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Educators’ Manual

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Child Centred Health Education Approaches

Educators’ Manual

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Child Resource Centre

PREFACE

This booklet represents one in a series of publications of the Child Resource Centre (CRC), aimed atpromoting activities and programmes which focus on child centred health education and development.

One of the aims of the Child Resource Centre is to assist in Improving the effectiveness andcapabilities of those working in the area of health education. Our strategy for achieving this is todocument successful learning approaches, as is being done through these booklets.

Increasingly, traditional teaching techniques are being replaced by more participatory activites andmethodologies. Many teachers and educators are searching for new ideas. The ideas and methodologypresented in this series of booklets are designed to be used by those interested in trying innovative,ALTERNATIVE APPROACHES in their work with children. The strategies are a step forward from staticclassroom teaching to a more relevant, hands-on and dynamic educational process.

The lesson plans and activities in this manual are specifically aimed at the children through educators’.It is important to keep in mind that activities in itself will not serve the purpose of providing healtheducation, unless debriefed properly.

The preparation of this manual has been a collective effort and large number of people includingdoctors, health workers, educators, teachers, trainers, communication experts, scientists and childrenthemselves have given their valuable suggestions during individual consultations, field-testing sessionsand during a teachers’ workshop organized especially for pre-testing the manual.

We are hopeful that this Manual will provide the necessary guidelines for imparting health education tochildren, and that it will help achieve CRC’s ultimate goal of enhancing children’s health anddevelopment.

We welcome your comments and suggestions and would be happy to answer any questions regardingthis Manual.

CRC Team

INTRODUCTION

Health is a central component of a child’s development. Schools are an effective medium through whichhealth education can be provided to children. However, it has become increasingly well recognized thatformal, didactic teaching is not an effective method for imparting health education. The textbookapproach taken assigns children the role of passive recipients and fails to link the subject matter withthe practical day-to-day experiences of children. Lessons are quickly forgotten and are not perceived by.the children as having any relevance to real life situations.

For health education to be more effective and meaningful, it is necessary to move away from thedidactic approach towards more practical educational methodologies. CHETNA’s Child-CentredHealth Education strategy is based on the understanding that in order for learning to take place,education must be experiential, interesting, enjoyable and stimulating. Its interactive, participatory andactivity-based approach places children at the centre of the learning experience. In this way, it involvesthem in the process of building their own knowledge base and encourages them to put into practicewhat they learn. At the same time, the children’s education has an outreach effect on the communitysince children will naturally initiate healthy practices in their home and neighbourhood.

THE CHILD CENTRED HEALTH EDUCATION

Approach benefits in three ways:1. The activities enhance the child’s own aquisition of concepts so that the CHILD ACTIVELYparticipates in the construction of his/her own knowledge-base rather than passively accepting it inready made format from the educator.2. Throughout this innovative process of imparting health education, the community is continuouslyinvolved at various levels and is educated indirectly.3. The activities may also benefit the people among whom the child lives as the child is in much betterposition to initiate appropriate health related action in the family and community.

The Educators’ Manual has been developed to assist educators In implementing the child-centredapproach. It consists of several lesson plans that contain useful and practical information on health. Itemphasizes the important health messages that need to be communicated to children. To reinforce thehealth message, each lesson plan is followed by an activity sheet which includes games, songs andother activities that are enjoyable and stimulating for children.

The final section of the manual contains useful suggestions for educators interested in designing theirown activities. This will enable facilitators to structure their own health programmes to suit differentneeds and circumstances.

1

• Module One: Balanced Diet

• Module Three :Nlght-Blindness

—,.. ~a

• Module Two : Anaemia

3

MODULE ONE: BALANCED DIET

Food is essential to satisfy hunger, to growhealthy and fight diseases. For survival, everyliving organism needs food. We need adequatefood for the growth and development of thebody, to repair body tissues and protectourselves from diseases. Food also providesheat and energy to the body for carrying outvarious daily functions and activities.

NUTRIENTS AND FOOD GROUPS

We eat many different types of food every day,such as chapatis, rice, pulses, vegetables,fruits, milk, etc. The nutrients present in thesefoods, such as carbohydrates, vitamins andproteins all serve a special function. Foods aredivided into three main food groups based onthe prominent nutrients present in them andtheir functions.

1. Energy-Giving FoodsFoods such as wheat, rice, barley, maize,jaggery, sugar, root vegetables like potato,sweet potato, and fatty foods such as oil, butter,ghee and margarine, are all energy-givingfoods. They provide the energy required by thebody to carry out functions and activities.

Foods such as milk, milk products, pulses,legumes, groundnuts, eggs, meat, fish, etc.contain nutrients for body growth anddevelopment. They also help in the repair andbuilding of body tissues.

3. ProtectIve FoodsThese foods provide protection against variousdiseases and help the body remain healthy. Alltypes of green leafy vegetables like spinach,fenugreek, radish leaves, coriander, cabbage,citrus and yellow fruits I!ke orange, amla,tomato, mango and papaya. Protectivenutrients are also found in animal foods likeeggs, meat, fish and milk.

NEED FOR A BALANCED DIET

A balanced diet is an appropriate mix of fooditems, in the right quantity and proportion fornormal growth and development. It mustprovide sufficient energy for daily activities aswell as for protecting the body from diseases.

It is necessary to include items from each foodgroup in our daily diet. For example, chapati,

LESSON PLAN 2. Growth and Body BuildingFoods

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ACTIVITY SHEET: BALANCED DIET

PROTECTIVE

FOODS

2. MAKE ME WHOLE

ObjectiveTo familiarize children with the functions of

different foods.

Activity

Draw 3 large circles on the ground/floor. Eachcircle will represent one food group, i.e. energygiving foods, growth and body building foodsand protective foods. Make a sign to identifyeach circle according to the food group itrepresents.

Have all the children stand in between the threecircles.

The educator calls out the name of one foodItem from any of the 3 food groups.The children are expected to run to theappropriate food group circle to which the fooditem belongs.

Those children who fail to reach the appropriatecircle in time are disqualified as well as thosewho run to the wrong circle.

Those children who run to the appropriate circlecontinue playing, until there is only one winner.

ObjectiveTo help children understand the classification of

food groups.

Activity

Four players can play this game at a time,others can cheer them.

Prepare a pack of 52 cards by cuttingcardboard into pieces approximately 6 X 4~.

Draw or write different food items on every carde.g. carrots, chapati, milk, chana, etc. See thatall food groups are represented equally in thedrawings.

Four players are given ten cards each. Theremainder of the cards are spread out facedown on the table.

The players look at their cards and attempt tomake a balanced meal with them.

The player who completes a balanced meal firstis the winner.

1. LET US PLAY!

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MODULE TWO: ANAEMIA

Anaemia is a condition which develops inpeople as a result of a substantial decrease inthe hemoglobin concentration of the blood,which is caused by a deficiency of iron. Thesymptoms of anaemia are so common thatpeople take them lightly. However, they canlead to severe complications. Regular intake ofiron rich foods can prevent anaemia and its illeffects.

Our blood is made of 2 types of cells: red bloodcells and white blood cells. It is the hemoglobinpigment in red blood cells which gives the redcolour to our blood. These red cells possess acompound called hemoglobin which transportoxygen from lungs to different parts of our body.This hemoglobin is composed of protein andiron. If we do not eat enough protein and iron inour diet, hemoglobin will not be produced insufficient amounts. This results in anaemia.Anaemia, then, is a condition where theoxygen-carrying capacity of our blood isreduced. Anaemia reduces the body’s capacityfor work as well as its resistance level, whichmakes an anaemic person much moresusceptible to other illnesses.

1. DefIcIency of Iron-rich foods: If green leafyvegetables, jaggery, meat, fish, liver, eggs, etc,are not included in sufficient amounts in ourdaily diet, it can lead to iron deficiency andanaemia.

2. DeficIency of vItamin B-12 and follc acid:Vitamin B-12 and folic acid are required for themultiplication and maturation of red cells. Whenthere is deficiency of vitamin B-12 or folic acidin the diet, hemoglobin is not synthesized in theblood. This leads to anaemia.

3. MalarIa and hookworm Infestation:Malarial parasites get their nutrition from ourblood cells. In the process, they destroy someof the blood cells present in the body andreduce the level of hemoglobin in the blood.Likewise, hookworms suck the blood from thebody. Repeated attacks of malaria andrecurrence of hookworm infestation cantherefore result in anaemia.

4. Severe blood loss: Severe blood loss dueto injury or menstruation, etc. can also lead toanaemia.

5. DefIciency of proteIn-rich foods andvitamIn C: If we do not get sufficient protein

LESSON PLAN CAUSES

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ACTIVITY SHEET: ANAEMIA

1. RHYME TIME 2. CATCH ME IF YOU CAN

ObjectiveTo help children recognize the symptoms ofanaemia through a rhyme.

ActivityJack and Jill went up the hillTo fetch a pail of water.Jack felt tired and sat to cry,But Jill could run up faster.Jack was pale and felt so weak.In running and playing,He could never beat.He felt giddy and nails turned flatJack was weak but it was all because he didn’teat well,While Jill was jumping, running up the hill.Jack sat brooding as to when will he reach?What could he do to get back his health?His treasure of joyous temper and good health?

At the end of the activity a questions andanswer session can follow to help childrenrevise the learned material.

ObjectiveTo make children aware about the importanceof iron rich foods to prevent anaemia.ActivityThe popular story of “The Hare and theTortoise” can be adapted to reflect thesymptoms of anaemia. The story can bepresented before the class or the community inthe form of a puppet show or a role play.

One child wears the mask of “mother hare, thesecond child wears the mask of “baby hare”,and the third child wears the mask of “babytortoise”.

Scene OneMother Hare is very worried about her son, whois fussy about food. He does not eat any leafyvegetables or fruits, but likes potatoes andnon-nutritious food. He is also very proud andquarrelsome, picking up fights with playmatesat school and usually ends up crying.

Scene TwoOne day, the school organizes a race wherebaby hare and a baby tortoise participate. Baby

- ____—__________________________-.-__—. —~ - ~

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—

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utensils, washing clothes and bathing getscollected.

AFTER ALL THESE ACTIVITIESTHE CHILDREN SHOULD KNOW...The causes of anaemiaThe symptoms of anaemiaHow to prevent anaemiaHow to Identify anaemlc patients

FOLLOW-UPTo ensure that the children remember and putinto practice the lessons learned, it would beuseful to follow up on them.

For example:

Follow up on the implementation of the kitchengarden.

Ask them questions regarding their diet.

Check their lunch boxes occassionally.

Quiz them on some of the items learned.

Organize presentations using slides andeducational material for children.

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EDUCATOR’S NOTE

ACTIVITY SHEET: NIGHTBLINDNESS

Objective

To help children understand the importance ofeyesight.

Activity

Ask the children to sit in a circle.Ask one child to sit blindfolded in the centre of

the circle.

Ask the child to hold hand open.

Let the children in the circle get up one by oneto clap on the hand of the blindfolded child.

Ask the blindfolded child to identify the childwho clapped.

If the blindfolded child can identify the child whoclapped, then the blindfold will be removed andthe identified child will be blindfolded in turn.

At the end of the activity, the facilitator candiscuss how difficult life would be withouteyesight. Also emphasize the importance ofeating proper foods.

ObjectiveTo help children understand the importance of

eating foods that are rich in vitamin A.

Activity

This exercise can be play-acted by the children.

Mother : Neela, oh Neela, why can’t you justcome and eat? Why do I alwayshave to shout after you?

Neela : Here mother, I have come.[Mothergives Neela her food.]

Neela : Oh mother, you know I don’t likethese vegetables. The green leavestaste like grass. Give me onlypotatoes and chapaties, otherwise Iwill not eat.

Mother : Neela, you must eat everything. It isnecessary for your health.[Neela refuses to eat. Later thatevening she goes out to play hideand seek with her friend, Sunil.]

Neela : Sunil, Sunil where are you? I can’tsee clearly, please come back.

1. RECOGNIZE ME 2. ROLE PLAY

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Add salt, chililes, coriander, turmeric etc. totaste. Any other green leafy vegetable can beused.Make small balls, roll them and then fry them inoil.Chapatis can also be made and roasted fromthe dough.This recipe contains approximately 1173 microgms of vitamin A. Children can write the recipeand try it out at home for the family.

REMEMBER!WASH EYES WITh CLEAN WATERREGULARLYIF ThE CHILD CANNOT SEE PROPERLY INThE DIM UGHT CONTACT A DOCTORIMMEDIATELYEAT FOODS RICH IN ViTAMIN A ON A DAILYBASISONCE ThE CORNEA IS DAMAGED, ITCANNOT BE CURED

AFTER ALL THESE ACTIVITIESTHE CHILDREN SHOULD KNOW...The importance of eyesightThe causes, symptoms, treatment andprevention of night-blindnessThe Importance of vitamin AFood sources of vitamin AHow to prepare simple recipes

FOLLOW UPTo ensure proper follow up, check with childrenafter a month or two, and ask:

Whether the children have played the game“Recognize Me” with their friends.

If they have prepared the above recipe athome.

Whether they are eating foods rich in vitamin A.

If any of their friends have had nightblindness.

Whether any children have collected moreinformation on the topic.A positive response to any of these questions isa good indication of material well learned.

EDUCATOR’S NOTE

16

~2i~7~~Module Four: Malaria

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Module Eight: Immunization

Module Five: Diarrhoea

Module Six: Worms

Module Seven: Scabies and Boils

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MODULE FOUR: MALARIA

LESSON PLANMalaria is a parasitic disease which is spreadby anopheles mosquitoes. The mosquitoesbreed only in water. They pick up malariagerms from infected people and then pass it onto others when they bite. Malaria causes feverwith chills, headache and bodyache. In somecases it also produces vomiting and diarrhoea,and can be fatal to young children.

SPREADWhenever the female anopheles mosquito bitesa person suffering from malaria, the malarialparasite enters the mosquito’s body through theblood. It takes about 10 to 20 days for themalarial parasites to develop inside the body ofthe mosquito. After this period, the mosquitocan pass on the parasite to a healthy person bysimply-biting them. This is how malaria spreadsfrom one person to another.

SYMPTOMSRecurring and periodic fever.Severe chills and headache, followed by fever.Fever drops with perspiration.Weakness and skin flushes.Sweating develops, which leads to a loss of

Fever may cause fits and the patient maybecome unconscious.Could lead to serious complications, such ascerebral malaria, and may cause death.

MALARIA IS A KILLER DISEASE SPREADBY MOSQUITOES. AVOID GET~lNGBITTENAND AVOID GETI1NG SICK. BE HEALTHY!

TREATMENTConsult a doctor.Follow the recommended doses of chloroquineas advised by doctor.Fever may be controlled by sponging body witha cool, wet cloth.Patient should be given plenty of fluids toreplace the loss of body water and minerals.After the malarial attack, patient should begiven plenty of green, leafy vegetables, milk,pulse, and legumes.

CHLOROQUINE TABLETS SHOULD NOT BETAKEN ON AN EMPTY STOMACH AS ITMAY LEAD TO VOMITING AND CAUSEACIDITY.

body water and minerals.

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ACTIVITY SHEET: MALARIA

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1. RAJU’S MALARIA

ObjectiveThis rhyme will help to familiarize children withthe general symptoms of malaria.

Activity

I had a headache, oh then,I had a headache, oh then!I had a headache and pain,I wished I was healthy again.

When I had fever, oh then,When I had fever, oh then!When I had fever, I had a shiver,I wished I was healthy again.

I was sweating, oh then,I was sweating, oh then!I was sweating and my fever just left,I wished I was healthy again.

My doctor was called, oh then,My doctor was called, oh then!My doctor was called and treat me he did,With tablets of chloroquine.

So I was healthy again,So I was healthy again!So I was healthy and happy,And very joyful again HI

After the rhyme is sung several times, discussthe content with the children.

2. SET ME RIGHT

ObjectiveTo familiarize children with terms related tosymptoms and prevention of malariaActivity -

Words related to malarial symptoms andprevention are listed below in jumbled form. Askthe children to re-arrange the letters to form thecorrect words.

JUMBLED ANSWERS

1. ALMIARA2. QSOMIUTSOE3. EOMSK4. ULSHC5. OCINQLROEHU6. KSENASEW

1. MALARIA2. MOSQUITOES3. SMOKE4. CHILLS5. CHLOROQUINE6. WEAKNESS

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MODULE FIVE: DIARRHOEA

Diarrhoea refers to the passing of watery stools.It is a common but serious illness especially inyoung children. It is caused by germs whichthrive in dirty water and human stool. Thesegerms can pass from one person to anotherthrough hands, food, drinks and flies. Diarrhoealeads to a loss of essential water and mineralsfrom the body, and causes dehydration as aresult. Getting rid of stools in a safe way,washing hands after defecation and coveringfood helps to prevent the spread of diarrhoea. ifthe community is made aware of the primarysymptoms of dehydration, its prevention andtreatment, millions of young children can beprevented from dying.

SPREADThe major cause of diarrhoea is contaminatedwater and food. If hands are not washedproperly after defecating, germs can stick to thenails. Such germs are then passed to food andwater while eating, cooking or removing waterfrom the pot, and then enter the body whenthese are consumed. The germs then causediarrhoea and sometimes dehydration.Flies also spread the germs which causediarrhoea. They tend to sit on stools which arepassed in the open. The germs from the stool

stick to their legs and are later passed on touncovered food or water, thus leaving thegerms behind on the food and water that is laterconsumed by people.

Children often defecate near the house wheredogs, hens and other stray animals roam about.These animals touch the stools and may latercome into contact also with uncovered food orwater, thus passing on the germs from the stoolto the food. When consumed by people, thegerms in the water and food will enter the bodyand cause diarrhoea.

SYMPTOMS OF DIARRHOEAWatery stools, sometimes accompanied byvomit and/or fever.Watery stool with pus, mucus and/or blood.In some cases, frothy and foul odoured stool.

SYMPTOMS OF DEHYDRATIONThe child’s mouth, lips and tongue dry up andthey become excessively thirsty.The child becomes weak and irritable.Skin loses its elasticity. If pinched, the skindoes not retract to normal position immidiately.Eyes are tearless/waterless and sunken.In infants, the fontanelle (top part of the headabove forehead) sinks in.

LESSON PLAN

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ACTIVITY SHEET: DIARRHOEA

Objective

To help children learn the method for preparing

ORS.

Activity

Keep salt, sugar/jaggery and pure drinkingwater available, depending on the number ofchildren.

Round the children and have them observe thepreparation of ORS

Take two glasses of drinking water (500 ml).

Add a pinch of salt and taste it. It should not besaltier than tears.

Add a scoop or matchbox full of sugar.

If available, add a few drops of lemon juice fortaste.

Have the children taste it.

Review the preparation and ask the children toprepare it themselves

Discuss again the treatment.

ObjectIve

To familiarize children with the ORS solution.

ActMty

Samir Is a clever boy who is studying in the 7thgrade. He has a younger sister named Minu.Every morning, Samir1s parents go to work andhis mother returns at noon just in time to seeSamir and his friends off to school. She doesnot worry about Minu because Samir takesgood care of her.

One day while his mother was at work, Minustarted crying. Samir rushed to her and sawthat she had passed a watery stool again.“Ohl, said Samir, “you have done it again.Mummy just cleaned you up half an hour ago”.Samir washed Minu, changed the sheet and puther back on the bed. Then he carefully washedhis hands. Samir had just finished washing thedirty sheet when he heard Minu crying again.The poor child had again passed a watery stool.Samir got worried and after cleaning Minu, hequickly ran to call Kavita -their neighbour andmother’s friend.

1. MAKING ORS 2. STORY-TELLING

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2. Number of family members3. Age of children in the family4. Occurrance of diarrhoea In the family in

the past three months5. What were the symptoms?

6. What was the treatment taken?7. Water handling practices In the family,

food storage and availability of latrine.8. ObservatIon of the level of cleanliness In

the house, flies, etc.At the end of the survey, children candemonstrate the preparation of ORS in everyhouse visited.

AFTER ALL THESE ACTIVITIESThE CHILDREN SHOULD KNOW...* The causes, symptoms, treatment and

prevention of diarrhoea.* How to prepare the oral rehydratlon

solution.* How to prepare rice-kangi.

FOLLOW UPChildren could be motivated to maintain ahealthy level of hygiene by having either theteacher monitor their cleaning habits or byselecting one student every week to monitor therest of the class.Here are some suggestions for a checklist:1. short and clean nails2. clean hands3. washing hands after defecating4. washing hands before eating5. washing fruits and vegetables before eating6. keep all water and food coveredChildren could also be encouraged to checkand monitor the level of hygiene in their owncommunity and school.Follow up on the survey conducted In theircommunity.

EDUCATOR’S NOTE

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PREVEN11ON

Use latrine or pit latrine for passing stools.Always wash hands with soap or ash afterdefecating and before eating or cooking.Keep nails short and clean.Always use a laddie to remove water from pot.Wash vegetables well before eating them.Prevent children from eating mud.

REMEMBER!Keep hands clean, especially before eatingand after defecating.Cover drinking water and food.Wear shoes, especially In areas whereothers defecate.

2. HOOKWORM

Hookworms suck blood and often produceweakness and in severe cases anaemia.TREATMENTComplete the course of deworming tablets asper the advise of a doctor or health worker.A complete course of iron tablets is alsoadvisable.PREVEN11ONAlways use latrine or dry pit latrine fordefecation.Use footwear outside of the house.

3. THREADWORM

These worms are very thin, thread like, andwhite in colour. They lay thousands of tiny eggsjust outside the anus, or near the vaginalopening among girls.SPREAD

Hookworms are 1 cm long and red in colour,although they cannot usually be seen in thefeces. Once they enter the body, they travelthrough the blood stream until they reach theintestines, where they attach themselves andsuck blood. Hookworm infestation can lead toserious complications. Among children, it maycause anaemia. Any child who is anaemic, verypale or eats mud may have hookworms.

SPREAD

The eggs of the hookworms come out In thestools of Infested persons and hatch on moistsoil. From here, the baby hookworn~scan entera person’s body through bare feet.SYMPTOMS

When the hookworms enter the body throughthe feet, they may cause itching.Within a few days after entering the body, thehookworms reach the lungs through theblood-stream, and may cause a dry cough.

The person coughs up the young worms andswallows them again.A few days later the person may have diarrhoeaor stomach-ache.

When a person scratches the infected area, theeggs of the threadworm stick to the nails andspread when the same unwashed hands areused to eat, cook food or serve water that willlater be consumed by others. Thus, the cycle ofinfection continues.SYMPTOMSItching and scratching around the anus, or nearvaginal opening among girls, particularly atnight, which disturbs sleep, causes Irritation andweakness.TREATMENTComplete course of deworming medicine as perthe advice of a doctor or health worker.Children who have thread worms should wearpants while sleeping to keep them fromscratching.Wash the child’s hands and buttocks with soapand water.PREVENTIONWash hands well with soap or ash and waterafter defecating and before eating or servingfood.Keep nails clean and short.

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One was fat and plump, another crooked, andthe third was very thin. The children werepuzzled, so they hid behind a tree to hear themtalk. From their conversation the children foundthat the funny looking creatures were noneother than the nasty worms.First of all the Roundworm said “My eggs areso small that people cannot see them. I lay myeggs and when they come out in stools theycan remain for a long time in the soil. I stick tothe nails of people and enter their body if theydon’t wash their hands. Also, some children eatmud and some women clean their utensils withmud. This makes it easier to enter their body.As soon as I enter, I eat up everything theperson eats, so their body becomes weak fromlack of food. Then I lay thousands of eggs andcome out through their feces. This way Icontinue my cycle. Ha! Ha! What a life!!!”.Upon hearing this, the Hookworm boasted,“Huh, what a life? You don’t know me! I am verydangerous. I stick to the intestines of the personand suck their blood, but I cannot be seen.People then become anaemic from lack ofblood. I leave my eggs on the moist soil throughfeces and when another person walks barefootover it, I enter their body. This is how I spread.So, you see my might? You only live on aperson’s food, but I am a superhero because Ifeast on precious blood!”.The Threadworm, who had so quietly listenedto the two, said, “I am thin and thread-like andlay my eggs outside the anus, which leads toitching at night. I also travel from faeces to themouth. I too like persons who are dirty, thosewho do not wash their hands properly,especially after defecating. But I can trouble aperson the most because I cause itching,irritation and weakness and give sleeplessnights. Wow, what fun !“.

All the three worms were happy with theirvictory, and quickly started to dance and sing-“We shall overcome...”The children were struck with disbelief onhearing all these stories. Chotu, the youngest ofall started crying because he had been eatingmud even though everyone had told him not to.

Now, he knew the consequences. The childrendid not know how to prevent worm infestations,so they all ran to Lata, an elderly friend ~f thechildren. They told her all they had heard andseen. They also told her that since Chotu waseating mud, he may have a lot of worms in hisbody. Lata said, “Oh no, that is not good. Youmust see a doctor and take deworming tablets.Also ask your parents to give the samemedicine to everyone in the family. Aside fromthe tablets, you have to take other precautionsto prevent another worm infestation becauserepeated infestations can cause seriouscomplications”.The children were relieved to get help, andasked Lata about preventive measures. Latatold them about personal hygiene, regularlycutting nails, using latrines, washing handsbefore eating and using footwear.Chotu listened carefully, then asked, “But Lata,what about that proud hookworm? He said thathe was causing paleness and weakness in usby sucking our blood”. Lata explained thathookworms can cause anaemia, but can beremoved by first completing the course ofdeworming tablets and eating iron-rich foodsuch as green leafy vegetables. She alsowarned that deworming tablets are not enough.Personal and environmental hygiene are just asimportant for the whole family. The childrenwere now happy and making fun of the worms.They’ started dancing and singing - ‘We shallovercome..The story could be followed with discussionsand a review of the lesson plan.

3. PU~LE

ObjectiveTo familiarize children with the treatment andpreventive measures against worm infestations.

ActivityMix words in a jumble of letters and ask thechildren to find them. The words should relateto the lesson plan just learned, For example:

30

MODULE SEVEN : SCABIES AND BOILS

Scabies and boils are bacterial skin diseaseswhich spread by contact. They develop from alack of personal hygiene, and are mostcommon among children.

1. SCABIES

Scabies are caused by a mite (sarcoptesscabies), similar to tiny ticks which maketunnels (burrows) under the skin. There, theycause a persistent itch. Scratching can causeinfections which produce boils or sores with pusand sometimes swollen lymph nodes/glands orfever.

SPBEADScabies can spread from one person to anotherin crowded areas, by sharing clothing andbedding and by keeping poor hygiene. It isprevalent in residential and school areas wherechildren come into close contact with oneanother. The spread of scabies is greaterduring winter season because it is whenchildren tend to sleep together more often.

SYMPTOMSCommon sites of infection are around finger

webs, inner surfaces of elbows, wrists, belt-line,thighs, external genitalia, nipples, abdomen andlower portion of buttocks.In children it is common to find scabies aroundthe neck, head, palms and soles of the feet.Itching is intense, particularly at night.Scratch marks can produce boils and eczema.

TREATMENT

Obtain benzyl benzoa,te from nearest primaryhealth centre, free of charge.Clean body and aftected areas with soap andwater.Rub well with clean towel.Apply benzy~Benzoate solution on the wholebody except the face.Let it dry on the body.Continue application for three days.Treat all members of the family at the sametime, even if they are not infected.Wear clean clothes after treatment.Wash all clothes, bedsheets, pillow-covers, etc.with water and soap and dry them under thesun.

Home Remedies

Boil some neem leaves and grind them with

LESSON PLAN

32

ACTIVITY SHEET : SCABIES AND BOILS

1. ROLE PLAY

ObjectiveThis role play will help children understand thespread of scabies and boils and its treatment.

Activity

Raju and Ramesh are good friends. Both arestudying in the same class. They are alwaystogether, while studying, playing, sharing eachother’s toys, etc.

One day...Raju: Ramesh what happened? Why are

you scratching your hands all thetime?

Ramesh: I don’t know. I can’t even sleepproperly because this itching persiststhroughout the night.

Raju: Show me your hands. [Lookingat thehands], Oh! I think you are infectedwith scabies. Last year my sisterManju also had scabies and at thattime my mother was using a whiteliquid to treat it. But first, you must cutyour nails and stop scratching or it willbe more painful. Let’s go to

Meenaaunty, the health worker. Shewill guide you properly.

[Theyboth go to the health worker]

Meena: Welcome children. Is there anyproblem?

Raju: Yes, my friend Ramesh is itchyaround his hands and elbows. I thinkhe is infected with scabies.[Examining Ramesh’s finger websand elbows]

Meena: You are right Raju. Ramesh hasscabies. But he will soon be alright. Iwill give him the medicine. Ramesh,here it is. First take a bath with soapand hot water, scrubbing well. Thenapply this on your entire body exceptyour face, and keep it on until the nextbath. Apply it for 3 days, but becareful not to apply it on your face.Also tell your mother to boil yourclothes, towels and bed sheets, andto dry them under the sun. Tell me,who is sleeping very near you atnight?

Ramesh: My brother, Suresh.Meena: Since scabies is an infectious

disease, it spreads through close

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4. QUIZ TIME

ObjectiveTo enable children to recall messages onscabies and boils.

ActivityKeep a list of quizzes on scabies and boilsready. Divide the children into two teams.

The quiz master asks each team in turn aquestion on scabies or boils.

Each correct answer gets 2 points.The team able to answer the most questions,and therefore to gain the most points, wins thegame.

exam pie

1. Name one of the causes of scabies/boils.2. Name one way in which boils/scabies is

spread.3. Name a common site of scabies/boils.4. What is the treatment for scabies/boils?5. How do you prevent boils/scabies?

AFTER ALL THESE ACTIVITIESTHE CHILDREN SHOULD KNOW...The causes and spread of boils and scabies.The symptoms and treatment of scables andboils.The preventive measures.

FOLLOW UP

The outreach effect of the lesson can begauged by noting the level of personal hygienein the children. For example, checking nails,hair, hands, clothes.Pairs of children can be formed so that they cancheck each other.Impromptu quizzes on scabies and boils can beorganized. This will indicate how well childrenhave retained information. The results can alsoserve as a guide for future lesson plans.

Parents’ behaviour when children are infectedcan also be monitored, looking at whether ornot the children are being sent to school wheninfected, whether their clothes are beingdisinfected, etc. This will reflect the outreacheffect of the lesson plan.

EDUCATOR’S NOTE

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2. DIphtheriaDiphtheria is a bacterial disease whichcommonly affects the respiratory passage(nose and throat). It can be deadly, particularlyamong children.This bacterial disease produces a greyish/whitemembrane around the tonsils and pharnyx, andcauses high fever, sore throat, swelling of theneck, difficutty in breathing, and a hoarse soundwhen breathing. it may spread to the windpipe,in which case it may prevent breathing alltogether. Medical help should be soughtimmediately.A patient with diphtheria should be kept in aseparate room and treated by a doctor. Suchchildren should not be allowed to play withothers unless cured completely. All their friendsand close contacts should be observedcarefully for symptoms. If they have not beenvaccinated before, they should be given avaccine immidiately. To prevent diphtheria, it isnecessary to follow a full course of tripplevaccine. Three doses of DPT should be givenduring the first four months after birth atintervals of one month between each dose.A DPT booster dose is also necessarybetween the ages of 16 to 24 months.

DPT IS A VACCINE WHICH PROTECTS THECHILD AGAINST DIPTHERIA, PERTUSISANDTETANUS

3. Pertusis (whooping cough)Whooping cough is a bacterial infection thatproduces inflammation of the lining in the nosepharynx, larynx and trachea. Severeconsequences of whooping cough lead tomalnutrition, pneumonia, T.B. and sometimesdeath.At first, it causes a cold with runny nose andfever; then, cough develops with a thickmucous. The coughs are rapid, withoutbreathing in between, and are sometimesassociated with vomiting. Nails and lips mayturn blue from lack of air. When the air finally

rushes back into the patient’s lungs, it producesa loud whoop.A doctor should be consulted as soon as thewhooping cough is detected. Patient should begiven plenty of liquids and food after each vomitto avoid malnutrition. To prevent this disease,it Is necessary to take three doses of DPTduring the first four months after birth withone month Intervals In between. A boosterdose should be given between 16 to 24months.

4. TetanusTetanus is one of the most dangerous diseasesleading to death. The tetanus germs arepresent in the environment, particularly in dirtand excreta.These germs enter the body through open cutsand wounds. It can also occur among childrenwith ear discharge, including wounds andpunctures made with unsterrilized syringes,needles, scissors and knives.Tetanus produces stiffening of the jaw and neckmuscles, making it difficult for the child to eat. Itcauses difficulty in breathing and swallowing.Generalised tetanus causes spasms andconvulsions of the whole body, making it rigidand arched like a bow.In most cases tetanus leads to death, but it mayalso be prevented through immediatetreatment.Prevention of tetanus Is possible with thethree doses of DPT vaccine given during thefirst four months after birth. Pregnantwomen should be given two Injections oftetanus at the interval of one month as soonas the pregnancy is confirmed.

5. PoliomyelitisPolio is a viral infection most common inchildren under the age of three years. It is thegreatest disabling disease among children, as itcauses irreversible damage in the body,particularly the limbs.The virus is spread through human excreta,water and air (due to coughing, sneezing etc).

38

NATIONAL IMMUNIZATION SCHEDULE

VACCINE NAMEOFDISEASE S

AGEOFCHILD

LOCATIONOFON THE BODY

THEVACCINE

B.C.G. T.B. BIRTH TO12 MONTHS

INJECTION ONSHOLDER

LEFT

OPT(TRIPLE)

DIPTHERIAPERTUSISTETANUS

1.1/2, 2.1/2,3.1/2 MONTHS

INJECTION ON BUTTOCKS

POLIO POLIO 1.1/2, 2.1/2,31/2 MONTHS

ORAL DROPS

MEASLES MEASLES 9T0 12MONTHS

INJECTION ON BUTTOCKS

OPT(TRIPLE)

DIPTHERIAPERTUSISTETANUS

1.1/2 YEARSBOOSTER DOSE

INJECTION ON BUTTOCKS

POLIO POLIO 1.1/2 YEARSBOOSTER DOSE

ORAL DROPS

DT DIPTHERIATETANUS

5 TO 6 YEARSBOOSTER DOSE

INJECTION ON BUTTOCKS

U TETANUS 10 YEARS INJECTION ON BUTTOCKS

U TETANUS 16 YEARS INJECTION ON BUTTOCKS

40

together. Mr. Measles has a cold, fever andrashes all over. His eyes are sore, red andwatery. Mr. Tetanus is weird-looking. His jaw iscrooked and his body bow-shaped. He has veryfrightening looks and keeps jerking. There is alot of noise around, coughing, sneezing,groaning, even shouting.Mr. Tetanus calls everyone to order, and theyall sit quietly. He asks each of the diseases togive an account of children they have killed.Mr. T.B. says that “I am getting old. It seemsthat no one gets affected by me and the BCGvaccine is my worst enemy. it is trying to defeatme”.Mr. Polio speaks up saying, “I too have a similarproblem. I can’t seem to affect many childrenthese days. My enemy is the polio vaccine.”Ms. Diphtheria and Mrs. Pertussis have similarstories to tell, saying that the OPT vaccine is areal menace for them. Mrs. Pertussis says, “Butwe are still better than all the others. Just now Ivisited a village and harassed so many children.Ha, Ha!”Mr. Measles then spoke, “Though the measlesvaccine is strong, I hope that I can strikeanytime, more so if parents have been carelessabout their childrens’ health.”The head of the killer diseases’ committeespoke, “I too am unhappy. The mothers of thenewborn babies are being immunized and sothe babies cannot get tetanus.”Mr. Polio then added, “Never mind, wait for 6 to8 weeks. Perhaps the parents will forget toimmunize their babies with the second booster.You can try to kill again when they are twomonths old.” Mr. Tetanus agreed that it was agood idea to wait.Mr. Measles looks at everyone with an angryface and says, “Two years ago we could eachkill more than 100 children. What’s wrong? Arewe ill with our own diseases?”All of them said, “We are weak because ofthose vaccines. That immunization schedule isa big disadvantage. It is our major enemy.Those clever children go with their mothers tothe clinic and even help their mothers carry

their newborn babies there.”All six diseases then decided to work still harderto fight against their biggest enemy,immunization.

This story can be used In different ways:

1. Select six children to read the story,assigning each one a specific role (Mr. Polio,Ms. Diphtheria, etc).2. The story can also be used for a play.Children can enact the story using costumesaccording to the role they play.3. The story could also become a puppet show.

3. IDENTIFY THE KILLER

ObjectiveTo help children understand the symptoms of

the six killer diseases.

ActivityDescribe the symptoms of any one of the sixdiseases, and ask the children to identify thedisease. Some examples of descriptions:1. Measles= Rita has a high fever, red eyes, arunny nose, a cough, noisy breathing, andrashes all over the body.2. Diphtheira= Pradeep has a sore throat, hisneck is swollen, and his breathing is noisy anddifficult.3. Tuberculosis= Manish has lost a lot ofweight. He coughs all the time and is veryweak.4. Tetanus= Laxmi cut her foot in a dirty field. Aweek later all her muscles became so tight thatshe could hardly breathe. They took her to thehospital but do not know if they can save her.5. Pertusis= Four year old Yousuf was coughingbadly. His lips became blue, the coughing waspersistent and there was a loud whoopingnoise.6. Polio= Ravha was first restless and cold withfever. Later she developed a severe headache,sore muscles and her neck became stiff.Eventually her right leg became paralyzed.

42

EDUCATOR’S NOTE

n=::=~uLI

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DesIgning your own Activity Sheet

44

DESIGNING YOUR OWN ACTIVITY SHEETAfter impiementors of health education programmes use ready made actMty sheets with children, newideas, topics and activities will naturally emerge. A time will come when the use of existing sheets oreven those already modified will no longer satisfy increasing demands, and a need will be felt todevelop new activity sheets for continued learning.Past experiences have shown that creating one’s own activity sheet can be very effective as it is likelyto involve everyone in the educational process and will undoubtedly be sensitive to local needs andresources.Some important guidelines are offered here for those who desire to develop their own activity sheets. Itis anticipated that this guideline will assist in maintaining a structured format while at the same timeproviding ample scope for the exercise of individual initiative and creativity.Before embarking on the design of activity sheets, it will be useful to review some key components ofChild-Centredness.CHILD-CENTREDNESSChild-Centred health education is based on the understanding that in order for learning to take place,education must be interesting, experiential, challenging and enjoyable. This is the principal reason fordesigning activity sheets.To achieve the Child-Centred goal, the activity sheets need to emphasize participation. Thisparticipatory strategy places children at the centre of the learning experience, where they are activeparticipants and not passive recipients of knowledge. There, they are likely to take real interest in theeducational process.Another important component is the activity-based approach. Involving children actively in educationalgames transforms learning into an experiential, learning-by-doing experience.In this way, there is direct link built between the subject matter and the practical, day-to-dayexperiences of children. At the same time, children find the process enjoyable, creative andchallenging.With this strategy, the Child-Centred approach ensures that children retain the knowledge gained. Italso encourages them to put into practice what they learn.THE ACTIVITY SHEETAn activity sheet is a teaching guide for teachers, facilitators, youth and social workers, organisers ofnon-formal education, as well as individuals interested in working with children.Based as it is on the Child-Centred approach, an activity sheet offers participatory, activity-basedsuggestions for teaching a health topic or theme to children:THE LESSON PLANBefore designing an activity sheet which introduces a new health topic, it is important to begin with alesson plan. For this, it is necessary to keep the following in mind:1. The tbpi~must be a real health priority for the children and their community.2. Ensure that the topic relates to those covered in the school syllabus. New topics cäti also beselected and at some point be introduced into the formal syllabus. -

3. The’content of the lesson plan must be absolutely medically correct and reflect up-to-date medicalinformation. - - ~‘ -

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1. Is the idea and focus of the sheet clearly stated?2. Does the activity fulfill the criterion of Child-Centredness?3. Does the activity sheet contain all the necessary and essential information for those who will beusing it?4. Is it clear from the sheet as to what educators are expected to do and what the children are expectedto do?5. Does the sheet suggest different activities for the younger and older groups of children?6. Is there sufficient mention of what children need to find out as a basis for the action they take? Thisis important for developing a sense of enquiry and awareness in children.7. Can the activities be made more interesting, challenging and fun?8. is the language clear and non-academic? Is the style economical? Are the main points alwayshighlighted?These guidelines should be sufficient for designing a complete activity sheet using the Child-Centredapproach.So now call, ready, steady, stop and go...

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Chetna’s Child Resource Centre (CRC) has published a series ofbooklets in English, Hindi and Gujarati focusing on Child-centredHealth Education.CRC’s booklets can serve as practical guidelines for bringing healtheducation messages to children using a participatory andactivity-oriented approach. The learning-by-doing strategy transformslearning into an experiential process and places children at the centreof the learning experience. This way, there is a direct link built betweenthe subject matter and the day-to-day experiences of children. At thesame time, children find the process interesting, challenging and~njoyabIe.The booklets are written in a simple, clear and concise manner and areattractively illustrated. They will be useful additions to libraries and arepractical guides for individuals and organizations involved inchild-centred activities. A list of the booklets available is given below.

Health Education Can Be Fun

Khel-KheI Mein: Learning Whilst Playing

Growing up Healthy

Balmela (Children’s Fair)

Gramyatra (Village Rally)

Child-Centred Health Education:An Educator’s Manual