INTEGRATED NUTRITION TRAINING SYLLABUS FOR

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSSESSIONSINTRODUCTIONS, OBJECTIVES, EXPECTATIONSTime: 1 hour and 15 minutesMaterials: Flipchart 1, flipchart and markersIntroductionsParticipants introduce themselves or pair by sharing: Name Village Community role Experience helping children in their villageObjectivesShow the training objectives on Flipchart 1.Flipchart 1:Training Objectives Explain the aim and activities of BFCI for the first 1,000 days in light of roles of communityagents Explain key information on nutrition in pregnancy, breastfeeding, complementary feeding Explain a cooking demonstration of nutritious family foods Demonstrate correct weighing of children and recording the weight (selected locations) Demonstrate home visit activities and reporting forms Demonstrate interpersonal communication based on age and monthly monitoring of child(observation or weight gain)Expectations and Ground Rules Ask participants to share expectations for the training. Write on a flipchart paper and linkto the objectives.Brainstorm with participants on the ground rules for the workshop. Rules should includepunctuality, active participation, respect, flexibility, etc. Write these ground rules on a flip chartand hang the list of rules in a visible place.PRETESTTime: 15 minutesMaterials: Knowledge evaluation questionnaire handout, pensAdminister the pretest to each participant (without names) [Annex 2]. Calculate the score[using Annex 3].SESSIONS6

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSSTUNTING PREVENTIONTime: 45 minutesMaterials: Flipchart 2, flipchart and markersExplain the first 1,000 days: 280 days for pregnancy 720 days for children until age 2.Show a picture of pregnant woman. Ask participants, “What do you think this mother expectsfrom her pregnancy? What should she do to achieve desirable outcome?After responses, Ask participants, “Is there a role for others to help the mother and family achievethe best for the child?”Summarize responses. Then add: This mother hopes that her baby will be born healthy and willgrow and develop healthy and strong. To help ensure that this happens, the mother will need totake certain actions from the time of conception – and even before - through childhood. Stuntingprevention is related to all actions that have to be taken to ensure adequate growth and healthof a child.Show Flipchart 2: Stunting presentation with no wordsStunting is when a child’s height is less than what is considered normal for his/her age (short forage). In Cambodia, one in three (32%) children are stunted. Among the poorest families, nearlyhalf (42%) are stunted. That means their body and brain has failed to develop properly becauseof malnutrition.NORMAL WEIGHT GAIN OF CHILDREN EVERY MONTHBirth - 2 months 800 g3 months - 4 months 600 g5 months - 6 months 400 g7 months - 2 years 200 gWhen many children are stunted in a village, it may not be noticeable. However, there are veryserious consequences. Children who are stunted have higher risk of death and illness duringchildhood, lower brain development, and lower school achievement. These lead to higher healthcare costs to the family and community, and lower earning potential as an adult. Stunted growthcan be passed on from one generation (mother-child) to the next creating a continuous cycle ofchronic malnutrition. Stunted girls who grow up have higher risk of obstructed labor duringpregnancy and low birthweight babies.There are three causes of stunting:1. Poor nutrition in the woman before and during pregnancy2. Poor consumption of nutrients by children due to poor diet or inadequate feedingpractices3. Poor use of nutrients by the child’s body due to poor hygiene or illnessHowever, we can prevent stunting. Prevention is only possible in the first 1,000 days of life. Thisis a “golden opportunity”.SESSIONS7

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSIf a child falls behind in height growth during these first 1,000 days, and has not caught up withthe standard by their second birthday, stunting usually persists for the rest of the child’s life.Preventing stunting by ensuring a mother’s optimal health and nutrition in pregnancy, and a child’soptimal health and nutrition during their first two years through health, WASH and agricultureinterventions, protect the child for a lifetime.To verify learning, ask participants to explain using their own words, “How could stunting inchildren affect families and the whole village?”Summarize participants’ responses. Then add: For these reasons, it is important that ALL children inthe village grow up healthy and strong, especially in the first 1,000 days from pregnancy to age two.ROLESTime: 1 hourMaterials: Flipchart 3, flipchart and markersStep 1:Explain that we all have an important role to play. For example, Village Chiefs mobilize community members to support children’s growth, using realinformation about the children in the village. Health workers support you as a community volunteer to provide quality services. Community agents ensure pregnant women get good nutritional care, monitor every childunder two every month and take actions to ensure that growth is adequate.Step 2:The Baby-Friendly Community Initiative is an initiative of the National Nutrition Program of theMinistry of Health. It is also called BFCI. NOURISH is helping the Ministry of Health to implementsits BFCI in three provinces.BFCI aims to engage volunteers in each community to promote early attachment to breast,exclusive breastfeeding for the first 6 months, and appropriate complementary feeding of youngchildren introduced at 6 months.This training is on BFCI for the first 1,000 days. As such, it brings together BFCI for child feedingas well as content on nutrition in pregnancy, water, sanitation and hygiene issues and agriculturetopics. In this way, you, as volunteers, can establish a baby-friendly community that addressesthe full set of issues that influence nutrition and healthy child growth. NOURISH will supportcommunity agents with new skills and tools.Step 3:Ask participants, “From your perspective, what is the role that community agents can play tosupport BFCI?”Post Flipchart 3. Lead a discussion on the expected roles.SESSIONS8

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSFlipchart 3COMMUNITY AGENTS/ BFCI VOLUNTEER ROLESRecord keeping: Collect and maintain a household register of pregnant women and children under 5Monthly monitoring, interpersonal communication and referral: Invite all caregivers of children under 2 to a fixed site for monitoring every month Provide interpersonal communication specific to the child’s age and weight gain Refer severely malnourished children to hospitals; and follow up on referrals made Provide information on children’s growth to Village Chiefs every month Routinely re-connect with health centersHome visits: Conduct home visits for:-Pregnant women – 2 times-Children 9-11 months – 2 times per month-Children who do not attend the monthly monitoring-Children who are not growing well-- 0-5 months once per week-- 6-23 months twice per monthChildren not growing well: no weight gain this month weight loss this month not in the adequate weight range for 2 months treated for malnutrition at a referral hospital and returned homeAsk participants, “From your perspective, what characteristics are needed in community agents?”PREGNANCY CARE AND DIETTime: 1 hourMaterials: IYCF Flipchart, HARVEST Nutrition and Pregnancy PosterStep 1: 10 minutesLead a discussion with the following questions: What have you done to help women before and during pregnancy eat healthy? What foods, and how much food, do women usually eat now before and duringpregnancy? What challenges do women have to have a healthy diet before and during pregnancy?Step 2: 10 minutesSESSIONS9

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSPresent IYCF Flipchart information on nutrition in pregnancy.HIGHLIGHT: It is important for pregnant women to gain enough weight during pregnancy tohave a healthy baby. Women too thin before pregnancy should gain 12-18 kg during pregnancy.Women who had a good weight before pregnancy should gain 11-16 kg during pregnancy.10Step 3: 15 minutesAsk participants to work in groups to read the related IYCF BFCI Flipchart cards on nutrition inpregnancy.Step 4: 10 minutesRead the following situations. Ask participants to name the correct card to use for each situation.The first person (or small group) to name the correct card wins the round.1. Srey is 2 months pregnant and often nauseous. Her family recommends local wine withherbs.Answer: Card 12. Tola’s wife is two months pregnant. She is not eating extra food although she is pregnantbecause she wants to have a small baby for an easier delivery. Tola thinks it is up to her,so says nothing.Answer: Cards 1 and 23. Pech is six months pregnant. She eats an extra potato every day for her baby, but still didnot gain weight for two months.Answer: Card 1Step 5: 15 minutesLet participants share experiences, and questions and answers. Conclude by explaining thatwomen need to take good care of themselves during pregnancy.Everyone in the family should assist and make a warm, caring environment. This includes: Go to the health center at least 4 times, starting as soon as she knows she is pregnant. Gain enough weight during pregnancy. Eat extra food such as 2 extra roasted sweet potatoes and eggs each day. The baby needsthis extra nutrition to be healthy. Avoid drinking alcohol and smoking during pregnancy. Reduce heavy work, and rest more.10Cambodia Fast Track Road Map for Improving Nutrition 2014-2020, launched on May 30, 2014 by the Health Minister HE.Mam Bunheng.SESSIONS10

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSBREASTFEEDINGTime: 1 hourMaterials: BFCI IYCF Flipchart, knitted breasts and doll (if available)Step 1: 10 minutesLead a discussion with the following questions: What experiences have you had promoting breastfeeding, from the first hour after birth? What experiences have you had promoting exclusive breastfeeding for the first sixmonths? What challenges do they have with exclusive breastfeeding?Step 2: 10 minutesPresent IYCF Flipchart information on early attachment to breast and on exclusivebreastfeeding.HIGHLIGHT: It is very important for mothers to empty both breasts when breastfeeding. Itis only this way that the body makes more milk. As babies get older, they become more efficient,so they may take about 5-10 minutes on each side, whereas newborns may feed for up to 20minutes on each breast.Step 3: 15 minutesAsk participants to work in groups to read the related IYCF Flipchart cards on breastfeeding.Step 4: 10 minutesRead the following situations. Ask participants to name the correct card to use for eachsituation. The first person (or small group) to name the correct card wins the round.1. Pov has a two-week-old baby. She fears she does not have enough milk to breastfeed.Answer: Card 72. Pech has a three-month-old baby. She fears she does not have enough milk tobreastfeed. You notice that she feeds only a few minutes each time.Answer: Card 63. On has a four-month-old baby. She needs to return to work in the field soon.Answer: Card 8Step 5: 15 minutesLet participants share experiences, and questions and answers.SESSIONS11

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSCOMPLEMENTARY CHILD FEEDINGTime: 1 hourMaterials: BFCI IYCF Flipchart, bowl, spoonStep 1: 10 minutesLead a discussion with the following questions: What experiences have you had promoting complementary feeding for children 6-8 months? What experiences have you had promoting complementary feeding for children 9-23 months? What do families usually do now related to complementary feeding? What challenges do they have with complementary feeding?Step 2: 10 minutesPresent IYCF Flipchart information on complementary feeding. Use the bowl and spoon to showparticipants quantity by age.Step 3: 15 minutesAsk participants to work in groups to read the related BFCI IYCF Flipchart cards.Step 4: 10 minutesRead the following situations. Ask participants to name the correct card to use for each situation.The first person (or small group) to name the correct card wins the round.1. Phalla has a seven-month-old baby. She feeds the baby plain borbor because he eats it.Her neighbor recommended adding other soft foods, but she does not know which foodsto add.Answer: Card 142. Tola has a nine-month-old baby. When breastfeeding, his daughter grew well. Recentlyshe is not gaining weight. His family says she cannot eat anything except borbor. But hesaw the neighbor with a child the same age feeding small fish and eggs.Answer: Card 133. Chamnang has a 10-month-old baby. He thinks that feeding the baby is his wife’sresponsibility only, but he can see that she is so busy.Answer: Card 244. Sopha has an 11-month-old baby. She prepares a full bowl for the baby each meal butthe baby finishes only a few bites. She is very busy so does not have time to wait longer.Answer: Card 13Step 5: 15 minutesLet participants share experiences, and questions.Close by explaining that children’s growth is a sign of their health. They need to grow everymonth. Children grow best with breastmilk and, from the age of 6 months, food. Start at 6SESSIONS12

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSmonths with small amounts of food and increase the amount and number of meals as the childgets older.Age6 months7-8 months9-11 months12-23 monthsBreastfeedingContinueThick Meals/ day6 TablespoonsContinue breastfeeding3 bowls – ½ full 10 minutes at a time each timeContinue 10 minutes at a time each timeContinue3 bowls – 2/3full3 bowls – fullHealthy Snacks/ dayPackagedSnacks01 02 0Children can digest – and need – vegetables and animal foods such as fish, eggs, frogs or insects– every day. Before the age of eight months, these foods can be cooked in borbor. After 8months, children can eat these foods soft.How children are fed is also very important. “Responsive feeding” is the most effective way. Thismeans to feed slowly and patiently, encourage them to eat, talk to the child and maintain eyecontact. Respond to their verbal and non-verbal cues.During illness and for the week after illness, increase fluid intake including more breastfeeding,and food. Offer soft, favorite foods.CLOSINGTime: 15 minutesMaterials: noneAsk participants to reflect on what they learned and how they will use the knowledge.Close by sharing this quote by Alvin Toffler:“The illiterate of the 21st century will not be those who cannot read and write, butthose who cannot learn, unlearn, and relearn.”SESSIONS13

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSDAY :00Reflection on Day 1Cooking DemonstrationAgriculture: micro-gardensLunchAgriculture continuedBreakWASH-nutritionClosingOperational District TrainerOD/ Health Center TrainerAgriculture expertAgriculture expertWASH expertNOURISHSPECIFIC LEARNING OUTCOMES Demonstrate cooking nutritious food for young children using local foodsExplain how to raise a micro-gardenExplain the links between nutrition and WASHDefine and demonstrate proper handwashing techniquesMATERIALS NEEDEDStationary:Flipchart paperMarkersHARVEST posters: handwashing, home hygieneStepping stones card gameTeaching aids:Utensils and local foods for cooking demonstration (provided by participants)Handwashing station, soapGlitter or chalkPictures of times to wash handsWater filterMicro-garden supplies: sack, soil, seedsSESSIONS14

NOURISH PROJECTINTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTSSESSIONSREFLECTION ON DAY 1Time: 30 minutesMaterials: noneAsk participants to discuss: What did you learn yesterday? What is the importance of the knowledge and skills? What can we do with this new knowledge and skills?COOKING DEMONSTRATI

NOURISH PROJECT INTEGRATED NUTRITION TRAINING FOR COMMUNITY AGENTS SESSIONS 7 STUNTING PREVENTION Time: 45 minutes Materials: Flipchart 2, flipchart and markers Explain the first 1,000 days: 280 days for pregnancy 720 days for children until age 2. Show a picture of pregnant woman.