The Exclusive Breastfeeding Method ... - Care Group Info



Child Feeding and CareLesson PlanModule 3 Child Feeding and CareTable of Contents: TOC \o "1-1" \h \z \u Lesson 1: Family Planning PAGEREF _Toc304895083 \h 1Lesson 2: Complementary Feeding: 6-8 months PAGEREF _Toc304895084 \h 12Lesson 3: Complementary Feeding: 9-11 months PAGEREF _Toc304895085 \h 22Lesson 4: Child Feeding: 12 – 24 months (1-2 years) PAGEREF _Toc304895086 \h 31Lessons 1-4 Pre and Posttest PAGEREF _Toc304895087 \h 42Lessons 1-4 Pre and Posttest ANSWERS PAGEREF _Toc304895088 \h 44Lessons, stories, and activities in the Child Feeding and Care Lesson Plan complement the information provided in Child Feeding and Care Lesson Leader Mother Flipchart. Understanding the Lesson PlanEach lesson begins with objectives. These are the behavior, knowledge and belief objectives that are covered in the lesson. There are four types of objectives. Each is described below. Behavior objectives: Most objectives are behavioral objectives written as action statements. These are the practices that we expect the caregivers to follow based on the key messages in the flipchart. Belief objectives: We know that beliefs and attitudes affect our practices. Many times it is a person’s inaccurate belief or worldview that hinders them from making healthy behavior change. In this module we are reinforcing the principle of child value: the belief that life (specifically the lives of children) is a valuable treasure that must be protected and nourished to avoid malnutrition and death. Behavioral determinant objectives: Behavioral determinants are reasons why people practice (or don’t practice) a particular behavior. There are eight possible behavioral determinants as identified in the Barrier Analysis surveys. By reinforcing the determinants that have helped the doers (caregivers in the community already practicing the new behavior) we are able to encourage the non-doers (caregivers who have not yet tried or been able to maintain the new practices). We also help non-doers (caregivers who are not practicing new behaviors) to overcome obstacles that have prevented them from trying or maintaining the practice in the past. Under the objectives, all of the materials needed for the lesson are listed. Materials with an asterisk (*) should be brought by the Activity Leader selected during Lesson 4 of Module 2. See below for more information. Each exercise (section of the lesson plan) is identified by a small picture. Pictures are used to remind non-literate Leader Mothers of the order of the activities. For example when it’s time to lead the game the lesson plan shows a picture of people laughing as if they are enjoying a game (see below). The pictures in the lesson plan cue Leader Mothers of the next activity. Review the descriptions below for more information.The first activity in each lesson is a game or song. Games and songs help the participants to laugh, relax and prepare for the lesson. Some games review key messages that the participants have already learned. GameFollowing the game, all facilitators will take attendance. Troubleshooting applies only to facilitators (promoters) training others. The promoter follows up with any difficulties that the Leader Mothers had teaching the previous lessons. Refer to the role play in Module 1, Lesson 4 for more information. Attendance and TroubleshootingNext the facilitator reads the story printed on the flipchart, using the images to share the story. The story in each lesson is followed by discussion questions. Discussion questions are used to discuss the problems faced by the two main characters in the module (Abuk and Achol). Use the story and discussion questions to find out the current practices of the women in the group. Ask about Current PracticesAfter turning to a new flipchart page ask, “What do you think these pictures mean?” After the participants respond, explain the captions and key messages written on the back of the flipchart. Share the Meaning of Each PictureThe lesson plan also contains additional information for the trainer. The additional information does not need to be discussed during the lesson unless it relates to questions asked by the participants.Next is an activity. Activities are “hands-on” exercises to help the participants understand and apply what they have learned. Most of these activities require specific materials and preparations. ActivityBeginning in Module 2, an Activity leader is responsible to organize materials for each lesson’s Activity. The Activity Leader meets with the facilitator ten minutes before each lesson to discuss the needed materials for the next lesson’s activity. The Activity Leader is responsible to talk with the others (Leader Mothers or neighbors) during the “Attendance and Troubleshooting” to organize the materials needed for the next meeting, asking them to volunteer to bring the items. The facilitator will lead the activity, but the Activity Leader will support her by organizing the volunteers and aiding the facilitator as needed during the activity. The facilitator asks if there are any obstacles that prevent the caregivers from trying the new practices. The facilitator and other group members give more information or a different perspective to help caregivers understand how to overcome these obstacles. Discuss BarriersNext is Practice and Coaching. We want to make sure that each Leader Mother understands the material and can present it to her neighbors. The promoter observes and coaches Leader Mothers as they practice teaching in pairs using the flipcharts.When Leader Mothers teach their neighbors, they will repeat this activity asking each woman to share the key messages (and practices) that she has learned with the woman next to her. The Leader Mother will go around and listen to each pair, making sure they understood the key messages correctly. Finally, the facilitator requests a commitment from each of the women in the group. It is up to each woman to make a choice. Do not force anyone to make a commitment if they are not ready. Request CommitmentsAll lessons follow the pattern described above. Lessons can be adapted as needed to fit the needs of your group. Lessons should not exceed two hours in length although some lessons may take longer than others. The suggested time for each section is listed below. Section nameTime needed for this sectionGameor SongAttendance and TroubleshootingStory Ask about Current PracticesShare the Meaning of Picture 2Share the Meaning of Picture 3Share the Meaning of Picture 4ActivityDiscuss BarriersPractice and CoachingRequest Commitments5 - 15 minutes 5 - 15 minutes5 minutes10 minutes10 minutes 10 minutes10 minutes15-30 minutes15 minutes20 minutes 10 minutes2 – 2 ? hoursAcknowledgementsMany thanks to the illustrators Jeff Del Nero and Gatobo Edgar. Sarah Borger, Julius Lanya, Mesfin Hailemariam, Comfort Yankson and Sonya Funna are greatly appreciated for reviewing and editing the materials. Games used in the lessons are available through the HIV/AIDS Alliance. See below for full details and resources used in the development of this module:International HIV/AIDS Alliance. (2002). 100 Ways to Energize Groups: Games to Use in Workshops, Meetings and the Community. Available at .TANGO International. (2009). Vulnerability, Livelihoods, Nutrition and Food Security Assessment in NBEG & Warrap. UNICEF/OLS Nutrition Section. (1997). Child Feeding Practices among the Nuer, Dinka and Latuko of Southern Sudan. Available: . The SSHiNE health and nutrition and empowerment program includes the following partners: the Adventist Development and Relief Agency (ADRA), Food for the Hungry (FH), Concern Worldwide (CW), Malaria Consortium (MCo) and the Johns Hopkins University, Bloomberg School of Public Health (BSPH).Suggested Citation: Hanold, Mitzi J. (2011) Child Feeding and Care. Washington DC. Food for the Hungry (FH), made possible through support provided by the Office of Food for Peace, Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S. Agency for International Development under the terms AID-FFP-A-10-00017-02. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the U.S. Agency for International Development.Lesson 1: Family Planning -53546716129000Caregivers will delay new pregnancy for two years after the birth of the last child. Mothers who become pregnant before two years are more likely to die from blood loss and long, difficult delivery. Infants born to mothers who become pregnant before two years are more likely to have weak blood (anemia) and be born too early, too small or dead. Caregivers will use one of the following methods or talk with a health worker for other options.Caregivers will prevent new pregnancy by exclusively breastfeeding their child for the first six months of life. Exclusive breastfeeding for six months prevents pregnancy as long as the infant was given the breast within one hour after birth, is breastfed on demand, and the mother’s monthly bleeding has not returned. Caregivers will talk with their spouse about fertility and follow the two day method to delay new pregnancy. Women will check for vaginal secretions twice each day in the afternoon. Vaginal secretions are a sign that new pregnancy is possible. To delay new pregnancy, women will abstain from sex if they see secretions yesterday or today. They will only have sex after two days without secretions. Caregivers will believe that having children too close together puts the mother at great risk of death during pregnancy and childbirth (increased perceived severity).Additional Information for the Trainer and PromoterThis lesson is designed for women. However these messages must be shared FIRST with community leaders. Encourage community leaders to share these messages with the men prior to teaching the women. Encourage community leaders to be aware of the dangers to women and their children when they become pregnant too soon. Materials:Attendance Registers Leader Mother Flipchart Five objects to represent days of bleedingTen objects to represent days of secretions(optional) A calendar pageSummary:Game: The Sun Shines OnAttendance and TroubleshootingShare the story: The Children Come Too Soon!Ask about family planning practices that are used by the women.Share the meaning of each picture on flipchart pages 6-11: Delaying New Pregnancy, The Exclusive Breastfeeding Method, and The TwoDay Method.Activity: TwoDay Method Discuss BarriersPractice and Coaching in pairsRequest Commitments1. Game: The Sun Shines On - 10 minutesAsk the women to stand in a circle. The facilitator stands in the middle of the circle. The facilitator shouts, “The sun shines on…” and names a color or piece of clothing that some of the women are wearing. For example, “The sun shines on everyone wearing red.” All the women wearing red must change places with one another. The facilitator tries to take the place of someone who is moving. The facilitator cannot squeeze into the circle in a new position; he must replace the spot of a woman who has moved. The person without a place to stand becomes the new facilitator and stands in the middle of the circle. The new facilitator shouts “The sun shines on…” and names a different color or piece of clothing or characteristic.Repeat the game so that many of the mothers have a chance to be in the middle of the circle.Now that we are energized, let’s begin our lesson.2. Attendance and Troubleshooting – 15 minutesPromoter fills out attendance sheets for each Leader Mother and neighbor group (beneficiary group).Promoter fills out vital events mentioned by each Leader Mother (new births, new pregnancies, and mother and child deaths).Promoter asks if any of the Leader Mothers had problems meeting with their neighbors. The Promoter helps to solve the problems mentioned. Promoter thanks all of the Leader Mothers for their hard work and encourages them to continue.Promoter asks the group’s Activity Leader to discuss the needed items for next week’s activity and solicit volunteers.The Children Come Too Soon (Picture 1.1) – 15 minutes3. StoryRead the story on page 4 of the flipchart.Early in the morning, Abuk visits Achol who is sitting with her three children. Achol is crying. “I am so tired. My body hurts and I don’t have any strength to care for my children. I cannot continue to have children every year. How can I delay new pregnancy? The children come too soon!” 4. Ask about Current PracticesRead the questions on page 4 of the flipchart.Why is Achol crying?Are you ready to be pregnant again? Why?What methods are you using to delay pregnancy?Ask the first question to review reasons why Achol is crying. She is tired and does not have strength to care for her children. A few months after she gives birth, she becomes pregnant again. Ask the second question to hear the women’s feelings about becoming pregnant again.Ask the last question to hear the methods used by the women to delay new pregnancy. Methods used may include modern contraceptive methods (condoms, injections, pills or implants) or natural family planning methods such as The TwoDay Method or other calendar methods. Encourage discussion. Don’t correct “wrong answers.” Let everyone give an opinion. This page is for discussion, not for teaching.After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following pages.”Delaying New Pregnancy (Picture 1.2) – 10 minutes5. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 7.Share the meaning of each picture using flipchart pages 6 and 7. Read the captions on the flipchart out loud.What do you think these pictures mean? Families that delay pregnancy for two years after each birth have healthy mothers and healthy children.Mothers are healthy during and after pregnancy.Children grow healthy and strong.Families that do not delay pregnancy suffer from poor health and sickness. Mothers and infants suffer from weak blood.Mothers are often sick during pregnancy.Children are small and do not grow well.When a woman becomes pregnant too soon, she and her infant are more likely to die.This mother suffered from weak blood in pregnancy.She and her infant died during delivery.Have you seen mothers suffer because of pregnancies that have come too soon? Tell me about them. Additional Information for the TrainerMother and Child DeathWomen with severe anemia (weak blood) are 3.5 times more likely to die during pregnancy and childbirth than women without anemia. In countries with high birth rates (such as Sudan) if women and their partners were given information and skills to prevent new pregnancies, it is estimated that 1 out of 3 maternal deaths and 1 out of 10 child deaths could be avoided. MiscarriageWomen who have given birth to a dead child or had an abortion should wait at least six months before becoming pregnant again.Pregnancy of Young Women Studies in both Gabon and Congo have shown that mothers who become pregnant before the age of 16 have a much higher risk (up to 37% increased risk) to have an infant born too small (low birth weight). Low birth weight infants are more likely to suffer sickness and death before age two. To prevent infant death, families should delay first pregnancy until after the woman is older than 16 years of age. The Exclusive Breastfeeding Method (Picture 1.3) – 10 minutes6. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 9 of the flipchart.Share the meaning of each picture using flipchart pages 8 and 9. Read the captions on the flipchart out loud.What do you think these pictures mean? The Exclusive Breastfeeding Method delays new pregnancy for six months if all of the following things are true: The woman’s monthly bleeding has not returnedThe child is younger than six monthsThe mother breastfeeds day and night whenever the child shows signs of hunger. The mother never gives water, porridge or other foods or liquids.All of these things must be true if you want to delay new pregnancy using this method. Bleeding is a sign that new pregnancy is possible.When your baby is six months, new pregnancy is possible.If you give other foods and liquids, new pregnancy is possible.Are you able to use this method to prevent pregnancy? Why or why not?What should you do if all of these things are not true? Talk with a health worker about other methods to delay new pregnancy. Additional Information for the TrainerFamily Planning in South SudanAccording to the TANGO International report, family planning and the use of birth control are not widely used. Most families believe family planning is not appropriate or against their cultural beliefs. In traditional Nuer culture, women must abstain from sex as long as they continue to breastfeed. The male spouse determines when he is ready to have a child and sleep again with his wife. At this point, the child is weaned from breast milk. Following this tradition, both mothers and their children are at great risk of anemia, malnutrition and death. ADRA staff have also reported hearing families discuss the importance of “having more children” now that the war has ended to “repopulate” the land. If family size increases and families do not wait two years after each birth before becoming pregnant again, the number of maternal and child deaths from anemia and malnutrition will continue to climb. FertilityFor non-breastfeeding women or women who give other foods or liquids to infants under six months of age, new pregnancy may be possible as early as 45 days after delivery. The Two Day Method (Picture 1.4) – 10 minutes7. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 11.Share the meaning of each picture using flipchart pages 10 and 11. Read the captions on the flipchart out loud.What do you think these pictures mean? Look for secretions each afternoon and evening when you use the latrine. Use your fingers or a cloth to wipe your genitals.Secretions are signs that new pregnancy is possible. New pregnancy is possible if you had secretions yesterday or today. If you had secretions yesterday and today, new pregnancy is possible. If you have secretions today only, new pregnancy is possible. If you had secretions yesterday only, new pregnancy is possible. To avoid new pregnancy, you and your partner must agree to use a condom or avoid sex on days when new pregnancy is possible. How can women encourage their husbands to abstain from sex on days with secretions? Additional Information for the TrainerTwo Day Method EfficacyWhen correctly used, the two day method is 96% effective in preventing new pregnancies. This means that if 100 women use this method correctly for one year, only four of them will become pregnant. SecretionsSecretions may be slippery and thin or thick and sticky. Women do not need to distinguish between the different types of secretions. All non-bloody secretions are signs that new pregnancy is possible. Semen may be present on the woman’s genitals the morning after sex. Checking for secretions in the afternoon and evening will help women to avoid mistaking semen for their own secretions. InfectionSecretions that continue for more than 14 days in a row may be a sign of a sexually transmitted infection or vaginal infection. Women with vaginal infections have thick lumpy secretions with itching and pain. Visit the health center immediately for diagnosis and treatment of infection. Fertile DaysUsing the TwoDay Method, most women will have 12-13 days each month when new pregnancy is possible. Postpartum WomenSecretions can be difficult to notice and interpret before the return of regular monthly bleeding. Women may have many days with secretions even on days when new pregnancy is not possible. This increases the days that she and her partner must abstain from sex. Further InformationFor more information or alternatives to the Two Day Method, encourage women to visit the health center. Program staff may find more information at the following website: 8. Activity: Two Day Method – 30 minutes313118515430500Needed objects:five objects to represent days when women bleed each monthten objects to represent secretions.A large calendar drawn in the sand (or made with long sticks): four rows with seven days in each row.Put four objects in the first row to represent days of bleeding.Fill the last six days of the second row with six objects to represent secretions.Put four objects to represent secretions in the first three days of the third week. Place one object to represent bleeding on the last day of the last week. Use the calendar to explain:Each month women have bleeding days.After bleeding days, there are a few days of no secretions.Then for 10-12 days a woman will see and feel secretions.Then there will be another time of no secretions.Finally the woman’s bleeding will start again.If a woman follows the Two Day Method, when should she avoid sex or use a condom? She should avoid sex or use a condom if she had secretions today or yesterday.297878519748500Which days on this calendar (pointing to the drawing on the ground) should she avoid sex or use a condom?Point to the days of secretions and the first day after secretions (the shaded days on the calendar to the right). On these eleven days it is possible for her to become pregnant. Each woman is different. Some women they will have more days of secretions. Other women will have fewer days of secretions. Each woman must check her body each day to find out when new pregnancy is possible. How do you feel about checking for secretions? Are you comfortable doing this?How can a woman remember her secretions from the day before? Ideas might include any of the following: Using a calendar to mark the secretions that you see.Using two rocks to remind you. Place two small rocks and a can inside the latrine. Put one rock inside the can on the first day of secretions. Put a second rock inside the can on the second day of secretions. If one or both rocks are inside the can, abstain from sex.On the first day that you do not see a secretion, remove one rock. On the next day that you do not see a secretion, remove the other rock. When both rocks are outside the can, you can have sex until secretions are seen again. How can you discuss this method with your spouse?9. Discuss Barriers – 15 minutesIs there anything that might prevent you from trying these new practices?Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share barriers and concerns they have about the new teaching. Together they should try to find solutions to these barriers. After five minutes, ask the Leader Mothers to share what they have discussed. Help find solutions to their concerns. If a woman offers a good solution to another woman’s concern, praise her and encourage others to consider this solution. Possible concerns:My husband will not agree to avoid sex or use a condom: Discuss ways the women can go to community leaders to ask them to speak to the men about the importance of delaying new pregnancy for the health or women and children in the community. If husbands will not agree to avoid sex, they may be willing to use a condom with their wife. In families with multiple wives, the husband could sleep with other wives who are not having secretions.Find a different method of family planning at the health center. Some methods do not require that the husband and wife avoid sex.I do not feel comfortable talking with my spouse openly about sex.Encourage women to come up with a sign to inform her spouse without speaking. For example, a woman ties a string around her belly on days when a condom must be used (or they should avoid sex). Or the woman leans a stick against the wall on days when a condom must be used (or they should avoid having sex). Work with community leaders to inform the men of the meaning of these signs. 10. Practice and Coaching ─ 20 minutesAsk each Leader Mother to share the teachings she has learned with the person sitting next to her. She will use the first two flipchart pages of today’s lesson. Each Leader Mother will teach the person next to them in the same way that the promoter taught her. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the third and fourth pages of the lesson.The Promoter watches, corrects, and helps Leader Mothers who are having trouble.When everyone is finished, answer any questions that the Leader Mothers have about today’s lesson.11. Request Commitments ─ 10 minutesBased on today’s teachings, what commitment will you make? Ask each mother to say aloud a new commitment that she will make today. For example: I commit to talking with my husband about the TwoDay method.I commit to checking for secretions each afternoon and evening.I commit to continuing to exclusively breastfeed and not give any water, food or porridge to my child.What was your commitment at the last lesson? Have you kept that commitment? How? What did you do?Lesson 2: Complementary Feeding: 6-8 months-51545818288000At six months of age, caregivers will begin offering soft porridge to infants.First foods are soft: not too thick or too thin. Mash or puree foods until they are smooth. Soft foods are easy for the child to swallow and will stay in the child’s mouth. Caregivers will prepare the first porridge with sorghum, millet, or maize. Add one spoonful of oil after cooking. Caregivers will breastfeed day and night whenever the child shows signs of hunger, always breastfeeding before offering porridge.Caregivers will offer three spoonfuls of soft porridge at each feeding starting at six months. Increase the quantity of porridge to 6 spoonfuls or a little less than half of the small metal cup at each feeding as the child’s appetite increases. If infants refuse some foods, caretakers will try other food combinations, textures or methods of encouragement.Increase the food as the child’s appetite increases. Caregivers will increase the variety of foods as the child grows.After four days of eating plain porridge, caregivers will add meat, chicken, fish, cowpeas, eggs, beans, simsim, tomatoes, mashed peanuts and greens. Caregivers will be able to prepare porridge for strong blood (high in iron), porridge for strong muscles and bones (high protein) and porridge to prevent sickness (high in Vitamin A). Caregivers will believe that they have the time, food and information they need to feed their 6-9 month old infant three times a day (increased perceived self efficacy).Materials:Attendance Registers Leader Mother Flipchart A cooking fire, pots and materials needed to make porridge.*Clean cups and spoons brought by each woman.*Foods needed to prepare the porridges.*Soap (or ash) and water to wash hands.*Summary:Game: Showing my EmotionsAttendance and TroubleshootingShare the story: Deng Spits and Turns AwayAsk the mothers about their current feeding practices Share the meaning of each picture on flipchart pages 14-19: First Foods at Six Months, Quantity and Frequency of Feeding, and Increased Food Variety. Activity: Making the First Porridge Discuss BarriersPractice and Coaching in pairsRequest Commitments1. Game: Showing My Emotions — 10 minutesAsk a volunteer to stand at a distance from the rest of the group. The group should secretly choose an emotion or way of behaving like happy, sad, patient, kind, angry, or joyful. Ask the volunteer to return. The volunteer asks the women to do an activity such as cleaning their teeth, dressing their child, feeding their child, or eating. The women in the group pretend to do the activity with the emotion that they chose. For example, if the women chose “mourning” and the volunteer says “pretend to breastfeed,” the women should pretend to breastfeed in a very mournful way. The volunteer should observe the women and try to guess the emotion that they are showing. When the volunteer guesses the emotion, pick a new volunteer and send her away from the group. Use new emotions and actions with each volunteer. Repeat the activity allowing several women to volunteer. How do emotions affect our behavior? We may be doing some helpful (like feeding an infant) but doing it in an angry or frustrated way that doesn’t allow the infant to eat well. As mothers the way we talk and act affects the way our children eat.We must try to be encouraging and supportive to help them grow well. 2. Attendance and Troubleshooting —15 minutesPromoter fills out attendance sheets for each Leader Mother and neighbor group (beneficiary group).Promoter fills out vital events mentioned by each Leader Mother (new births, new pregnancies, and Mother and child deaths).Promoter asks if any of the Leader Mothers had problems meeting with their neighbors. The Promoter helps to solve the problems mentioned. Promoter thanks all of the Leader Mothers for their hard work and encourages them to continue.Promoter asks the group’s Activity Leader to discuss the needed items for next week’s activity and solicit volunteers.Deng Spits and Turns Away (Picture 2.1) ─ 15 minutes3. Story: Read the story on page 12 of the flipchart.Achol followed the advice of Abuk and stopped giving Deng water or porridge. Deng gained weight. Now he is six months old. Achol tries to feed Deng but he spits and turns away. Her neighbors say, “It is too early to give solid foods, he only needs cow’s milk.” Achol wonders if she should wait to feed him until he is older. 4. Ask about Current PracticesRead the questions on page 12 of the flipchart.Why isn’t Deng eating?At what age, should a mother offer food to her infant?When did you give your youngest child his first taste of porridge?Ask the first question to find out the women’s beliefs about reasons that infants refuse foods. We hope the women respond in this way: He is not used to porridge. Achol must offer a small amount of porridge once or twice a day until Deng accepts the new food. At six months the child’s body is ready, but the mother must still encourage the infant to try new foods.Ask the second question to hear the women’s belief about the best time to begin offering food.The recommended age to offer food is six months of age. Many mothers in Sudan offer foods and water before six months of age. Ask the last question to learn the common age when the mothers offered porridge to their youngest children. Encourage discussion. Don't correct "wrong answers." Let everyone give an opinion. This page is for discussion, not for teaching.After the participants answer the last question, move to the next flipchart page by saying, "Let's compare your ideas with the messages on the following pages."First Foods at Six Months (Picture 2.2) — 10 minutes5. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 15.Share the meaning of each picture using flipchart pages 14 and 15.Read the captions on the flipchart out loud.What do you think these pictures mean? At six months of age, begin giving soft foods after breastfeeding.Breastfeed whenever the child shows signs of hunger. Breast milk is still the most important source of food.Always breastfeed before giving foods.At six months, the child also needs food to help the body grow.Prepare porridge with sorghum, millet or maize. Add oil after cooking. Uncooked oil is better for the child than cooked oil. Porridge can also be made with pumpkin.Porridge should be soft: not too thick or too thin.Thick porridge may block the child’s throat.Thin porridge will slip out of the child’s mouth.Thin porridge does not provide enough food for the child.Soft foods stay in the child’s mouth.If the infant refuses new foods, what should the mother do? Prepare porridge made from another food. Add breast milk to the porridge.Offer one spoonful twice a day until the child is ready for more. Additional Information for the TrainerComplementary Feeding in South SudanAccording to the TANGO survey, only one out of every four children (24%) is introduced to foods at six months. The average age foods were offered was 6.69 months. Note: Infants customarily consume porridge at a very young age and may drink unpurified water which might not be reflected in this data. Thick and Thin PorridgeSoft porridge provides more nutrients and food than thin porridge. If a mother feeds very watery porridge the child will need to each two times as much porridge to get enough nutrients.Soft porridge allows the child to eat less but obtain the needed nutrition.Quantity and Frequency of Foods: 6-8 months (Picture 2.3) ─ 10 minutes6. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 17.Share the meaning of each picture using pages 16 and 17.Read the captions on the flipchart out loud.What do you think these pictures mean? Offer porridge three times a day. Offer 6 tablespoons or a less than half cup at each feeding. Offer porridge in the morning, at noon and in the evening.The first week of feeding, offer 2 or 3 spoonfuls each day.Increase the quantity each day as the child appetite increases until the child is able to eat 5 or 6 spoonfuls at each feeding.Feed infants slowly and patiently. Encourage them to eat, but do not force them.Sing or talk to the child to encourage them.If they do not like porridge with sorghum, try porridge with another grain. Add breast milk to porridge to encourage them to eat.Breastfeed whenever the child is hungry day and night. Breastfeed whenever the child shows signs of hunger.Always breastfeed before offering foods. Why do you think that Abuk and her husband spend so much time helping Achok to eat?They know that Achok must eat to grow well.Without encouragement she may not eat well and grow thin.They value their child and do all they can to help her grow.Additional Information for the TrainerForced FeedingDo not force a child to eat. Food may get into the child lungs if the child cries and inhales the food. Food in the lungs could cause infection and death. Breast milk and WaterOffer breast milk to quench the child’s thirst. Only offer water that is boiled, or chlorinated. Using water that is not boiled or chlorinated may cause diarrhea.Increased Food Variety: 6-8 months (Picture 2.4) ─ 10 minutes 7. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 19.Share the meaning of each picture using flipchart pages 18 and 19.Read the captions on the flipchart out loud.What do you think these pictures mean? Slowly add new foods to the child’s porridge. After four days of plain porridge, add one new food.Wait four days before adding another food.Add dried fish and simsim to porridge to build strong blood.Pound the fish to make it easier for child to swallow. Remove tough pieces that might cause choking. Fish and simsim are rich in iron.Iron prevents weak blood (anemia). Add eggs and groundnuts to porridge to build strong muscles and bones.Mash eggs and groundnuts before adding to the porridge. Egg and peanuts are body building foods.They contain protein to strengthen muscles and bones. Add tomatoes, greens and oil to porridge to prevent sickness.Tomatoes and greens are protecting foods.The contain vitamins to prevent child illness.Which of these foods did you offer to your child yesterday? What can you add to the porridge tomorrow to make it healthier?Additional Information for the TrainerChild GrowthAs the infant grows the amount of blood, muscle and bone in the body increases. Extra iron is needed to keep the child’s blood strong. Body building foods are needed for healthy growth of bone and muscle.We do not recommend red meat for children 11 months or younger because of the texture and toughness of the meat. Dried fish after pounding (or after bones are removed from fresh fish) should be soft enough for a child to eat. TomatoTomatoes are rich in nutrients that strengthen the immune system (body’s germ fighting system). A study in Sudan in 1988 studied tomato eating of children 6 to 72 months, over a period of six months. Compared with children who did not consume tomatoes at all, those who ate tomatoes on the days preceding the surveys were at a 17% reduced risk of diarrhea and a 50% reduction in the risk of diarrhea with fever. Dried Fish and Egg TaboosAccording to local taboos, only the salted dried fish is given to children. The unsalted dried fish is believed to be too dry for children causing stomach problems. From our understanding after pounding, either fish can be given and will not cause harm to the child. Egg is believed by some in South Sudan to cause meningitis or slow the child’s ability to talk. Research has not shown a connection between eggs slowness of speech or meningitis. Eating raw eggs can cause sickness; never give raw eggs to children. Offering cooked eggs to children will not harm them. Instead it will make them stronger, building muscles and bones. 8. Activity: Making the First Porridge — 30 minutes The Activity Leader will organize mothers to bring the food and cooking materials needed to make the porridge. Making Plain PorridgeAsk everyone (mothers and children) to wash their hands with soap (or ash) and water. Using local foods and the help of the women in the group, make a plain porridge made with sorghum, maize or millet and oil.Discuss the consistency. Adding water while cooking or breast milk after the food is cooked so the porridge is soft and not too thick or too thin.Offer this porridge for mothers with infants who are 6 months of age.Porridge for Strong Blood (Iron rich porridge)Prepare the iron rich porridge or the body building porridge listed on the flipchart with the remaining porridge.Mixing it again until it is the right consistency (not too thin and not too thick).When the final porridge is made, feed infants and children six months or older who have already shown tolerance to all of the foods which have been added to the porridge.9. Discuss Barriers – 15 minutesIs there anything that might prevent you from trying these new practices?Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share barriers and concerns they have about the new teaching. Together they should try to find solutions to these barriers. After five minutes, ask the Leader Mothers to share what they have discussed. Help find solutions to their concerns. If a woman offers a good solution to another woman’s concern, praise her and encourage others to consider this solution. Possible concerns:Women may not have enough money to add three or four foods to the porridge. If they can’t add three foods, encourage them to add only two foods. If they can’t add two foods, encourage them to add one additional food. Encourage them to take small steps towards the goal. Even if they can’t reach the goal, they will still be helping the child to grow better than before. 10. Practice and Coaching ─ 20 minutesAsk each Leader Mother to share the teachings she has learned with the person sitting next to her. She will use the first two flipchart pages of today’s lesson. Each Leader Mother will teach the person next to them in the same way that the promoter taught her. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the third and fourth pages of the lesson.The Promoter watches, corrects, and helps Leader Mothers who are having trouble.When everyone is finished, answer any questions that the Leader Mothers have about today’s lesson.11. Request Commitments ─ 10 minutesBased on today’s teachings, what commitment will you make? Ask each mother to say aloud a new commitment that she will make today. For example: I will offer porridge to my six month old child three times a day.I will always breastfeed before feeding my eight month old child.I will add fish and simsim to my infant’s porridge to build strong blood. What was your commitment at the last lesson? Have you kept that commitment? How? What did you do?Lesson 3: Complementary Feeding: 9-11 months -4849783619500Women will breastfeed their 9-11 month old day and night whenever the child shows signs of hunger.After breastfeeding, caregivers will offer 1/2 of the small metal cup (150ml) or 8 spoonfuls to the child four times each day. Caregivers will increase the amount of food based on the child’s appetite.Caregivers will offer foods cut into small pieces, mashed foods and finely chopped foods that the child can eat with his fingers.Caregivers will prepare snacks for the child to give in addition to porridge.Offer fruits from your kitchen garden such as mashed or finely chopped fruit tomato, mango, guava, papaya, banana, watermelon and forest fruits. Offer boiled or fried foods such as pumpkin, simsim, potato, eggplant, and egg. Caregivers will believe that children who are not fed frequently will suffer from malnutrition and death (increased perceived severity). 10Caregivers will actively feed children, encouraging them to eat. They will feed while looking into their face, use songs and words of encouragement to help the child to eat. MaterialsAttendance Registers Leader Mother Flipchart Fruits vegetables and foods which can be used as child snacks*Knives and materials needed to prepare snacks*Summary:Game: Blindfolded PairsAttendance and TroubleshootingShare the story: Deng is Hungry All DayAsk the women how many times they feed their nine, ten or eleven month old each day.Share the meaning of each picture on flipchart pages 22-27: Complementary Feeding: 9-11 months; Quantity and Frequency of Feeding; and Snacks for Children. Activity: SnacksDiscuss barriersPractice and Coaching in pairsRequest Commitments1. Song: Blindfolded Pairs — 5 minutes An obstacle course is set for everyone to see (place chairs, or mats, or other people in the path to the other side). An ending line or “target” is identified on the opposite side of the room.Participants split into pairs. One of the pair ties fabric around their head covering their eyes (or closes their eyes tightly) so they cannot see. The other member of the pair now gives advice and direction to their partner to help them to get safely to the other side of the room. What helped you to get to the other side? If you tried to cross the room without any help, would it be difficult for you? Encourage discussion.What can we learn from this game? As we teach, we need to guide those who are “following unhealthy practices” or “blindfolded.”We need to encourage others and support them, (not force them) to make changes in their lives. Now that we are finished with our game, let’s begin.2. Attendance and Troubleshooting — 15 minutesPromoter fills out attendance sheets for each Leader Mother and neighbor group (beneficiary group).Promoter fills out vital events mentioned by each Leader Mother (new births, new pregnancies, and Mother and child deaths).Promoter asks if any of the Leader Mothers had problems meeting with their neighbors. The Promoter helps to solve the problems mentioned. Promoter thanks all of the Leader Mothers for their hard work and encourages them to continue.Promoter asks the group’s Activity Leader to discuss the needed items for next week’s activity and solicit volunteers.Deng is now 9 months old. Achol prepares porridge for Deng three times a day. But he often grows hungry between meals. Achol is upset. She doesn’t have time to cook for him many times each day. Her husband tells her to make more food, “Why aren’t you feeding Deng enough food? Are you trying to starve my son?” Deng is Always Hungry (Picture 3.1) ─ 15 minutes3. Story: Read the story on page 20 of the flipchart.4. Ask about Current Practices: Read the questions on page 20 of the flipchart.Do you think Achol has a right to be upset with Deng?How often do you feed your 9-11 month old child? How much do you give the child at each feeding?Ask the first question to find out the women’s beliefs about Achol’s reaction.We hope participants answer in this way: Anger will not fill Deng’s stomach or help him to grow. Achol should breastfeed and offer foods to Deng whenever he shows signs of hunger. Achol should find ways to solve the problem instead of becoming angry. Ask the second and third question to hear how the mother’s currently feed children 9-11 months of age. From 9-11 months, caregivers should offer foods four times each day, offering half of the small metal cup or 17 spoonfuls at each feeding. Encourage discussion. Don’t correct “wrong answers.” Let everyone give an opinion. This page is for discussion, not for teaching.After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following pages.”Complementary Feeding: 9-11 months (Picture 3.2) ─ 10 minutes5. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 23.Share the meaning of each picture using flipchart pages 22 and 23.Read the captions on the flipchart out loud.What do you think these pictures mean? Breastfeed day and night whenever the child shows signs of hunger.Breast milk is the most important food for the child. Breast milk is better than goat’s milk, cow’s milk and water.Continue to breastfeed for two or more years. Offer foods to your child after breastfeeding. Always breastfeed before giving foods.At nine months offer small pieces of chopped food or chunky, mashed food. Offer foods that the child can eat with their fingers. Chunky foods help the child to learn to chew.The pieces should be small so they won’t get stuck in the child’s throat. Encourage the child to pick up foods with his fingers.This helps them to strengthen their fingers. How would you describe the texture of the foods that you fed your 9-11 month old child yesterday?What finger foods did you offer your 9-11 month old child yesterday?Additional Information for the TrainerBreastfeeding Breast milk provides one half or more of a child’s energy needs between 6 months and 1 year. Before age one, breast milk is the most important food for children. Children who breastfed each day have fewer illnesses than those who are not breastfed, they recover from illness more quickly and are less likely to die from child illness.Children breastfeed less often when foods are given. Women need to breastfeed often and always BEFORE giving foods at this age to help children stay healthy.Quantity and Frequency Increased (Picture 3.3) ─ 10 minutes6. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 25.Share the meaning of each picture using flipchart pages 24 and 25.Read the captions on the flipchart out loud. What do you think these pictures mean? For children 9 to 11 months, offer food four times each day. Offer food in the early morning, mid-day, afternoon and evening.Offer chunky porridges and finely chopped foods.Offer snacks once or twice a day.Offer 8 spoonfuls of food at each feeding.This is about half of the small metal cup. You will be able to see how much the child eats. If the child is still hungry, offer more foods.Children who are not fed four times a day suffer from malnutrition.This father only offers his child family foods twice a day.The child is two years old, but growing very ill.He is malnourished and is too weak to walk. Abuk spends a lot of time helping Achok to eat. Why does she do this?She knows that her child is vulnerable to sickness and death.By offering small amounts of foods many times a day, she protects Achok from severe illness and death. Snacks for Children (Picture 3.4) ─ 10 minutes 7. Share the Meaning of Each PictureAsk the caregivers to describe what they see on page 27.Share the meaning of each picture using flipchart pages 26 and 27.Read the captions on the flipchart out loud.What do you think these pictures mean? Offer raw foods like tomato, cucumber, mango, papaya, banana, watermelon and forest fruits. Uncooked snacks are easier for mothers to prepare.Carry a snack with you when you are away from home. Offer boiled or fried foods like egg, potato, pumpkin, simsim and eggplant.Prepare cooked foods in the morning.Offer these foods to the child on the same day. Offer biscuits and groundnut paste. Offer foods of many different colors.Foods of different colors have different vitamins inside.Children who eat foods of many different colors are healthy and strong. What snacks did you offer your child 9 months or older yesterday? What snacks can you add tomorrow?Additional Information for the TrainerHot and Cold FoodsAlways offer hot porridge to children. Germs (things that cause sickness) multiply as the porridge cools. Cold porridge may cause great sickness to young children. Prepare cooked snacks like egg, potato and pumpkin in the morning. Offer them to children within 2-3 hours. The longer the mother waits, the more likely it will bring sickness. Keep foods cool in a covered ceramic pot or in a dish covered by another plate or bowl. 8. Activity: Snacks — 30 minutes The Activity Leader will organize mothers to bring the food and materials for cutting or preparing foods as needed. Everyone begins by washing their hands (and their child’s hands) with soap (or ash) and water. Gather the foods brought by the mothers and discuss which foods are rich in vitamins (all fruits and vegetables), which snack foods are rich in vitamin A (all red, dark green and orange flesh foods), which snacks are body building foods (meat, fish, groundnuts). Discuss how each food is prepared and offered to the child. For example, a potato should be cooked. It can be kept for many hours and fed to the child between meals. The potato can be mashed, but with some small lumps. Many of the other foods can be washed and cut into finger sized pieces for the child. Fruit snacks can be easily carried to the field if the mother takes the child with her. Choose one or two foods to chop and mash for the children who are 9 months of age and above. Encourage mothers to take seeds from fruits and vegetables in the market and plant them in their own kitchen gardens. Answer questions. 9. Discuss Barriers – 15 minutesIs there anything that might prevent you from trying these new practices?Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share barriers and concerns they have about the new teaching. Together they should try to find solutions to these barriers. After five minutes, ask the Leader Mothers to share what they have discussed. Help find solutions to their concerns. If a woman offers a good solution to another woman’s concern, praise her and encourage others to consider this solution. Possible concerns:Don’t have money to prepare snacks. Offer fruits or cooked foods like potato and pumpkin to your child instead.Encourage women to buy seeds for fruit trees or vegetables (potato and pumpkin) and plant them near their home.10. Practice and Coaching ─ 20 minutesAsk each Leader Mother to share the teachings she has learned with the person sitting next to her. She will use the first two flipchart pages of today’s lesson. Each Leader Mother will teach the person next to them in the same way that the promoter taught her. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the third and fourth pages of the lesson.The Promoter watches, corrects, and helps Leader Mothers who are having trouble.When everyone is finished, answer any questions that the Leader Mothers have about today’s lesson.11. Request Commitments ─ 10 minutesBased on today’s teachings, what commitment will you make? Ask each mother to say aloud a new commitment that she will make today. For example: I will offer one or more snack for my 9-11 month old child each day.I will offer foods to my child whenever they shows signs of hunger.I will always breastfeed before offering foods to my child 6-11 months of age. What was your commitment at the last lesson? Have you kept that commitment? How? What did you do?Lesson 4: Child Feeding: 12 – 24 months (1-2 years)-54610012398700At 12 months of age, caregivers will offer 200 ml of food (almost a full 250ml metal cup) to the child five times a day. Caregivers will offer family foods and two or more small meals for the child.Caregivers will increase the amount of food as the child’s appetite (and stomach) increases, offering a full cup (17 tablespoons) at each feeding. Caregivers will offer foods before breastfeeding. Continue to breastfeed whenever the child wants breast milk for two or more years. Breast milk continues to protect the child against many illnesses as long as the child is breastfed. Caregivers will chop foods, or mash them so they are easy for the child to swallow. Meat will be cut into small pieces. Fish bones and tough skin will be removed to prevent choking. Caregivers will prepare food to help the child grow healthy and strong:Offering red, yellow, and deep green foods to prevent sickness. These foods are rich in vitamin A. Offering meat, eggs, poultry and fish for strong bones and strong blood. These foods are rich in protein (body building foods) and rich in iron (to make strong blood). Add a sprinkle of iodized salt to family foods. Iodized salt contains iodine which helps children’s brain development so they will learn well in school.Offer foods from each food group each day: protecting foods (such as vitamin A foods and other fruits and vegetables), body building foods (meat, fish and animal products are the strongest body building foods) and energy foods (oils, sugars and grains). Caregivers will believe that they can prepare meals from each food group (with their current time and money) in order to child prevent malnutrition (increased perceived self efficacy). Materials: Attendance Register Leader Mother FlipchartA bucket filled with 4 full cups (small metal cups) of dirt, sand or pebbles At least two tablespoons Summary:Game: The Breastfeeding SongAttendance and TroubleshootingShare the story: Achol’s Husband sends Deng AwayAsk about current practices relating to weaning a child from breast milk.Share the meaning of each picture on flipchart pages 30-35: Continue Breastfeeding; Quantity and Frequency of Feeding and Variety of Foods. Activity: A Child’s StomachDiscuss BarriersPractice and Coaching in pairsRequest Commitments1. Game: the Breastfeeding Song ─ 5 minutesReview the song from Lesson 6 of Module 2. Health Managers add the song lyrics here for the song that was created.Now that we are energized and ready for our lesson, let’s begin!2. Attendance and Troubleshooting ─ 15 minutesPromoter fills out attendance sheets for each Leader Mother and neighbor group (beneficiary group).Promoter fills out vital events mentioned by each Leader Mother (new births, new pregnancies, and Mother and child deaths).Promoter asks if any of the Leader Mothers had problems meeting with their neighbors. The Promoter helps to solve the problems mentioned. Promoter thanks all of the Leader Mothers for their hard work and encourages them to continue.Promoter asks the group’s Activity Leader to discuss the needed items for next week’s activity and solicit volunteers.Achol‘s Husband Sends Deng Away (Picture 4.1) ─ 15 minutes3. Story: Read the story on page 28 of the flipchart. One afternoon, Achol’s husband says, “It is time to wean the child from breast milk. Let us send Deng to cattle camp.” “Are you sure? Achol asks. “Look Deng has gained weight and is doing so much better now that he is drinking breast milk.” “It is time,” says her husband and walks away. 4. Ask about Current PracticesRead the questions on page 28 of the flipchart. Why is Achol’s husband sending Deng away?Will this decision help or harm Deng? Why?What is the best age to wean a child from breast milk?Ask the first questions to review the beliefs about why children are weaned. In some cultures, the husband cannot sleep with his wife if she is breastfeeding. Achol’s husband may be sending Deng away so he can sleep again with Achol. Her husband may believe that weaning Deng will make him strong.Her husband may believe that cow’s milk is better for Deng than breast milk.We do not know the exact reason why he is sending Deng away.Ask the second question to discuss how this action might help or harm the child.We hope the mothers respond in this way: Without breast milk, Deng is more likely to become sick. His sickness will last longer if he is not breastfed. He will not grow healthy and strong without breast milk. He will be small and weak. Sending Deng away will keep him from growing healthy and strong.Ask the last question to hear the women’s current weaning practices.We hope that caregivers breastfeed until the child is at least two years old. Encourage discussion. Don’t correct “wrong answers.” Let everyone give an opinion. This page is for discussion, not for teaching.After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following pages.”Continue Breastfeeding: 1-2 years (Picture 4.2) - 10 minutes5. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 31.Share the meaning of each picture using flipchart pages 30 and 31. Read the captions on the flipchart out loud.What do you think these pictures mean? After the child turns one, offer foods first then breastfeed. Continue to breastfeed for two or more years.Breastfeed whenever the child asks for it.Breast milk helps protect children from sickness. Children who continue to drink breast milk are healthy and strong.This child was breastfed for two years.The child is healthy and strong.He does not suffer often from sickness.Children who stop drinking breast milk suffer from sickness.This child was sent to cattle camp.This child drinks cow’s milk instead of breast milk.He is weak and thin at two years of age.This child suffers from frequent diarrhea. How do mothers feel about breastfeeding for two or more years? How do fathers feel about breastfeeding for two or more years? How can we help them to understand the importance of continuing to breastfeed?Additional Information for the TrainerWeaning Practices in Southern SudanHalf of mothers (51.7%) in Warrap and NBEG stop breastfeeding before their children reach their second birthday. The average age of weaning is 19 months. Cow and Goat milkCow’s milk does not have much iron. A child that drinks cow’s milk instead of breast milk is at risk of anemia (weak blood). These children must eat foods high in iron each day to prevent anemia. Goat's milk is high in sodium (like cow's milk) and is very high in chloride and potassium, which puts stress on the infant’s kidneys. This can cause internal bleeding and can result in anemia and poor growth (these problems are usually undetected until months later). Goat milk is also deficient in folic acid, which can lead to anemia. Quantity and Frequency of Feeding: 1-2 Years (Picture 4.3) - 10 minutes6. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the pictures on page 33.Share the meaning of each picture using flipchart pages 32 and 33.Read the captions on the flipchart out loud.What do you think these pictures mean? For children one to two years old, offer food five times a day. Offer porridge two snacks and family foods each day. Offer family foods two or more times each day.Offer children the same foods others are eating. Feed children from a separate bowl. Offer up to one full metal cup or 17 tablespoons of food at each feeding. Feed children from a separate bowl or plate so you can see how much they eat.Begin with the small metal cup that is almost full.Increase to a full cup as the child grows. If the child is still hungry, offer more.Chop or mash foods which are difficult to chew and swallow.Cut meat into small pieces. Chop, pound or mash foods that might cause choking. Why does Abuk continue to feed her child so many times each day? She knows that small children are vulnerable to sickness and death.By offering small amounts of foods many times a day, she protects Achok from severe illness and death.Variety of Foods: 1-2 Years (Picture 4.4) ─ 10 minutes7. Share the Meaning of Each PictureAsk the caregivers to describe what they see in the picture on page 35.Share the meaning of each picture using flipchart pages 34 and 35.Read the captions on the flipchart out loud.What do you think these pictures mean? Offer red, orange and deep green foods to prevent sickness.Offer pumpkin, dark green leaves, mango, papaya and tomato. Red, yellow and dark green foods have Vitamin A.Vitamin A protects against illness.Offer meats, eggs, poultry and fish for strong bones and strong blood.Offer liver, red meat, eggs, chicken, fish and bush meat.These foods are rich in iron and protein.Add a sprinkle of iodized salt to family foods. This salt helps children to do well in school.It helps their mind to develop well.What other foods are needed to help children grow?Energy foods like oils, sugar and grains.Beans and simsim. Fruits like mango, papaya and guava.Additional Information for the TrainerFoods eaten in Southern SudanIronMeats may have less iron content than plant products; however they are easily absorbed by the body and work quickly to build iron in the body. Offering small amounts of meat or other animal products each week is the best way to prevent low iron. For more information about iron, review Lesson 2 of Module 2.Body Building GroupFrom the Tango report, meat and fish were consumed by about 20% of the people in the last 24 hours. Meat is not often consumed by vulnerable households (sixteen percent) or most vulnerable households (only nine percent) but was consumed by more than seventy percent of non-vulnerable households.Lentils and pulses were consumed by only 9% of the population in the last 24 hours. Milk, dairy products and eggs were consumed by about 20% of those surveyed. Before 12 months of age, meat is not recommended for children because they are tough and difficult for children to chew and swallow. Protecting FoodsIn the Tango report, green leafy vegetables were the most common food added to the staple food (67% of families ate green leafy vegetables in the last 24 hours). Fruits were consumed by only 8% of the populations and vegetables other than green leafy vegetables only 17% of the population. Vitamin A is an important nutrient to protect children from sickness and shorten the duration of sickness. To learn more about Vitamin A supplements, review Lesson 5. Energy FoodsOils and fat products are consumed by 23% of the surveyed population. Grains were consumed by 87.2% of those surveyed in the last 24 hours. 8. Activity: A Child’s Stomach – 20 minutes Before the activity begins, gather the following items:A metal cup (250 ml)A pot or bucketAt least 2 tablespoonsSoil (4 cups of soil = 1000 ml) Fill the cup with soil. Pour the soil into a pot or bucket. Fill the cup three more times and add the soil to the bucket or tub. Now the bucket contains 1000ml of soil.Show the bucket or pot filled with 1000ml of soilExplain that this soil represent the amount of food that a healthy one year old child needs each day to be healthy and strong. Pour the soil into three piles on the ground. Explain that each of these piles is a little more than one cup of food.Can a child one year old (12 month old) child eat more than one full cup (more than 19 tablespoons) at each feeding? Explain: Probably not. One overflowing cup is too much for 1 one year old child (12 months). Ask the women to divide the soil into smaller portions – the amount that a one year old could eat at one meal using the tablespoons and the cup. After they choose the amount the amount of food that can be eaten by a one year old child, ask them to repeat the same sized pile until they have used all of the soil in the bucket. Each pile represents a meal given to the child. Allow several minutes for mothers to discuss and divide the soil into equal piles until they are happy with their answer. How many portions did you choose? The only way a one year old child can get the 1000ml of food is if he eats small portions (a little less than one cup of food – 15 tablespoons) five times a day. This way, a child is able to fill his stomach, but also eat enough each day to be healthy and strong. As he grows, he will eat up to 17 tablespoons at each feeding. What if the mother chooses to only feed her child two or three times each day? What will happen?Explain: Children this age need 1000 ml of food each day. If a mother only feeds her child two or three times, the child will not get enough food. He will not grow well. He will become malnourished. Offer a 12 month old child a little less than one full cup at 12 months, but feed the child five times each day. As the child’s appetite increases, add to the cup so the child is satisfied after each feeding. By 18 months, you child will probably be able to eat a full cup (1, five times a day. 9. Discuss Barriers – 15 minutesIs there anything that might prevent you from trying these new practices?Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share barriers and concerns they have about the new teaching. Together they should try to find solutions to these barriers. After five minutes, ask the Leader Mothers to share what they have discussed. Help find solutions to their concerns. If a woman offers a good solution to another woman’s concern, praise her and encourage others to consider this solution. 10. Practice and Coaching ─ 20 minutesAsk each Leader Mother to share the teachings she has learned with the person sitting next to her. She will use the first two flipchart pages of today’s lesson. Each Leader Mother will teach the person next to them in the same way that the promoter taught her. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the third and fourth pages of the lesson.The Promoter watches, corrects, and helps Leader Mothers who are having trouble.When everyone is finished, answer any questions that the Leader Mothers have about today’s lesson.11. Request Commitments ─ 10 minutesBased on today’s teachings, what commitment will you make? Ask each mother to say aloud a new commitment that she will make today. For example: I will feed by 1 year old child five times each day. I will purchase iodized salt this week to add to our family foods.I will offer dark green, red and orange foods to my child each day.What was your commitment at the last lesson? Have you kept that commitment? How? What did you do?Lessons 1-4 Pre and PosttestTwo questions from each lesson are listed below. Before and after teaching the materials to staff and trainers, give the posttest to evaluate their comprehension. For those who score 75% or less (must have at least 9 correct answers), give them more training to help them understand the information. Trainers should not teach others until they are able to score 75% or better.1. How many months should a mother wait after delivery before she begins a new pregnancy? _________2. Achol follows the two day method. She wants to avoid new pregnancy. Which days can Achol have sex without becoming pregnant?_______________________________________________________ 3. At what age should a mother offer the first porridge to infants? A) At birth if the woman does not have enough breast milkB) When the child is 3 months of ageC) When the child is 6 months of ageD) When the child is 9 months of age4. How much food should be offered to a 7 month old child each day after breastfeeding?A) Offer 1 full cup (small metal cup or 17 tablespoons) once a day.B) Offer ? of the small metal cup (8 spoonfuls) twice a day.C) Offer ? of the small metal cup (8 spoonfuls) four times a day.D) Offer 3-6 spoonfuls three times a day.5. True of False. A mother should always breastfeed before offering foods to children from 6 months to one year of age. 6. Name three snacks that can be given to children when the mother is in the field (AWAY from the cooking fire).1)2)3)7. How much food should be offered to a 1 year old child each day before breastfeeding?A) Offer 3-6 spoonfuls (1/3 cup) five times a day.B) Offer up to one full cup (17 tablespoons) five times a day.C) Offer ? cup (8 tablespoons) three times a day.D) Offer up to one full cup (17 tablespoons) three times a day.8. Which of the following foods should be given to a one year old child? Circle each correct answer. More than one answer may be correct. A) Foods to build strong blood (meat, cowpeas, simsim, shisha and pumpkin leaves) B) Foods to build strong muscles and bones (meat, fish, beans, eggs, and groundnut paste), C) Foods that contain a sprinkle of iodized salt to build a healthy mind.D) Foods that contain vitamin A (pumpkin, dark green leaves, mango, papaya and tomato).Lessons 1-4 Pre and Posttest ANSWERS1. How many months should a mother wait after delivery before she begins a new pregnancy? _24 months or 2 years2. Achol follows the two day method. She wants to avoid new pregnancy. Which days can Achol have sex without becoming pregnant?Any one of the following answers is correct.When she has no secretions today or yesterday.Days when she is having her monthly bleeding. 3. At what age should a mother offer the first porridge to infants? C) When the child is 6 months of age4. How much food should be offered to a 7 month old child each day after breastfeeding?D) Offer 3-6 spoonfuls three times a day.5. True A mother should always breastfeed before offering foods to children from 6 months to one year of age. 6. Name four snacks that can be given to children when the mother is in the field (AWAY from the cooking fire).Any four of the following answers are correct as well (as any other local foods discussed during the lesson which are not listed here).TomatoCucumberMangoWatermelonPapayaBananaBoiled eggBoiled or fried pumpkin Pounded groundnutBiscuitsChips (fried potato, fried yam, etc)7. How much food should be offered to a 1 year old child each day before breastfeeding?B) Offer up to one full cup (17 tablespoons) five times a day.8. Which of the following foods should be given to a one year old child? ALL of the FOLLOWING ANSWERS ARE CORRECT and should be CIRCLED. A) Foods to build strong blood (meat, cowpeas, simsim, shisha and pumpkin leaves) B) Foods to build strong muscles and bones (meat, fish, beans, eggs, and groundnut paste), C) Foods that contain a sprinkle of iodized salt to build a healthy mind.D) Foods that contain vitamin A (pumpkin, dark green leaves, mango, papaya and tomato). ................
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