Islamic Republic of Afghanistan Ministry of Public Health Community Health Worker Training Manual

236 Pages·2006·4.85 MB·English

Islamic Republic of Afghanistan
Ministry of Public Health

Community Health Worker
Training Manual

General Directorate of Preventive Medicine and Primary Health Care

Community Based Health Care (CBHC) Department

Ministry of Public Health
2005

TABLE OF CONTENTS

ACKNOWLEDGEMENTS .......................................................................... X
INTRODUCTION......................................................................................1
I. The Community Health Worker.................................................................................2
The health problems in Afghanistan...........................................................................2
Community-based Health Care:..................................................................................2
Community Health Workers and their Selection........................................................3
CHW Training and “Active CHWs”...........................................................................3
Supervision and accountability of CHWs:..................................................................3
Provision of supplies to CHW:...................................................................................4
Records of the CHW’s work:......................................................................................4
Compensation:............................................................................................................4
II. Community Health Worker (CHW) Job Description.................................................6
General Responsibilities:............................................................................................6
III. Training of Community Health Workers....................................................................8
The Curriculum...........................................................................................................8
Making it Easier for CHWs to Learn..........................................................................9
PHASE I: A HEALTHY COMMUNITY BY PREVENTING INFECTIOUS
DISEASES..............................................................................13
1.1 DISEASES THAT SPREAD FROM PERSON TO PERSON ..................14
Background...............................................................................................................14
Things to know.........................................................................................................14
1. Common diseases..................................................................................................14
2. Most infectious diseases get better........................................................................15
3. How are infections spread?...................................................................................15
4. How can spread be prevented?..............................................................................16
1.2. PERSONAL AND HOME HYGIENE:.............................................17
Background...............................................................................................................17
1. Taking Care of our Bodies....................................................................................17
Things to Know.........................................................................................................17
Things to Do.............................................................................................................18
2. Keeping our Homes Clean....................................................................................20
Things to Know.........................................................................................................20
Things to Do.............................................................................................................20
3. Taking Care of Household Waste.........................................................................21
Things to know.........................................................................................................21
Things to do..............................................................................................................21
4. Safe Latrines.........................................................................................................22
Things to know.........................................................................................................22
Things to Do.............................................................................................................23
Key Points.................................................................................................................23
i
1.3. SAFE FOOD............................................................................24
Background...............................................................................................................24
Things to Know.........................................................................................................24
Ways in which germs are spread to food:.................................................................24
Things to do..............................................................................................................24
1. Basic safety guidelines:.........................................................................................25
2. Storage and preparation:.......................................................................................25
3. Cleaning of utensils...............................................................................................26
Key Points.................................................................................................................26
1.4. SAFE WATER.........................................................................27
Background...............................................................................................................27
Unsafe water to drink................................................................................................27
Things to know.........................................................................................................27
1. Protecting sources of drinking water....................................................................27
2. Disinfection of Water............................................................................................29
3. Storage of drinking water......................................................................................31
Things to Do.............................................................................................................31
Key Points.................................................................................................................32
1.5. CONTROL OF DISEASES SPREAD BY INSECT-BITES....................33
Background...............................................................................................................33
Things to Know.........................................................................................................33
1. Malaria..................................................................................................................33
2. Cutaneous Leishmaniasis......................................................................................34
Things to do..............................................................................................................35
1. Treat cases.............................................................................................................35
2. Reduce the number of insects...............................................................................35
3. Use bed nets..........................................................................................................35
Key Points.................................................................................................................36
1.6. INTERPERSONAL COMMUNICATION AND USE OF TEACHING
AIDS......................................................................................37
Basics of interpersonal communication....................................................................37
1. What is interpersonal communication?.................................................................37
2. Interpersonal communication skills......................................................................37
3. The purposes of interpersonal communication are to:..........................................37
How to use support materials....................................................................................39
1. How will support materials make the CHW’s work easier?.................................39
2. How to use non-print media..................................................................................39
How to Use Posters and Flipcharts...........................................................................39
1. Posters...................................................................................................................39
2. Flipcharts...............................................................................................................39
3. Booklets................................................................................................................40
1.7. IMMUNIZATION........................................................................41
Background...............................................................................................................41
Things to Know.........................................................................................................41
1. General Information about immunizations...........................................................41
ii
2. Routine childhood immunizations........................................................................42
Vaccination Schedule for Children 0-12 Months of Age.........................................45
3. Adult immunizations.............................................................................................45
Five Dose Tetanus Vaccination Schedule for Females.............................................45
All women and girls between the ages of 14 and 49 years should receive five
doses of tetanus toxoid vaccine.................................................................................45
Things to Do.............................................................................................................46
Key Points.................................................................................................................47
1.8 DIARRHEA..............................................................................48
Background...............................................................................................................48
Things to Know.........................................................................................................48
Things to do for a child with diarrhea.......................................................................48
1. Assess the child with diarrhoea.............................................................................48
2. Classify the child with Diarrhea............................................................................51
3. Treat Dehydration.................................................................................................54
Key Points.................................................................................................................56
1.9. COMMON SKIN AND EYE DISEASES..........................................57
Background...............................................................................................................57
Things to Know/Things to Do..................................................................................57
1. Eye Infections: Conjunctivitis..............................................................................57
2. Impetigo...............................................................................................................58
3. Abscess................................................................................................................58
4. Scabies.................................................................................................................58
Key Points.................................................................................................................60
1.10 PICTORIAL TALLY SHEET ........................................................61
Background...............................................................................................................61
Things to Know.........................................................................................................61
1. Lay-out of the Form..............................................................................................61
2. Data Sources.........................................................................................................61
3. Who prepares........................................................................................................61
4. Definitions.............................................................................................................61
Things to Do.............................................................................................................61
5. Submission Guidelines..........................................................................................64
PHASE II: PROMOTING MATERNAL, CHILD HEALTH AND
FAMILY PLANNING..................................................................67
2.1. PREGNANCY AND ANTENATAL CARE........................................68
Background...............................................................................................................68
1. A Woman’s Monthly Cycle..................................................................................68
2. Pregnancy..............................................................................................................68
Things to Know.........................................................................................................69
1. How to know if a woman is pregnant..................................................................69
2. Staying Healthy during Pregnancy......................................................................69
3. Common Problems during Pregnancy..................................................................69
4. Serious Problems of Pregnancy:...........................................................................71
The Danger Signs......................................................................................................71
iii
5. Women Who have Extra Risks.............................................................................72
Things to Do.............................................................................................................72
2.2. GETTING READY FOR BIRTH:...................................................74
Background...............................................................................................................74
Things to Know.........................................................................................................74
1. Signs that labor is near..........................................................................................74
2. The three stages of labor.......................................................................................74
3. Danger signs during labor.....................................................................................75
4. Getting Ready for Delivery...................................................................................76
Things to Do.............................................................................................................76
1. The Birth Plan.......................................................................................................77
2. Advice for the daia helping at delivery.................................................................79
Key Points.................................................................................................................80
2.3. CARE OF THE MOTHER AND THE NEWBORN AFTER BIRTH..........81
Background...............................................................................................................81
Things to Know.........................................................................................................81
1. Care of a new mother............................................................................................81
2. Danger signs for the mother..................................................................................81
3. Care of a New Baby..............................................................................................82
4. Mild problems in the newborn..............................................................................83
5. Birth defects that are not serious...........................................................................84
6. Danger Signs in a Newborn Baby.........................................................................84
Things to Do.............................................................................................................85
1. The First Day........................................................................................................85
2. At One Week.........................................................................................................86
Key Points.................................................................................................................86
2.4 BREAST FEEDING:..................................................................87
Background...............................................................................................................87
Things to Know.........................................................................................................87
1. *Breast milk is the best method for feeding babies and small children
during the first 2 years of life....................................................................................87
2. *How long should a Baby Breastfeed?.................................................................87
3. How to Breastfeed.................................................................................................88
4. Common Worries and Problems...........................................................................88
5. Pain and Swelling in the Breasts...........................................................................89
Things to Do.............................................................................................................90
Key Points.................................................................................................................90
2.5 FEEDING YOUNG CHILDREN: STARTING ADDITIONAL FOODS......91
Things to Know:.......................................................................................................91
1. Feeding young children.........................................................................................91
2. How much food to give at different ages..............................................................91
3. Preparing food for young children........................................................................92
4. Starting foods for young children.........................................................................92
Things to Do.............................................................................................................93
Key Points.................................................................................................................93
iv
2.6 EATING FOR GOOD HEALTH ....................................................94
Background...............................................................................................................94
Things to Know.........................................................................................................94
1. Eat a Balanced Diet...............................................................................................94
2. Eating a Balanced Diet in Winter.........................................................................96
3. Preventing Iodine Deficiency................................................................................97
4. Preventing Weak Blood (Anemia)........................................................................97
5. Preventing Night Blindness and Infections...........................................................97
Things to Do.............................................................................................................98
Key facts...................................................................................................................98
2.7 PROMOTING BIRTH SPACING...................................................99
Background...............................................................................................................99
1. Explaining the advantages of family planning......................................................99
Things to Know.........................................................................................................99
1. It is best to space births at least 2 to 3 years apart............................................99
2. It is best to avoid pregnancy before 18 years....................................................99
3. It is best to avoid too many pregnancies.........................................................100
Things to do............................................................................................................100
2. Explain the different methods of contraception..................................................100
Things to know.......................................................................................................100
1. Exclusive breastfeeding for birth spacing.......................................................100
2. Condoms.........................................................................................................100
3. Pills for birth spacing (combined pills)...........................................................101
4. Injection for birth spacing...................................................................................101
5. IUD (“loop”) (Copper T 380A)..........................................................................102
Things to do............................................................................................................102
3. Planning contraception after childbirth...............................................................102
Things to know.......................................................................................................102
Things to do............................................................................................................103
4. Talking about family planning............................................................................103
2.8 PROVIDE CERTAIN CONTRACEPTIVES IN THE VILLAGE.............104
Background.............................................................................................................104
1. Condoms.............................................................................................................104
Things to know.......................................................................................................104
Things to do............................................................................................................105
2. Pills for Birth Spacing.........................................................................................105
Things to know / Things to do................................................................................105
3. Injection for Birth Spacing..................................................................................107
Things to know.......................................................................................................107
Things to do............................................................................................................108
2.9 HIV/AIDS............................................................................121
Background.............................................................................................................121
Things to Know.......................................................................................................121
Things to do............................................................................................................121
Key Points...............................................................................................................122
v
2.10 STRUCTURE AND FUNCTION OF THE HUMAN BODY..................121
Background.............................................................................................................121
Things to Know.......................................................................................................121
1. Musculoskeletal System......................................................................................121
2. Cardiovascular System........................................................................................122
3. Respiratory System.............................................................................................122
4. Digestive System................................................................................................122
5. Urinary System...................................................................................................123
6. Reproductive System..........................................................................................123
7. Nervous System..................................................................................................124
8. Immune System..................................................................................................124
Things to Do...........................................................................................................124
2.11 RUMORS AND MISCONCEPTIONS:...........................................125
2.12 COMMUNITY MAPPING...........................................................127
Background:............................................................................................................127
Things to know:......................................................................................................127
2.13 CONDUCTING THE HOUSEHOLD SURVEY.................................128
Background.............................................................................................................128
Things to know.......................................................................................................128
1. Purpose of the household survey:.......................................................................128
2. Maintaining privacy............................................................................................128
3. Defining the eligible population.........................................................................128
Things to do............................................................................................................128
1. Preparation for the household survey.................................................................128
2. Doing the survey.................................................................................................129
3. Summarizing the information.............................................................................130
2.14 DRAWING THE COMMUNITY MAP............................................131
Background.............................................................................................................131
Things to do............................................................................................................131
1. Preparing to make the map:................................................................................131
2. How to draw the map:.........................................................................................132
3. Updating and Replacing the Community Map:..................................................134
4. How to update a Community Map..................................................................135
2.15 THE PICTORIAL REGISTER .........................................................141
Background.............................................................................................................141
Things to know.......................................................................................................141
Things to do............................................................................................................142
Section-1: Client family history..............................................................................143
Section-2: Family Planning....................................................................................144
Section-3: Maternal Health Services.....................................................................146
Section-4: Child Health Services...........................................................................149
PHASE III: CHILDHOOD ILLNESSES.....................................................153
3.1 INTRODUCTION TO TREATING SICK CHILDREN.........................154
Background.............................................................................................................154
vi
Things to Know.......................................................................................................154
1. Assess and classify the child...............................................................................154
2. Treat the child.....................................................................................................154
3. Follow up............................................................................................................155
Things to Do...........................................................................................................155
1. Assess and Classify the Sick Child.....................................................................155
2. Treat the Child....................................................................................................158
3. Advise the mother when to return to a health worker.........................................159
3.2 CHECK FOR GENERAL DANGER SIGNS...................................160
Things to know.......................................................................................................160
Things to do............................................................................................................160
3.3 COUGH OR DIFFICULT BREATHING.........................................157
Background.............................................................................................................157
Things to Know.......................................................................................................157
Things to Do...........................................................................................................158
1. Assess cough or difficult breathing.....................................................................158
2. Classify and Manage cough or difficult Breathing.............................................161
3. Treat the Child....................................................................................................163
3.4 FEVER.................................................................................165
Things to Know.......................................................................................................165
Things to Do...........................................................................................................166
1. Assess Fever...................................................................................................166
2. Classify and Manage Fever.................................................................................170
3. Treating Malaria..................................................................................................174
4. Classify and Manage Measles.............................................................................175
3.5 EAR PROBLEMS ...................................................................178
Things to Know.......................................................................................................178
Things to Do...........................................................................................................178
1. Assess Ear Problems...........................................................................................178
2. Classify Ear Problems.........................................................................................179
3. Dry the Ear By Wicking.....................................................................................180
3.6 TREAT THE CHILD.................................................................183
1. Select the appropriate medicine and determine the dose and schedule.............183
2.Use good communication skills...........................................................................185
3. Teach the mother to give drugs by mouth at home.............................................190
3.7 ADVISE THE MOTHER WHEN TO RETURN TO A HEALTH
WORKER .............................................................................193
1. Follow-up Visits..................................................................................................193
2. When to Return Immediately..............................................................................194
3. Next Well-Child Visit.........................................................................................194
3.8 TUBERCULOSIS ....................................................................195
Background.............................................................................................................195
Things to Know.......................................................................................................195
1. Spread of the disease...........................................................................................195
vii
2. Diagnosing the disease........................................................................................196
3. Treatment............................................................................................................196
Things to Do...........................................................................................................197
1. Prevention:......................................................................................................197
2. Diagnosis and treatment......................................................................................197
Key Points...............................................................................................................198
3.9. MALNUTRITION AND NUTRIENT DEFICIENCIES .........................199
Background.............................................................................................................199
Things to Know.......................................................................................................199
1. Anemia................................................................................................................199
2. Vitamin A Deficiency.........................................................................................200
3. Vitamin D Deficiency.........................................................................................201
4. Vitamin C Deficiency.........................................................................................201
5. Iodine Deficiency................................................................................................201
Things to Do...........................................................................................................201
Key Points...............................................................................................................202
3.10 INTESTINAL PARASITES.........................................................203
Background.............................................................................................................203
Things to Know.......................................................................................................203
1. Roundworm (Ascaris).........................................................................................203
2. Pinworm (Oxyrus Worm)...................................................................................203
3. Hookworm..........................................................................................................203
Things to Do...........................................................................................................204
1. For pregnant women...........................................................................................204
2. For children, 2 – 5 years......................................................................................204
Key Points...............................................................................................................204
3.11 VITAL SIGNS ........................................................................205
Background.............................................................................................................205
Things to Know.......................................................................................................205
1. Pulse....................................................................................................................205
2. Respiration..........................................................................................................205
3. Temperature........................................................................................................205
Things to do............................................................................................................206
Key Points...............................................................................................................206
3.12. FIRST AID ............................................................................207
Background.............................................................................................................207
Things to Know/Things to Do................................................................................207
1. Injuries to Skin and Muscle................................................................................207
2. Fracture...............................................................................................................207
3. Bleeding..............................................................................................................207
4. Shock...................................................................................................................208
5. Burns...................................................................................................................208
6. Snake Bite...........................................................................................................209
7. Dog Bite..............................................................................................................209
8. Frostbite..............................................................................................................210
viii