetreatmentathome Part3:Treatthechild:Givetreatmentandimmunize thechildattheclinic,Giveextrafluidfordiarrhoea andcontinuefeeding Part4:Counselthemother, Part5:Followupthechild CAREOFYOUNGINFANT AGEDUPTO2MONTHS Part1:Essentialcare,Part2:Assessandclassify younginfant Part3:Identifytreatmentforyounginfant,treatand counsel,Part4:Followuptheyounginfant Datewhen thetasks shouldbe finished

Trainingweek 1

2 3

5 6 7 8

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ANNEX7:DISTANCELEARNINGTRAININGCHECKPARTICIPANTPROGRESSANDGIVE INDIVIDUALFEEDBACK
Checkprogress ParticipantsStudentprofile CopyallparticipantsStudentprofilesfromtheirUSBflashdiskstotheDocumentsinyour computer(ICATTsavesStudentprofilesinDocumentsdirectorybydefault).ThenopenICATT trainingplayer,loadeachstudentprofile,startthetraining,gotoPracticescreen,andlookatthe Trainingunitsprogress: Howmanytrainingunitweredone(greenorredsquares)? Howmanytrainingunitswerepassed(greensquares)?

RecordthenumbersintoIndividualrecordofparticipantprogress. Ideally,participantsshouldgetanindividualfeedbackonwronganswerstoTESTexercises.If thisisplanned,copyallStudentprofilesfromyourcomputertoUSBsoneforeachfacilitator whowillprovidethefeedback. Completedprintedrecordingformsforclinicalpractice Countthenumberofcompletedrecordingformssubmittedbyaparticipantandrecord thenumberintoIndividualrecordofparticipantprogress. Checkiftheformsarecompletedproperly:entryinformationaboutthepatient,initialor followupvisitticked,dangersignsticked,signscircled,classificationscorrectaccording tothesignsrecorded,andtreatmentscorrespondstoclassification(s).Markanyerrors witharedpencil.WritethenumberofcorrectlycompletedformsintoIndividualrecord ofparticipantprogress. Note:Iftherearetoomanyformstocheckandthetimeislimited,checkseveralforms (about5)ofeachparticipant. Listthemostcommonerrorsfoundforthegroupfeedbacksession.

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ICATTbasedIMCItraining Individualfeedbackinsmallgroups Aimofthesession.Thissessionisconductedafterthegroupfeedbackandproblemsolving sessionanditsaimistoprovideparticipantsindividualpersonalcontactwithafacilitatorand answerstoquestionsnotaddressedinthelargegroupsession. Organization:Participantsaredividedintosmallgroups(upto45participants).Eachsmall groupgatherstogetherwithonefacilitator.Acomputerisneededifindividualfeedbackon wronganswerstoTESTexercisesisplanned.Thefacilitatorgivesindividualfeedbacktothe participantsonebyone.Whileheorsheworkswithoneparticipant,otherparticipantslisten andobserve. ThefacilitatordesignatedtochecktheStudentprofilesandcompletedrecordingformsprovides eachsmallgroupfacilitatorwiththefollowing: CompletedIndividualrecordsofparticipantsprogress USBflashdiskwithparticipantsStudentprofiles(ifindividualfeedbackonwrong answerstoTESTexercisesorotherexerciseswillbegiven) Participantscompletedrecordingformsforclinicalpracticewitherrorsmarked.

Givefeedback: LookattheIndividualrecordofparticipantsprogressStudentprofileNumberoftraining unitsdone: Iftheparticipanthasworkedthroughallthetrainingunitsrequired,orevenworked further,praisehimorherforcompletingthetaskoftheselflearningphase. Iftheparticipanthasnotworkedthroughallthetrainingunitsrequired,askhimorher forthereasonanddiscusswiththehimorherhowheorshewillproceedfurtherin ordertocompletetheICATTtrainingintime.

LookattheIndividualrecordofparticipantsprogressStudentprofileNumberoftraining unitspassed: Iftheparticipantpassedalltrainingunits,praisehimorher. Ifsomeofthetrainingunitwerenotpassed,theparticipantshouldideallygetan individualfeedbackonwronganswerstoTESTexercises. Toprovideindividualfeedback,loadparticipantsStudentprofile,gotoCheck resultsaccessiblefromStudentprofile,scrolldownthescreenandidentifythe TESTexercise(s)withwronganswers.Starttraining,gotherelevantexerciseand workthroughittogetherwiththeparticipant.Makesurethattheparticipant understandswhatwaswrong. NOTE:TheProgressbarindicatestrainingunitaspassedwhen80%of answerstoTESTexercisesarecorrect,sooccasionally,theremaybeawrong answerevenwhentheunitisindicatedaspassed. Ifthisisnotpossibleduetotimelimitation,gotothenextpoint. Asktheparticipantisheorshehasanyquestionsnotaddressedduringthegroup feedbackandproblemsolvingsessionandanswerthemasneeded.

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Facilitatorguide Commentonthenumberofpatientsseen(Anacceptablenumberofpatientswilldepend onlocalconditions) o Iftheparticipanthasseenonlyafewpatients,discusswiththeparticipanthow heorshecanseemorepatients(e.g.longerormorefrequentclinicalsessions) Explainanddiscussanyomissionsanderrorsmarkedintherecordingforms. Returntherecordingformstotheparticipant.

AsktheparticipanttoshowyouhisorherParticipantworkbookandlookattherecordsinit (ICATTselflearningschedule,Recordofclinicalpracticesessions,Recordofclassificationsseen) Iftheparticipanthascompletedtheforms,praisehimorher. IftheparticipanthasNOTcompletedtheforms,askwhyandremindhimorherthat keepingtherecordshelpshimorhertomonitorhisorherprogressandtomanagetime. Itisalsoimportantfortheevaluationofthetraining. LookattheRecordofclassificationsseen:Hastheparticipantseenallclassifications commoninthearea?Ifnot,asktheparticipantaboutpossiblereason.

Asktheparticipantifheorshehasanyremainingquestions.Answerasappropriate.Then providefeedbacktothenextparticipant.

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ANNEX8:DISTANCELEARNINGTRAININGEXAMPLEINDIVIDUALRECORDOF PARTICIPANTPROGRESS
Participantname:_______________________________________________________________________________________ 1.ICATTStudentprofile Numberoftrainingunitsdone(Trainingunitsprogress/Progress barsquaregreenorred) Numberoftrainingunitspassed(Trainingunits progress/Progressbarsquaregreen) 2.Completedrecordingformsforclinicalpractice Numberofcompletedprintedrecordingforms(casesseen) Numberofprintedrecordingformscompletedcorrectly Communicationswithfacilitatorduringselflearningphases Facilitator:Recordherethedateswhenyoucommunicatedwiththeparticipantduringtheself learningphaseandbrieflydescribethecontentofcommunication. Intermediate Final encounter encounter

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