Instruction: you may want to focus your attention on an effectiveness of teaching method, which are listed below under the appropriate category.

1= Poor,2= Needs improvement,3= Satisfactory,4= Very satisfactory,5= Excellent

Strength areas of teacher:

Weak areas of teacher:

Questionnaires on Study of Effectiveness of Different types of Teaching Methodology Regarding Childhood Diarrhoea.

You are requested to answer the following questions in writing. The time provided for answering is 30 minutes. Please try to be as specific as possible in your answer.

• Define diarrhoea.
• List the name of the types of diarrhoea.
• List the high-risk (pre-disposing) factors leading to diarrhoea.
• List the causes of diarrhoea.
• List the complications of diarrhoea.
• Define dehydration.
• List the signs of sever dehydration.
• List the signs of some (mild) dehydration.
• Explain the degree of dehydration according to the given classification:

Severe dehydration
Some dehydration
No dehydration

10. List the name of fluids to prevent dehydration.
11. List conditions when to take the diarrohea patient to the health institution.
12. List the steps of preparing Jeevan Jal.
13. How much tea glass of Jeevan Jal do you need to give to a Child under 2 years of age after passing each loose stool?
14. How much tea glass of Jeevan Jal do you need to give to a child who is between the age of 2 to 10 years after passing each loose stool?
15. How much tea glass of Jeevan Jal do you need to give to a child who is 11 years old or above after passing each loose stool?
16. List measures in the prevention

The entire session evaluation format had same sample for example, which were given below;

You are requested to answer the following questions. The time provided for answering is 10 minute. Please comment on the statements by using the tick (Ö ) in the appropriate column as follows;

1= Strongly disagree 3= Agree not disagree, natural option

2= Disagree 4= Agree, 5= Strongly agree

8. Do you have any suggestions or ideas to improve this session?

Roll No: 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60

Roll No: Group A: 1, 7, 13, 19, 25, 31, 37, 43, 49, 55

Group B: 4, 10, 16, 22, 28, 34, 40, 46, 52, 58

Mixed Group:

Lecture:

Roll No: 2, 5, 8, 11, 14, 17, 20, 23, 26, 29, 32, 35, 38, 41, 44, 47, 50, 53, 6, 59

Group Discussion:

Group A: 28, 14, 20, 26, 32, 38, 44, 50, 56

Group B: 5, 11, 17, 23, 29, 35, 1, 47, 53, 59

Steps of random sample were such as; firstly, collected 1-60 roll numbers of the concerned students. Secondly, left roll numbers 1,2,3. Thirdly, started to count roll number from 4. Fourthly, gave name L for 4 role number student, M for 5 and G for Fifthly, continued this process until last roll number. Sixthly, returned again in roll number 1,2,3 using same previous method. Seventhly, finished to give name L, M.

Made a cluster of given name of the L, M, S. Lastly, gave a full name of the L= Lecture, M= mixed, S= Group discussion. One group of the students was taught (intervene) by a teacher using lecture method only. The second group was taught by using small group discussion method and the third group taught by using all (lecture, small group discussion) methods. There were pre tests before intervention and posttest after intervention.

Childhood Diarrhoea

General Objective: At the end of this session students should be able to explain and manage diarrhoea patient in the community/hospital setting.

Specific Objective: At the end of this session student should be able to:

Define diarrhoea
List types of diarrhoea
Define dehydration
List high risk factors
List the causes of diarrhoea
List the sings of the dehydration
State the classification of dehydration
List the complications of diarrhoea
Explain the management of the diarrhoea
Outline the steps in preparing Jeevan Jal
Describe the preventive measures of the diarrhoea.

1. Definition of diarrhoea:

Diarrhoea is defined as the passing of liquid or watery stools usually at least 3 times in a 24 hours period. (Infants who are exclusively breast-fed normally pass several soft or semi liquid stools each day).

2. Types of diarrhoea:

There are three types of diarrhoea such as given below;

1.    Acute watery diarrhoea: Diarrhoea that begins acutely, less than 14 days and involves the passage of frequent loose or watery stools without visible blood The most important causes of acute watery diarrhoea in developing countries are rotavirus or Escherichia Coli and Vibrio cholera. Acute watery diarrhoea causes dehydration.

2.    Dysentery: Diarrhoea with visible blood in the faeces. The main cause of acute dysentery is Shiga. A number of other complications may occur.

3.    Persistent diarrhoea: Diarrhoea that begins acutely but unusually long duration more than 14 days. Persistent diarrhoea is cause by E. Coil, Shiga and other microbial cause. It makes marked weight loss in frequent.

3. Definition of dehydration

During diarrhoea there is a loss of water and electrolytes (sodium, chloride, potassium and bicarbonate) from the body through the diarrhoeal stool. Fluid and electrolytes are lost through the vomit, sweat, urine, and breathing. Dehydration occurs when these losses are not replaced adequately and the body develops a deficit of water & electrolytes.

4. High Risk Factors: Factors, which make an infant or child more susceptible to diarrhoea, are:

• Bottle-feeding
• Inappropriate supplementary foods
• Solid foods introduced too early
• Raw unripe food or adult - type food is given without preparing it.
• Unhygienic surrounding & - not disposing excreta properly.
• Contaminated water supply
• Malnutrition
• Breast feeding problem due to sick of mother
• Early death of mother
• Incomplete immunization

5. Causes of Diarrhoea:

The causes of diarrhoea among children are:

• viral infections, e.g. rota virus
• bacterial salmonalla, V. Cholera
• protozoal infections, e.g. Giardia
• Fungal infections, e.g. Candid

Infections outside the intestine – otitis, urinary tract infection, pneumonia, malaria.
Food poisoning – contaminated food or drink
Secondary – intolerance to lactose (present in milk).

- Restless, irritable
- Sunken eyes
- Drinks eagerly, thirsty
- Skin pinch goes back slowly

- Not enough signs to classify as some or sever dehydration

• If the child has two or more of the signs of severe dehydration is classified as sever dehydration.
• If the child does not have signs of sever dehydration and if the child has two or more of the signs of some dehydration is classified as some dehydration.
• A child who does not have two or more signs from the severe dehydration and some dehydration is classified as having no dehydration.

• Dehydration
• Under nutrition
• Death

• Explain the three rules for managing diarrhoea at home: (I) Fluid (II) Food

• Rice water, jaulo, khole, and yogurt based drinks (lassi, moi) vegetable soup, thin potato soup, green coconut watery weak tea.
• Thin porridge from rice or any other grain. Add enough water to make it drinkable. Give plenty of water to drink also.
• Breast milk or milk feeds prepared with twice the usual amount of water
• These are first line home based fluids and foods used throughout Nepal. They contain nutrients, which give the body strength to fight diseases.
• Give ORS or water rather than a food based fluid if child in less than 6 months and not yet eating solid foods.
• Give as much as the child will take.

- Continue to breast feed frequently

• If the child is not breast fed, give whatever milk the child usually drinks (cow, goat, powdered)
• If the child is 6 months or older or already taking solid food
• Give cereals mixed with vegetables, beans, eggs meat or fish. Add 1-2 teaspoons of oil, ghee or butter to each serving.
• Give fresh fruit juice, bananas, potatoes or pumpkin to provide potassium.
• Give freshly prepared food: cook and mash or grind food well to make it easier to digest.
• Encourage child to eat as much as he went – offer food at least 6 times a day (every 3 or 4 hours) or more often if child in young.
• Give the same foods often diarrhoea stops; give one extra meal each day for I weeks or until the child has regained normal weight.
  
  (III) When to return: Mother / Relatives should take patient to a health worker if he is not better in 3 days or has any of the following:
  
• many watery stools
• marked thirst
• sunken eyes
• fever
• eating or drinking poorly
• repeated vomiting
• blood in stool

- Wash your hands first by soap and water

- Keep it covered at all times

- Taste should be as salty as tears

- Throw away any ORS solution remaining after 24 hours.

- Don't boil mixed solution of ORS

Give a teaspoon every 1-2 minutes for a child under 2 years.
Give frequent sips from a glass for an older child.
If patient vomits, wait 10 minutes, then give more slowly
For every loose stool give:

Improved weaning practices: weaning foods should be started when the child in 4-6 months old to satisfy his or her increasing nutritional requirement. Good weaning practices involve selection local nutrition's foods and using hygienic practices when preparing them. Good weaning practices also involve adapting behaviors that will help to prevent the contamination of foods.

Wash hands before preparing weaning food and before feeding the child
Wash uncooked food in clean water before feeding it to the child.
Cook or boil food well when preparing it.
If possible, prepare foods immediately before they will be eater.
Cover foods the are being kept. Keep foods is a cool place.
If cooked food is prepared more then 2 hours advance of feeding it need to reheat before giving it to the child.
Feed the child with a clean spoon.

Breast-feeding: During the first 5 months of life infants should be exclusively breast feed. This means that the healthy baby should receive milk and no other fluid such as; water, fruit, and juice formula. Breast – feeding should be continued until at least 12 months of age.

Use of safe water: Using the cleanest available water and protecting it from contamination can reduce the risk of diarrhoea.

Family should collect water from the cleanest available source. Not allow bathing, washing and defecation near the source. Latrines should be located 10 miters away and downhill.

Keep animals away from protected water sources.
Collect and stove water in clear containers. Keep the storage container covered.
If fluid is available water need to be boil for the drinks or foods for young children and other family members.

Hand washing: Hands that have bean contaminated by fecal material can spread All diarrhoeal disease agents. Good hand washing requires the use of soap or a local substitute and a sufficient amount of water.

Use of latrines and proper disposal of stools: Every family needs access to a clean functioning latrine. If one is not available the family should defecate in a designated place and bury the faces immediately. Stool of young children should be collected soon after defecation and disposed in a latrine or buried.

Measles Immunization: Measles immunization can substantially reduce the

incidence and severity of diarrhoeal diseases. Every infant should be immunized for measles as well as other immunization within the age of one year.

Sourse:

• WHO,1992
• WHO,1994
• WHO1995
• WHO, UNICEF and Institute of Medicine Dept. of Child Health Nepal 2000 and USAID, 1999).

The rest of the Questionnaires were found to be clear, understandable and corresponding to their level.

Pre- test: 09.00 –09. 30 AM (all students 60).

09.30 AM-10.15 AM

10.15 AM-10.30 AM ( Break only 15 minutes 17 students)

10.30 AM-11.15 AM

11.15 AM-12.00 PM (Group Discussion 18 Students)

12.00 PM –12.15PM (Break only 15 minutes)

12.15 PM-01.00 PM (Group Discussion )

Break only 01.00-01.30 (for the Observers and Teachers)

Lunch break : 12.30 PM -01.30 PM ( all students must have to take their lunch in separate classes).

01.30 PM 02.15 PM Lecture 19 students

02.15 PM 02.30 PM Break only 15 minutes

02.30 PM-03.15 PM Group Discussion

03.15 PM-03.45 PM Post Test

03.45 PM-03.55 PM Session evaluation

Students are not allowed to communicate between the three groups (Lecture, Small group discussion and mixed group).

What is diarrhoea?
Do you know about types of diarrhoea there are?
What are the high risks (or predisposing) factors leading to diarrhoea?
What are the causes of diarrhoea?
What is dehydration?
How do you classify dehydration according to degree of dehydration. How will you distinguish between severe, mild and no dehydration?
What are the signs of dehydration?
What are the complications of diarrhoea?
How do you manage diarrhoea?(management includes fluid, food and referral)
What are the steps of preparing Jeevan Jal?
What are the preventive measures of Diarrhoea?

30 minute: Small group discussion
10 minute: Presentation for A Group
10 minute: Presentation for B Group
10 minute: Presentation for C Group
20 minute: Large group discussion
10 minute: Summarize by teacher.
90 minute: Total time

15 minute: Small group discussion.
5 minute: Presentation for A group
5 minute: Presentation for B group
5 minute: Presentation for C group
10 minute: Large group discussion
5 minute: Summarize by teacher.
45 minute: Total time.

Table of Data Analysis

* Means: Correct answers according to the content.

No stars means = No answers according to the content.

ORS = Oral Rehydration Solution.

H.E. = Health education.

I.V. = Intra -Venous.

Lecture method was the most effective. This question needs only one correct response. It examines the factual knowledge.

Table:3.1

2: Name of Diarrhoea

Three methods found similarly effective.

Table:3.2

Note: This question needs 3 responses.

Lecture method found highly effective than other 2 methods.

Table: 3.3

Note: This question needs 10 responses.

Lecture method seems to be more effective than other 2.

Table 3.4

Note: This question needs 8 responses.

Lecture method was highly effective than other 2.

Table :3.5

Note: This question needs 4 responses.

It seems that three methods were highly effective.

Table:3.6

Note: This question needs only one correct response.

Lecture method found respectively effective than other 2.

Table:3.7

Note: This question needs 4 responses.

Mixed method found highly effective than other 2.

Table3.8

Note: This question needs 4 responses.

It shows that lecture method was relatively highest than other 2.

Table:3.9.A

Note: This question needs only one correct response.

It shows that lecture method was relatively highest than other 2.

Table:3.9.B

Note: This question needs only one correct response.

Effectiveness of lecture method was relatively highest than other 2.

Table:3.9.C

Note: This question needs only one correct response.

Lecture method seems to be relatively highest than 2.

Table:3.10

Note: This question needs 6 responses.

It seems that lecture and mixed group were similarly higher than other 1.

Table:3.11

Note: This question needs 7 responses.

Mixed method shows that respectively best than other 2.

Table:3.12

Note: This question needs 7 steps.

Mixed method was the most effective.

Table:3.13

Note: This question needs only one response.

14: Amount of Jeevan Jal (ORS) between 2-10 years

It shows that lecture and mixed group were similarly higher than 1.

Table:3.14

Note: This question needs only one response.

Three methods were highly effective.

Table:3.15

Note: This question needs only one response.

Mixed group shows that relatively higher impact than other 2.

Table:3.16.a

Note: This question needs 7 responses.

It seems that lecture method was slightly higher than other 2.

Table:3.16.b

Note: This question needs 4 responses.

Small group discussion method was the most effective.

Table:3.16.c

Note: This question needs 2 responses.

It seems that SGD method was relatively higher than other 2.

Table:3.16.d

Note: This question needs 3 responses.

Mixed method seems to be higher effective than other 2.

Table:3.16.e

Note: This question needs 2 responses.

It shows that mixed group was relatively higher than other 2.

Table:16.f