Overview
DIARRHOEA
Diarrhoea and dehydration cause 2 million, largely unnecessary deaths each year. By the simple use of home-based Oral Re-hydration Solution (ORS) most of these deaths could be prevented.
In preparing a programme with the community decide which forms of ORS are most appropriate for the area, and which containers and measuring devices most suitable. Any method used must be acceptable to the community and follow national guidelines.
All community members should learn how to make and prepare ORS and be able to feed it to those with diarrhoea. Repeated and imaginative teaching methods are needed to raise community awareness and change incorrect beliefs. Unnecessary medicines should always be avoided, but zinc supplements help in diarrhoea and antibiotics are useful in dysentery (bloody diarrhoea). As well as treating dehydration, we must teach methods to prevent diarrhoea. Usually these will include developing cleaner water sources, improving sanitation and careful hand washing of both adults and children.
The programme should be evaluated after an agreed length of time, to make sure ORS is actually being used in practice.
PNEUMONIA
Acute respiratory infection (ARI), usually in the form of pneumonia, kills 2 million children each year. Nearly all these deaths can be prevented at community level, if simple guidelines are followed. These indicate which children need antibiotics and suggest ways in which they are immediately available when needed.
The Community Health Worker (CHW) plays a key role in this process. She teaches the community how to prevent ARI, working with them in reducing risk factors. She keeps and uses antibiotics according to simple guidelines. She knows when and how to refer children who are seriously ill.
MALARIA
Malaria is one of the three main causes of death in children and is found in over 100 countries. It is best prevented by destroying breeding sites, killing adult mosquitoes and preventing mosquitoes from biting. Community-wide control measures use a variety of methods suitable for each particular situation. Project, community and government must work in close partnership. The use of insecticide-treated bed nets, especially those that are long-lasting are a vital part of control.
CHWs and health clinics need to work in unison to develop effective ways of recognising and treating malaria, especially amongst children under five and pregnant women. Mild cases can be treated by CHWs in the community, or by mothers at home; severe cases must be recognised promptly, treated and referred without delay. We should follow national programme guidelines, or those from the IMCI (see ‘Guidelines and Good Practice’) ideally using drugs currently recommended in the country we are working in.
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Excerpt from setting up community Health programmes by Ted Lankester
In areas where malaria is common and family members are familiar with symptoms, they can become the main providers of antimalarial treatment. For example: in Nigeria and Mali mothers have been shown to manage almost three quarters of their children’s cases of malaria with home-based treatment.
Where malaria is common we need to ensure that correct treatment is available at least within 24 hours of symptoms starting and preferably earlier. Home-based care is one obvious answer.
In practice CHWs can train mothers, other family members and care givers how to recognize and treat malaria. Family members will do this most safely if they are included in the health programme and obtain supplies from the programme or other trusted suppliers, rather than from unregulated private practitioners.
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