Icatt Imci: Based Training

ICATT BASED IMCI TRAINING
TRAINING AID:
COORDINATE ROLE PLAYS
ICATT based IMCI training: Training aid
NOTE FOR ADAPTATION/TRANSLATION

The role plays in this document are those included into the Facilitator guide of WHO
generic 11 day course adapted according to IMCI guidelines used in ICATT 2008 version 1.
For this reason it is not necessary to adapt/translate this text - you can use your national
materials.
Role plays included in the generic ICATT Facilitator guide are marked with an asterisk (*)
Placement in WHO generic

Facilitator guide for 11 day
Activity
IMCI training course
(page in version 1997)
Demonstration role play: Teaching a mother to give oral Treat the child Procedure No.9,
drugs at home using good communication skills, Gert p. E-32
*Role play: Teaching a mother to give oral drugs - Treat the child Procedure No.11,
Dasar p. E-38
Role play: Teaching a mother to care for a dehydrated Treat the child Procedure No.20,
child – Lura p. E-73
Role play: Assessing feeding – Zuwena Counsel, Procedure No 5, p.F-11
Demonstration role play: Giving feeding advice using
Counsel, Procedure No.8, p.F-19
good communication skills – Akono
Role plays: Giving feeding advice using good
Counsel, Procedure No.9, p.F-22
communication skills – Sudi and Javas
Demonstration role play: Giving advice on fluid and Counsel, Procedure No.11, p.F-
when to return using good communication skills - Akono. 25
*Role play: Using good communication skills and the Counsel, Procedure No.12, p.F-
entire COUNSEL chart and Mother's card – Felice 28
2
Coordinate role plays
CONTENTS
Facilitator technique: Coordinating a role play........................................................................................... 3
Demonstration role play: Teaching a mother to give oral drugs at home using good
communication skills............................................................................................................................................... 4
Role play: Teaching a mother to give oral drugs - Dasar.........................................................................8
Role play: Teaching a mother to care for a dehydrated child - Lura.................................................10
Role play: Assessing feeding - Zuwena......................................................................................................... 13
Demonstration role play: Giving feeding advice using good communication skills...................16
Role plays: Giving feeding advice using good communication skills – Sudi and Javas..............19
Role play: Giving advice on fluid and when to return using good communication skills -
Akono.......................................................................................................................................................................... 24
Role play: Using good communication skills and the entire COUNSEL chart and Mother's card
- Felice......................................................................................................................................................................... 27
3
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FACILITATOR TECHNIQUE: COORDINATING A ROLE PLAY

 Before the role play, refer to the appropriate notes in this guide to remind yourself of
the purpose of the role play, roles to be assigned, background information, and major
points to make in the group discussion afterwards.
 Assign roles. At first, select individuals who are outgoing rather than shy, perhaps
by asking for volunteers. If necessary, a facilitator may be a model for the group by
acting in an early role play.
 Give role play participants any props needed, for example, a baby doll, and drugs.
 Give role play participants any background information needed (See in this Aid).
 Suggest that role play participants speak loudly.
 Allow preparation time for role play participants.
 When everyone is ready, arrange seating/placement of individuals involved. Have

the "mother" and "Health worker" stand or sit apart from the rest of the group, where
everyone can see them.
 Begin by introducing the players in their roles and stating the purpose or situation.
For example, you may need to describe the age of the child, assessment results, and
any treatment already given.
 Interrupt if the players are having tremendous difficulty or have strayed from the
purpose of the role play.
 When the role play is finished, thank the players. Ensure that feedback offered by
the rest of the group is supportive. First discuss things done well. Then discuss
things that could be improved.
 Try to get all group members involved in discussion after the role play. There are
questions given in this Aid to help structure the discussion.
 Ask participants to summarize what they learned from the role play.
SELECT ROLE PLAYS FOR YOUR TRAINING ACCORDING TO THE SITUATION.

The most important role plays that should not be omitted are
 Teaching a mother to give oral drugs - Dasar
 Using good communication skills and the entire COUNSEL chart and Mother's card
– Felice
5
DEMONSTRATION ROLE PLAY: TEACHING A MOTHER TO GIVE ORAL DRUGS AT HOME

USING GOOD COMMUNICATION SKILLS
Purpose: To demonstrate good communication skills and show the steps of teaching a
mother to give oral drugs to a sick child.
Highlights of the case: A Health worker has decided that a young girl named Gert needs the
antibiotic cotrimoxazole. The Health worker must now teach Gert's mother how
to give the drug to the child.
Gather the following supplies. Put them on a table in front of the participants.
* TREAT chart or chart booklet opened to the box titled,
"Give an Appropriate Oral Antibiotic"
* Doll or other "baby"
* Bottle of cotrimoxazole tablets
* Drug envelope with label
* Pen
* Cup and spoon
* Small amount of milk
The role play script is on the following pages.
Read the role of the Health worker. Ask a co-facilitator or a participant to read the role of
the mother. You will need an extra copy of the script for the person who plays the role of
mother (you may use the one in your facilitator's guide). Practice the demonstration at least
once before performing in front of the group.
Introduce the role play by telling the participants that you are going to demonstrate teaching
a mother to give an oral drug at home. Ask participants to observe the demonstration and to
look for:
* the steps to follow when giving oral drugs to the mother of a sick child, and
* whether good communication skills were used while teaching the mother to give the
drugs at home.
After the demonstration, lead a group discussion. Ask participants to read the general steps
listed in the upper left of the TREAT chart in the box titled, "Teach the Mother to Give Oral
Drugs at Home." Point out that these steps were followed in the demonstration.
Ask a participant to list the basic teaching steps that they read about in the training unit
Teach the mother to give treatment at home, Key information, page 2 and 3. Their list
should include:
6
 giving information,
 showing the mother an example (by demonstrating how to measure a dose),
 letting the mother practice, and
 checking the mother's understanding.
A Health worker should ask good checking questions and then praise the mother when she
answers a checking question correctly.
SCRIPT FOR DEMONSTRATION ROLE PLAY

Health worker: Now I am going to teach you how to give this drug to Gert. This is
cotrimoxazole which is an antibiotic. She needs to take this drug to
treat her pneumonia. Are you the person who will give the drug to
Gert?
Mother: Yes, I am.
Health worker: Good. I will show you how much to give her. Since Gert is a baby, 9
months old, she needs to take just one-half of one of these tablets at a
time.
(Holds up one cotrimoxazole tablet.)
You will have to break the tablet in half, like this (breaks tablet in
fingers) or you can cut it in half with a knife. (Holds up half tablet.)
This half is one dose. Now you try it. (Hands a tablet to the mother.)
Mother: Yes, I will try. (Mother struggles a bit but breaks the tablet in half.)
Health worker: Good, you did it. Now, how much is one dose for Gert?
Mother: (Mother holds up the half tablet.) This much.
Health worker: That's correct. Now you are going to give the tablet to Gert. Have
you ever given tablets to Gert before?
Mother: No. I have only given her liquid medicines.
Health worker: Ah. Liquid medicines are easier to give to a baby. To give a tablet,
you will have to make it so the baby can swallow it. You should
crush it or grind it until it is in very small pieces, and then mix it with
a little milk or food. Here is a cup and spoon for you to use. (Hands
mother a cup and spoon) Put the dose into the cup and.....
Mother: Do that now?
Health worker: Yes, now. I would like you to prepare a dose and give it to Gert now.
(Mother nods.) Put the half tablet into the cup and crush it with the
spoon.
7
(Mother begins crushing the tablet. Health worker watches her and
looks into the cup to see when it is crushed.)
That's correct. Now add a little of this milk and mix it in. At home,
you could use a little bit of Gert's cereal, or some mashed banana,
instead of milk.
Mother: (Mother mixes milk into the crushed tablet.) Gert likes banana.
Health worker: Good, then you might want to try that. OK, that looks ready. Now,
with the spoon, try to put the medicine into Gert's mouth.
Mother: I'll try. (She spoons it into the baby's mouth.) She doesn't like it.
What should I do?
Health worker: You are doing fine. See, she is swallowing it now. At home, try
mixing it with banana.
Mother: I will.
Health worker: You need to give a dose to Gert two times each day, once in the
morning, such as at breakfast, and again at dinner. I am giving you
enough tablets for 5 days.
(Health worker writes the instructions on the envelope and then puts 5
tablets into the envelope. He closes the envelope and the jar of
cotrimoxazole. He hands the envelope to the mother so that she can
see the instructions.)
Mother: Thank you.
Health worker: I have written the instructions on the envelope to remind you when to
give the medicine. Would you read me the instructions on the
envelope?
Mother: (Looking at envelope) What is this picture?
Health worker: That is a picture of the sun rising. The round sun represents midday,
the next picture is sunset....
Mother: Yes, of course. I see now. (Mother tries unsuccessfully to read the
instructions on the envelope.)
Health worker: (Reads the instructions on the envelope to the mother.) Who can help
you read the envelope?
Mother: My sister can read. She lives with us.
Health worker: Good. I want to tell you another important thing -- continue giving
Gert the medicine in this envelope until it is all gone. Even if she
seems to be better, she needs to take all the tablets to be sure that she
will get well and stay well.
Mother: I can do that.
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Health worker: Good. And how much will you give Gert each time?
Mother: I will give her one-half tablet.
Health worker: Correct. And how will you prepare it?
Mother: I will crush it with a little milk or banana.
Health worker: Good. Can you tell me how many times each day you will give Gert
a dose of the medicine?
Mother: I will give the medicine at sunrise and at sunset.
Health worker: That's correct. Twice each day. I want you to bring Gert back to see
me in 2 days, so that I can be sure she is getting better.
Mother: When is that?
Health worker: The day after tomorrow, ____________________. Will you, or
someone else in your family, be able to bring Gert back?
Mother: Yes, I can bring Gert back on ______________________.
Health worker: Good, I will expect you then.
Mother: (Gathering up her things and Gert and leaving ) Thank you.
Health worker: Good bye.
9
ROLE PLAY: TEACHING A MOTHER TO GIVE ORAL DRUGS - DASAR
Purpose: To PRACTISE teaching mothers to give oral drugs at home.
Highlights of the case: A Health worker has decided that a baby named Dasar needs 2 different
drugs, co-artemether and iron. The iron is in syrup form. The Health worker will
need to teach the mother how to give Dasar the drugs at home.
Select two participants to play the roles of the Health worker and mother. Explain the roles and give
the participants time to prepare.
Explain to the participant who will be the Health worker how to adjust teaspoon amounts when using
a spoon that mothers will likely use at home (One teaspoonful usually equals to 5 ml). Tell the
participant to be sure to explain a dose in such a way that the mother can measure the dose herself.
Also tell the participant that he should measure and give the mother enough of tablets and syrup for
the full course of therapy, that is, co-artemether 5 doses and iron for 14 days.
Tell the participant who will be the mother to listen carefully to the instructions that the Health
worker gives her. Ask questions if she does not understand the instructions. Answer any questions
she is asked by the Health worker. Encourage her to act like a normal, concerned mother. Suggest
that the mother be confused about the schedule, the dose, or be concerned about giving more than
one oral drug at a time.
Gather all of the following supplies.
* TREAT chart or chart booklet opened to the page titled,

"Teach the mother to give oral drugs at home"
* Drug labels and a pen
* Co-artemether tablets
* Iron syrup (or tablets, if there is no syrup at your clinic)
* Common spoon for measuring syrup
* Small bottles (or drug envelopes) for mother to take drugs home
Introduce the role play by telling participants that the Health worker will follow the steps for
teaching a mother how to give oral drugs at home. This role play will not include assessing or
classifying Dasar, which has already been done. Distribute copies of the handout on the next page.
Introduce the mother and the Health worker. Read aloud the situation from the handout. Remind the
observers to think about the questions listed in the handout as they watch. Ask the players to begin
the role play.
When the role play is finished, thank the participants. Then begin a discussion of the questions listed
in the handout. Also ask the participants to mention the different or additional steps that a Health
worker should do when more than one drug is given.
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Handout for observers
Role play: Teaching a mother to give oral drugs - Dasar
SCENARIO
Dasar is an 8-month-old (5 kg) boy. His mother brought him to the clinic because he has
fever. The fever has been present for 4 days.
A Health worker finds that Dasar has no general danger signs, no cough, no diarrhoea and
no ear problem. He has a fever of 38'C, with no stiff neck and no measles. He is very low
weight for age and has some palmar pallor. The Health worker classifies Dasar as
MALARIA, and ANAEMIA. To treat the MALARIA, the Health worker decides to give co-
artemether. He notes that Dasar should be given one tablet in clinic, 1 tablet after 8 hours, 1
tablet two times daily for the next two days.
To treat ANAEMIA the Health worker notes that Dasar needs 1/4 tsp of iron syrup. The
Health worker asks the mother whether Dasar has sickle cell anaemia. She says "No."
OBSERVERS:
Watch the role play. Do not interfere. Read the following questions and answer them as
you watch.
a. Does the Health worker give information to the mother about why the oral drugs are
important, and how/when to give them?
b. Does the Health worker show the mother examples of how to measure a dose of each
drug?
c. Does the Health worker observe the mother:

practise measuring a dose of each drug, and
practise giving the drug to her child?
d. Does the Health worker correctly label and package the drugs?
e. Does the Health worker tell the mother when to return immediately?
Does the Health worker tell her when to return for follow-up care?
f. Does the Health worker check the mother's understanding?
g What checking questions does the Health worker ask? What other checking
questions would you ask?
When everyone is ready, there will be a group discussion.
11
ROLE PLAY: TEACHING A MOTHER TO CARE FOR A DEHYDRATED CHILD - LURA
Purpose: To practise talking with mothers about treatment of diarrhoea.
Highlights of the case:
Part 1 - A Health worker has decided that a baby named Lura has diarrhoea with SOME
DEHYDRATION and should be treated with ORS solution on Plan B. In the role play, the
Health worker will instruct the mother how to give the ORS to the child.
Part 2 - Lura's dehydration has improved and she is ready for Plan A. In the role play, the
Health worker will teach the mother Plan A.
Preparations:
Gather the following supplies:
* The TREAT chart or chart booklet opened to diarrhoea treatment Plans A and
B
* ORS solution, already mixed (for Part 1)
* Cup and spoon
Write the highlights of the case on a flipchart.
Select two participants to play the roles of a mother and a Health worker in Part 1. Select
two other participants to play these roles in Part 2. This will give more participants a chance
to practise. Explain the roles and give the participants time to prepare.
Take the participants aside who will be the mothers. Encourage them to act like normal,
concerned mothers. Suggest that the mother could ask for some medicine to stop the
diarrhoea. Or, she could become alarmed when Lura vomits some of the solution.
Give the “mothers” and “Health workers” following instructions:
HEALTH WORKER – Part 1:

To start the role play, tell the mother that Lura needs treatment with ORS. Ask the mother
to stay at the clinic to give Lura ORS solution. Then follow Plan B to get the mother started
giving ORS solution. Show the mother how much ORS to give. Show her how to give it.
Answer her questions and help with any problems.
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HEALTH WORKER – Part 2

Teach the mother Plan A. Give her ORS packets and zinc supplements to take home. Ask
her checking questions to be sure she remembers and understands the 4 rules of home
treatment.
MOTHER:
Listen to the Health worker and try to do what he says. Ask questions about anything that is
not clear. After you have given ORS solution for a few minutes, tell the Health worker that
Lura just vomited the solution.
To conduct Part 1:
Tell the participants that a Health worker will practise talking with a mother about treatment
of diarrhoea. Tell them to look at treatment plans, observe the role play, and notice what the
Health worker explains well and what could be done better.
Read aloud what happened so far:

A young mother brought 2-year-old Lura to the clinic because she has had diarrhoea
for 1½ days. The Health worker found no general danger signs. There was no blood
in the stool. Lura was irritable. Her eyes looked sunken. When pinched, the skin of
Lura's abdomen went back immediately. She drank eagerly. She had no other
problems. The Health worker classified Lura as SOME DEHYDRATION. She has
no other disease classifications and NOT VERY LOW WEIGHT and NO
ANAEMIA. The Health worker selected Plan B treatment with ORS solution.
Remind the group that the role play will not include assessing or classifying Lura, which has
already been done. Remind the observers to refer to the appropriate diarrhoea treatment
plan and to note how the Health worker communicates with the mother.
Introduce the mother and the Health worker. Then ask the players to begin Part 1 of the role
play.
When Part 1 is finished and the mother is successfully giving ORS solution, thank the
players. Then stop the role play and lead a discussion. Ask the observers to comment on the
following:
What did the Health worker do well?
 Did the Health worker leave out anything important?
 Be sure to comment on:

o if the Health worker told the mother the amount of ORS to give in the next 4
hours,
o if the Health worker said to give the ORS slowly, and
o if he showed her how to give the fluid with a spoon.
 How were the 3 basic teaching steps (information, example, practice) demonstrated?
 How did the Health worker check the mother's understanding?
13
To conduct Part 2:
After the discussion, tell participants that 4 hours has passed. The Health worker reassessed
Lura after 4 hours. She had NO DEHYDRATION. Her diarrhoea continued, but the Health
worker thought that she was ready to go home on Plan A. The mother has already been
taught how to mix ORS. In this part of the role play, the Health worker will teach the
mother Plan A, but does not need to mix ORS. Remind observers to refer to Plan A and to
note the communication skills that the Health worker uses.
Introduce the other two players, Lura's mother and the Health worker. Ask them to begin
Part 2 of the role play.
When Part 2 is finished, thank the players. Lead a discussion of the role play. Ask the
observers to comment on the following:
 What did the Health worker do well?
 Did the Health worker leave out anything important?
 Be sure to comment on:

o if the Health worker told the mother the amount of fluid to give and when to
give it,
o if the Health worker said to continue giving normal fluids,
o if he told her to give extra fluid until the diarrhoea stops,
o if he discussed continued feeding, and
o if he discussed when to return immediately.
 How were the 3 basic teaching steps (information, example, practice) demonstrated?
 How did the Health worker check the mother's understanding?
14
ROLE PLAY: ASSESSING FEEDING - ZUWENA
Counselling steps covered in this role play

(Do not read this to the participants beforehand, but ensure that the points are covered in
discussion afterwards.)
 asking questions to assess feeding

 identifying correct feeding and feeding problems
Highlights of case: Breast milk is being reduced too quickly as complementary food is
added. Feeding has changed during illness (sugar water added).
Plan to assign every participant a role in one of the role-plays in this module. If a participant
does not play a role in this exercise, be sure that he or she is assigned a role in a later role
play.
Assign the role of Health worker to a participant who seems confident and understands the
course materials well. Explain that the "Health worker" will use the questions on the Sick
Child Recording Form to identify feeding problems. Explain that the Health worker may
need to ask additional questions if the mother's answers are unclear or incomplete.
Remind the Health worker that he is not giving advice in this role-play but simply
identifying the feeding problems and correct feeding practices.
Assign the role of the mother in the role-play to a different participant. (If there are not
enough women, men can play the roles of mothers.) Give the "mother" the box on the next
page describing her child's feeding. This box may be copied or cut out. Tell the mother that
she may make up additional realistic information that fits the situation if necessary. She
should behave as a real mother might behave.
Conduct the role play. Participants not playing roles should record answers on the Sick
Child Recording Form section reprinted in the module. They should make notes of correct
feeding practices and feeding problems discovered.
After the role-play, lead a brief discussion. Review the answers that the mother gave to the
feeding questions. List on the flipchart or chalkboard correct feeding practices mentioned in
the role-play, and feeding problems discovered. (See Answers to Role play.) Also discuss
whether all the necessary questions were asked of the mother. If not, what additional
questions should have been asked'? What might be the consequences of not asking these
questions?
15
Role play: Assessing feeding - Zuwena
SCENARIO
The child's name is Zuwena and she is 5 months old. Zuwena has no general danger signs.
She has: COUGH OR COLD, NOT VERY LOW WEIGHT, and NO ANAEMIA.
The Health worker has already told the mother about a soothing remedy for cough. Now the
Health worker is going to assess Zuwena’s feeding.
HEALTH WORKER: Use the questions at the bottom of the Sick child
recording form (reprinted below) to assess feeding. Record the mother's answers
and any feeding problems. Below the form, also record correct feeding practices.
MOTHER: You will be given a card that describes your attitude and situation.
OBSERVERS: Listen carefully and record the mother's answers on the form below. Also
record correct feeding practices and feeding problems below.
ASSESS CHILD'S FEEDING if child has VERY LOW WEIGHT or is less than 2 years Feeding problems:
old.
Do you breastfeed your child? Yes___ No___
If Yes, how many times in 24 hours? _____times.
Do you breastfeed during the night? Yes___ No___
Does the child take any other foods or fluids? Yes___ No___
If Yes, what foods or fluids? _____________________________________
_____________________________________________________________________
How many times per day? _____times. What do you use to feed the child?
________________________________
If very low weight for age: How large are servings?
__________________________________________________
Does the child receive his own serving?_____ Who feeds the child and how?
______________________________
During this illness, has the child's feeding changed? Yes___ No___
If Yes, how?
___________________________________________________________________
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Handout for the Mother

Role play: Assessing feeding - Zuwena
Description for Zuwena's mother
You are the mother of Zuwena, a 7-month-old girl. You have brought her to the Health
worker because she has a cough and runny nose. The Health worker has already told you
about a soothing local remedy for cough. Now the Health worker will ask you some
questions about how you feed Zuwena.
You are still breastfeeding Zuwena about 3 times each day and once during the night. In the
past month you have started giving her a thin cereal gruel, because she seemed hungry after
breastfeeding and your mother-in-law suggested it. You give the porridge by spoon 3 times
each day. You do not own or use a feeding bottle.
During the illness Zuwena has breastfed as usual, but she spits out the gruel and cries. Your
friend suggested giving Zuwena some sugar water instead of the gruel while she is sick.
You have tried giving the sugar water by cup, and Zuwena seems to like the sweet taste.
Answers to role play: Assessing feeding - Zuwena

ASSESS CHILD'S FEEDING if child has VERY LOW WEIGHT or is less than 2 years old. Feeding problems:
Do you breastfeed your child? Yes___ No___ Not breastfed often enough -
If Yes, how many times in 24 hours? ___4__times. increase to 8 times
Do you breastfeed during the night? Yes___ No___
Does the child take any other foods or fluids? Yes___ No___
Porridge too thin, not nutrient
If Yes, what foods or fluids? ____thin cereal gruel ______________
rich and given too often (3 x a
_____________________________________________________________ day)
How many times per day? __3___times. What do you use to feed the child?_ spoon,
no feeding bottle ___________________________ Sugar water should not be
If very low weight for age: How large are servings? given
__________________________________________________
______________________________
During this illness, has the child's feeding changed? Yes___ No___
If Yes, how?___ spits out gruel, gives sugar water instead _________
__________________________________________________________________
Notice that the questions for "very low weight, for age " were not answered, for Zuwena
because her weight is not very low.
CORRECT FEEDING PRACTICES:

Still breastfeeding
Uses a spoon or a cup rather than feeding bottle
FEEDING PROBLEMS:
Not breastfeeding often enough. The child needs to breastfeed as often as the child wants.
Complementary food (thin cereal gruel) is too thin, not energy-rich and nutrient-rich. Mother
needs to offer thicker foods.
Sugar water should not be given.
17
DEMONSTRATION ROLE PLAY: GIVING FEEDING ADVICE USING GOOD COMMUNICATION

SKILLS
Counselling steps and communication skills covered in this role play

 asking questions to asses feeding

 identifying correct feeding and feeding problems
 praising the mother when appropriate
 advising the mother using simple language and giving only relevant advice about
feeding
 using the Mother's card
 checking mothers understanding
This demonstration gives participants a model of the entire process of feeding assessment
and counselling. (A later continuation of this demonstration covers advice about fluids and
when to return.)
Highlights of case: Child has lost appetite during illness. Information given on
complementary. feeding for an 8-months-old.
This is a scripted role play about Akono, an 8-month-old child. You may play the role of
the Health worker and have a participant or your co-facilitator read the role of the mother.
You will need an extra copy of the script for the mother; you may use the one in your co-
facilitator's guide. Have the Mother's Card ready to use. A baby doll will be helpful.
Practice the demonstration at least once before doing it in front of the group.
To the left of the script, the communication skills being used are listed in italics. Write these
skills on the flipchart or blackboard before the role play:
Ask, listen, Praise, Advise, Check understanding
You or your co-facilitator should stand near the flipchart or blackboard during the role play.
Point to each skill as it is used in the script. This will make participants aware of the skills
being used.
After the role play, ask participants to tell you what feeding problems were found and
whether all of the relevant advice about feeding was given. Feeding problems: Akono is not
feeding well during illness. Akono needs more varied complementary foods. He also needs
one more serving per day. All of the relevant advice was given.
18
SCRIPT FOR DEMONSTRATION ROLE PLAY
Health worker: Let’s talk about feeding Akono. Do you breastfeed him?
Ask, listen
Mother: Yes, I'm still breastfeeding.
Health worker: That's very good. Breast milk is still the best milk for Akono.
Praise How often do you breastfeed him each day?
Ask, listen
Mother: It varies. Maybe 4 or 5 times.
Health worker: Do you also breastfeed at night?
Mother: Yes, if he wakes up and wants to.
Health worker: Good. Keep breastfeeding as often as he wants.

Praise Tell me, are you giving Akono any other foods or fluids
Ask, listen besides breast milk?
Mother: Sometimes I give him cooked cereal, or banana mixed in yoghurt.
Health worker: Those are good choices. How often do you give them?
Praise
Ask, listen
Mother: When he seems hungry.
Health worker: How often is that?
Mother: Usually about 2 times a day.
Health worker: Do you ever give Akono a feeding bottle?
Mother: No, I don't have one.
Health worker: Good. It is much better to use a spoon or cup.

Praise Tell me, during this illness, has Akono's feedings changed?
Ask, listen
Mother: He is still breastfeeding, but he has not been hungry for the cereal or
yoghurt.
Health worker: Well, he's probably just lost his appetite due to the fever. Most
children do.
Advise Still, keep encouraging him to eat. Try giving him his favourite
nutritious foods. Give him small servings frequently.
19
Ask, listen Have there been any other problems with feeding?
Mother: No, I don't think so.
Health worker: You said you were feeding Akono cereal 2 times a day.
Advise At his age, he is ready to eat foods like cereal about 3 times each day.
Make sure the cereal is thick. Akono is ready for some different foods
too. Try adding some mashed vegetables or beans to the cereal, or
some very small bits of meat or fish. Also add a little bit of oil for
energy. Would this be possible for you to do?
Mother: Yes, I think so.
Health worker: Let me show you on this Mother's card what Akono needs.
Advise Since he's 8 months old, he should get the foods under this picture.
(Mention some local foods.)
Mother: Should I give him these foods now, while he is sick?
Health worker: Try offering them. He might like the taste, and these are the best
foods if he will eat them. Offer the foods that he likes.
Advise And most importantly, keep breastfeeding.
Mother: All right. I will try adding some more things to the cereal.
Health worker: Good.

Check understanding What do you have that you will add?
Mother: I will add a little oil, and some mashed peas. Sometimes I can add
vegetables or chicken, when I have one.
Health worker: Good.

Check understanding And how often will you try to feed Akono these foods?
Mother: Three times each day.
Health worker: That's right. I am sure you will feed him well.
Praise
20
ROLE PLAYS: GIVING FEEDING ADVICE USING GOOD COMMUNICATION SKILLS – SUDI
AND JAVAS
Counselling steps and communication skills covered in this role play

 asking questions to assess feeding

 identifying correct feeding and ,feeding problems
 praising the mother when appropriate
 advising the mother using simple language and giving only relevant advice about
feeding
 using the Mother's card
 checking the mother's understanding
In the role play about Akono, the above process was demonstrated. In these role plays the
participants must practice the process themselves.
Highlights of role play 1, Sudi: 7-month-old child is still exclusively breastfed but needs
complementary foods. Health worker must explain good complementary foods to give and
how often.
Highlights of role play 2, Javas: 15-month-old child has very low weight and has persistent
diarrhoea. Health worker must explain how to feed a child with persistent diarrhoea.
Assign roles and conduct the role plays as follows:
1. Assign the role of Health worker in each role play to a different participant. Give these
participants a copy of the Mother's card to use in the role play. Encourage these participants to take
several minutes to review the feeding questions on the Recording form and the feeding
recommendations for the child's age on the Mother's card or in the chart booklet. Tell them they
should be prepared for the mother to behave like a real mother, to ask questions, etc.
2. Assign the role of the mother in each role play to a different participant. Give each mother a
slip of paper describing the situation, the child's usual feeding and feeding during the illness, and her
attitude. These slips of paper are provided below and on the next page of this guide and may be
photocopied. Tell the "mothers" that they may make up additional realistic information that fits the
situation if necessary. Help them prepare to play the role.
3. Conduct each role play. During the role play, observers should complete the Assess child’s
feeding section of the recording form and write down the feeding advice given. They should be
prepared to answer and discuss the questions given in the handout.
21
4. After each role play, lead a brief discussion using the questions on the handout. Ensure that
positive comments are made as well as suggestions for improvements. (Note: If the Health worker
in the second role play does not properly explain the recommendations for persistent diarrhoea, be
sure to explain them in this discussion.)
22

Role play: Giving feeding advice using good communication skills – Sudi
SCENARIO:
Sudi is a 7-month-old boy with a cough and runny nose. He has no general danger signs and has
been classified as COUGH OR COLD, NOT VERY LOW WEIGHT and NO ANAEMIA. He has
no other classifications. The mother has been taught to soothe the throat and relieve the cough. In
the role play the Health worker will assess feeding and counsel the mother about feeding.
OBSERVERS: Listen carefully and record the mother's answers on the form below. Also
record correct feeding practices and feeding problems below.
old.
_____________________________________________________________________
________________________________
__________________________________________________
______________________________
If Yes, how?
___________________________________________________________________
Feeding advice given: ________________________________________________________

__________________________________________________________________________
__________________________________________________________________________
After the role play you will discuss the following questions:
a. Did the Health worker ask all of the necessary questions to assess Sudi's feeding?
Did the Health worker finish the feeding assessment before identifying the feeding problems
and giving advice?
b. What feeding problems did the Health worker find?
c. Did the Health worker give appropriate praise for something the mother had done?
d. Did the Health worker give advice relevant to this child's situation?
Was any advice given that was not relevant? If so, what?
e. Was the advice correct and complete for the child's age and any problems identified?
f. Did the Health worker use clear, simple language?
g. What checking questions were asked? Were they good checking questions? If they
were answered incompletely or incorrectly, did the Health worker clarify the advice?
23
Role play: Giving feeding advice using good communication skills – Javas
SCENARIO:
Javas is a 15-month-old boy with no general danger signs, diarrhoea with NO
DEHYDRATION, PERSISTENT DIARRHOEA, and VERY LOW WEIGHT (no pallor).
Javas has no other classifications. His mother has been taught how to give fluids on Plan A
for diarrhoea. In the role play the Health worker will assess feeding and counsel the mother
about feeding.
OBSERVERS: Watch the role play and record information on the form. Be prepared to
answer the questions below.
old.
_____________________________________________________________________
________________________________
__________________________________________________
______________________________
If Yes, how?
___________________________________________________________________
Feeding advice given:________________________________________________________

__________________________________________________________________________
a. Did the Health worker ask all of the necessary questions to assess Sudi's feeding?
Did the Health worker finish the feeding assessment before identifying the feeding problems
and giving advice?
b. What feeding problems did the Health worker find?
c. Did the Health worker give appropriate praise for something the mother had done?
d. Did the Health worker give advice relevant to this child's situation?
Was any advice given that was not relevant? If so, what?
e. Was the advice correct and complete for the child's age and any problems identified?
f. Did the Health worker use clear, simple language?
g. What checking questions were asked? Were they good checking questions? If they
were answered incompletely or incorrectly, did the Health worker clarify the advice?
24
Handout for the Mothers
Role play: Give feeding advice using good communication skills - Sudi
Description for the Mother
You are the mother of 2 years old boy named Sudi. Sudi has cough and runny nose. You
have been taught to give a soothing cough remedy. Now the Health worker is going to ask
you some questions and give you some advice about feeding Sudi.
You are anxious to leave the health centre as Sudi has been crying, you did not get much
sleep last night so you are tired.
You normally give Sudi family meals 2 times a day and Sudi is sharing the plate with his
two brothers your traditional healer advised you not to give meat or fish to Sudi as it will
interfere with healing process so Sudi has not been given meat or fish at all.
Role play: Give feeding advice using good communication skills - Javas
Description for the Mother
You are the mother of Javas, a 15-month-old boy who has very low weight and has
persistent diarrhoea. The Health worker has explained how to give extra fluid to treat
diarrhoea at home (ORS, water and food-based fluids such as_________). Now the Health
worker is going to ask you some questions and advise you about feeding Javas.
You are worried about Javas, but you have little food available in your home, and you have
three other children to feed. You are timid when talking with the Health worker, and you
are hesitant to ask questions, even when you are confused. You tend to answer the Health
worker very briefly so that he or she must ask further questions to get the necessary
information.
Javas is no longer breastfed. He takes goat's milk and foods eaten by the rest of the family,
2 or 3 times each day. He has continued to eat everything that he is offered during the
diarrhoea. If the Health worker asks what foods are given, describe low energy foods
common in your area. If asked who feeds the child and how, describe feeding practices
common in your area.
25
ROLE PLAY: GIVING ADVICE ON FLUID AND WHEN TO RETURN USING GOOD
COMMUNICATION SKILLS - AKONO
The earlier demonstration about Akono covered the steps of assessing feeding,
identifying feeding problems, and counselling the mother about feeding. This demonstration
completes the interaction by covering advising the mother about fluid and when to return.
In other words, this role play covers the remaining parts of the COUNSEL chart.
Highlights of the case: Health worker uses the Mother's card to teach the signs to
return immediately, including the very important signs - fast breathing and difficult
breathing.
Continue the scripted role play about Akono beginning on the next page. Have the
same people play the roles of the Health worker and mother. Use the Mother's card. A baby
doll will be helpful. Practise the demonstration at least once before doing it in front of the
group.
Before the role play, remind participants that Akono is 8 months old and has no
general danger signs. He has: COUGH OR COLD, MALARIA, NOT VERY LOW
WEIGHT and NO ANAEMIA.
In the previous demonstration, the Health worker assessed feeding and found three
feeding problems: Akono was not feeding well during illness; he needed more varied
complementary foods; and he needed one more serving each day. The Health worker
counselled the mother to keep feeding during illness even though Akono had lost his
appetite. The Health worker also gave advice on good complementary foods for Akono and
advised the mother to feed him 3 times per day. Now, the Health worker will give advice on
fluid and when to return. (Point to the parts of the COUNSEL chart to be used.)
To the left of the script, notice that the communication skills are again listed in
italics. You previously wrote these on the flipchart or blackboard:
Ask, listen
Praise
Advise
Check understanding
As in the previous demonstration about Akono, you should point to each skill as you
use it in the script.
26
SCRIPT FOR DEMONSTRATION ROLE PLAY, part 2: Giving feeding advice using
good communications skills – Akono.
Health worker: We've already talked about how important breastfeeding is.
Ask, listen Does Akono take any other fluids regularly?
Mother: Sometimes I give him orange juice.
Health worker: That's good. During illness children may lose fluids due to
Praise fever, and it is important to give extra fluid to replace those.
Advise You can do that by breastfeeding frequently and by giving
Ask, listen fluids like orange juice or soups as well. How do you give him his
orange juice now?
Mother: In a cup. I hold it while he sips.
Health worker: That's very good. That is the best way to give him extra
Praise fluid.
Advise Now we need to talk about when you should bring Akono back to see
me. If his fever continues for 2 more days, bring him back.
Otherwise, come back in 5 days so we can find out how he is feeding.
Mother: In 5 days?
Health worker: Yes, that will be Monday. If you can come in the afternoon
Ask, listen at 3:00, there will be a nutrition class that would be helpful for you.
Can you come then?
Mother: I think so.
Health worker: I also want you to bring Akono back immediately if he is not able to
Advise drink or if he becomes sicker. This is very important. I'm going to
show you these pictures on the Mother's Card to help you remember.
(Points to Mother's Card and describes the pictures for these signs)
Mother: I understand.
Health worker: Good. Now I am going to tell you two more signs to look for so you
Advise will know if Akono needs to come back. The signs are fast breathing
and difficult breathing. If you notice Akono breathing fast, or
having difficulty breathing, bring him back immediately. These signs
mean he may have developed pneumonia and may need some special
medicine. I do not expect this will happen, but I want you to know
what to look for. Here is another picture to help you remember to
look at Akono's chest for fast breathing. (Points to Mother's card.) If
Akono is breathing faster than usual, or he seems to have trouble
breathing, bring him back.
Mother: All right.
27
Health worker: I also want to see Akono again in one month for his measles
immunization. I know this is a lot to remember, but don't worry, I'm
going to write it down for you.
Check Can you remember the important signs to bring Akono back
understanding immediately?
Mother: Yes, fast breathing and difficult breathing.
Health worker: Good. And how will you recognize fast breathing?
Mother: If it's faster than usual?
Health worker: Good. That's right. And there were two more signs that I
Praise told you first.
Mother: Oh yes, if he cannot drink and...?
Health worker: If he cannot drink and if he becomes sicker. Let's look again at the
Mother's Card. You can take it home to help you
Check remember everything. (Health worker points to the relevant
understanding pictures again and asks the mother to say the signs.)
Mother: Not able to drink....sicker....fast or difficult breathing....
Health worker: Excellent. Bring Akono back if any of these signs appear.
Praise I'm also writing the day to come back for measles immunization here.
That is very important to keep Akono from getting measles. And
remember, if his fever doesn't stop in 2 days, you also need to come
back. Do you have any questions?
Mother: No, I think I understand.
Health worker: You were right to bring Akono today. I will see you again
Praise on Monday. I hope his cough is better soon.
28
ROLE PLAY: USING GOOD COMMUNICATION SKILLS AND THE ENTIRE COUNSEL
CHART AND MOTHER'S CARD - FELICE
This exercise allows participants to practice the entire process covered on the COUNSEL
chart: feeding assessment, counselling on feeding, giving advice on fluid, and teaching when
to return. Participants do the whole process using good communication skills and using the
Mother's card.
Highlights of the case: Child has VERY LOW WEIGHT and feeding problems. As well as
assessing feeding and counselling on feeding, the Health worker will practice giving
instructions on when to return for VERY LOW WEIGHT and a feeding problem.
Conduct the role play as the role play „Giving feeding advice using good communication
skills – Sudi and Javas”. Give the "mother" the situation described on the next page and
instruct the players as follows:
HEALTH WORKER: Assess feeding, identify feeding problems, and counsel the mother on
feeding, fluid, and when to return. Use good communication skills. Use the Sick Child
Recording Form given in this exercise. Also use the Mother's Card.
MOTHER: Try to behave as a real mother might behave. For example, you may be worried,
timid, confused, or anxious to leave the clinic. You may make up additional realistic
information that fits the situation if necessary. You will be shown a card with details about
your child's illness, age, and diet, and other information.
After the role play, use questions in the handout to lead a group discussion.
Description for Felice’s mother

You have a 2-year-old daughter named Felice who has very low weight and has an ear
infection. The Health worker has already given you instructions on wicking the ear and
giving an antibiotic for the ear infection. He or she will now assess feeding and counsel you
about FOOD, FLUID, and WHEN TO RETURN.
You are timid with the Health worker and do not volunteer information unless asked. You
have come a long way to the clinic and you are tired. You are reluctant to come back for a
follow-up visit because transportation is difficult for you. You are not able to read the
words on the Mother's Card, but you try to understand the pictures.
Felice is no longer breastfed. She eats family foods about 3 times a day. She drinks cow's
milk when it is available. She does not use a feeding bottle. Food servings are small and
Felice finishes all of her food. (If asked about family foods and feeding practices, describe
foods and feeding practices that are typical in your area.)
29
Role play: Using good communication skills and the entire COUNSEL chart and
Mother's card
This role play will include the entire process covered by the COUNSEL chart: assessing
feeding, identifying feeding problems, counselling about feeding, advising about fluid, and
advising about when to return.
Listen and watch carefully. Write the answers to the feeding questions and any feeding
problems on the recording form. Notice whether the feeding questions are used, advice is
correct and complete, and good communication skills are used. Be prepared to discuss the
questions below.
old.
_____________________________________________________________________
________________________________
__________________________________________________
______________________________
If Yes, how?
___________________________________________________________________
Feeding advice given: ________________________________________________________

__________________________________________________________________________
__________________________________________________________________________
a. Were all the necessary questions asked about the child's feeding? Did the Health
worker finish the feeding assessment before identifying the feeding problems and
giving advice?
b. What feeding problems were identified, if any?
c. Was the mother praised for something she has been doing correctly?
d. Was counselling about FOOD complete and correct for the child's age and feeding
problems?
e. Was advice on FLUID complete and correct?
f. Was advice on WHEN TO RETURN complete and correct? Did it include signs to
return immediately?
g. Did the Health worker ask appropriate checking questions?
If no to any of the above, what could have been done better? Be prepared to make
suggestions.
30

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ICATT BASED IMCI TRAINING

NOTE FOR ADAPTATION/TRANSLATION

Placement in WHO generic

Role play: Teaching a mother to give oral drugs - Dasar.........................................................................8

Role play: Teaching a mother to care for a dehydrated child - Lura.................................................10

Role play: Assessing feeding - Zuwena......................................................................................................... 13

FACILITATOR TECHNIQUE: COORDINATING A ROLE PLAY

 Suggest that role play participants speak loudly.

 Allow preparation time for role play participants.

 When everyone is ready, arrange seating/placement of individuals involved. Have

SELECT ROLE PLAYS FOR YOUR TRAINING ACCORDING TO THE SITUATION.

DEMONSTRATION ROLE PLAY: TEACHING A MOTHER TO GIVE ORAL DRUGS AT HOME

The role play script is on the following pages.

 showing the mother an example (by demonstrating how to measure a dose),

 letting the mother practice, and

 checking the mother's understanding.

SCRIPT FOR DEMONSTRATION ROLE PLAY

ROLE PLAY: TEACHING A MOTHER TO GIVE ORAL DRUGS - DASAR

Purpose: To PRACTISE teaching mothers to give oral drugs at home.

Gather all of the following supplies.

* TREAT chart or chart booklet opened to the page titled,

Handout for observers

Role play: Teaching a mother to give oral drugs - Dasar

c. Does the Health worker observe the mother:

f. Does the Health worker check the mother's understanding?

When everyone is ready, there will be a group discussion.

ROLE PLAY: TEACHING A MOTHER TO CARE FOR A DEHYDRATED CHILD - LURA

Purpose: To practise talking with mothers about treatment of diarrhoea.

Highlights of the case:

Gather the following supplies:

Write the highlights of the case on a flipchart.

Give the “mothers” and “Health workers” following instructions:

HEALTH WORKER – Part 1:

HEALTH WORKER – Part 2

Read aloud what happened so far:

 Did the Health worker leave out anything important?

 Be sure to comment on:

 How did the Health worker check the mother's understanding?

 What did the Health worker do well?

 Did the Health worker leave out anything important?

 Be sure to comment on:

 How did the Health worker check the mother's understanding?

ROLE PLAY: ASSESSING FEEDING - ZUWENA

Counselling steps covered in this role play

 asking questions to assess feeding

Handout for observers

Role play: Assessing feeding - Zuwena

Handout for the Mother

Description for Zuwena's mother

Answers to role play: Assessing feeding - Zuwena

CORRECT FEEDING PRACTICES:

DEMONSTRATION ROLE PLAY: GIVING FEEDING ADVICE USING GOOD COMMUNICATION

Counselling steps and communication skills covered in this role play

 asking questions to asses feeding

SCRIPT FOR DEMONSTRATION ROLE PLAY

Mother: Yes, I'm still breastfeeding.

Mother: It varies. Maybe 4 or 5 times.

Health worker: Do you also breastfeed at night?

Mother: Yes, if he wakes up and wants to.

Health worker: Good. Keep breastfeeding as often as he wants.

Mother: Sometimes I give him cooked cereal, or banana mixed in yoghurt.

Mother: When he seems hungry.

Health worker: How often is that?