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Seasonal Malaria Chemoprevention Training for Community Health Workers

This Flipbook provides essential training for Community Health Workers on Seasonal Malaria Chemoprevention (SMC) to effectively identify eligible children, administer medication, refer sick children, and communicate with caregivers. Created with support from various organizations, it includes modules on SMC introduction, eligible children, medication administration, safeguarding, and interpersonal communication. The book guides trainers on using visual aids, facilitating discussions, demonstrations, role-plays, and practical activities for effective learning. Emphasizing engagement, support, clear communication, and active participation, the training aims to enhance SMC implementation and malaria prevention efforts.

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Seasonal Malaria Chemoprevention Training for Community Health Workers

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  1. FEDERAL MINISTRY OF HEALTH FEDERAL MINISTRY OF HEALTH National Malaria Elimination National Malaria Elimination Programme Seasonal Malaria Chemoprevention (SMC) Seasonal Malaria Chemoprevention (SMC) Programme (NMEP) (NMEP) TRAINING FLIP BOOK for Community Health Workers 1 1st stEdition 2019 Edition 2019

  2. Contents Contents How to Use this Flipbook Purpose of SMC Training for CHWs Module 1— Introduction to SMC Module 2—Children Eligible for SMC Module 3—Referring Children to the Health Facility Module 4—Administering SPAQ to Eligible Children Module 5—Safeguarding Children Module 6—Interpersonal Communication This SMC Training Flipbook for Community Health Workers was developed by Malaria Consortium and was made possible by the generous support from grants from GiveWell Directed Funds, the Global Fund, and USAIDs President’s Malaria Initiative, the International Federation of the Red cross and individual charitable donations from the American people. 2

  3. How to Use this Flip Book • This flip book is designed to be used by SMC Trainers as they are conducting training for Community Health Workers • The flip book should be placed so that the participants can see the pictures and the trainer can view the key messages and explanations on the back of each page • Keep the flip book high on a platform or hold it high so that everyone can see the pictures • Use a pen to point to the pictures as you explain key information • Be sure to review all the content on the Trainer’s View and ensure all participants understand, before turning the page Participant View Trainer View 3

  4. The Trainer View • If there is only content information in the Trainer View, explain the content slowly and in a way that everyone understands ASK: • Read the question to the participants and wait for them answer • If the answer is incorrect or incomplete, provide the answer and explain it EXPLAIN and DISCUSS: • Engage participants in a dialogue by asking them to think about an issue and provide their opinions • Ensure all participants are given an opportunity to contribute by asking them individually, “what do you think?” DEMONSTRATION and PRACTICE: • Give instructions by telling and showing participants what to do • Instruct participants to practice after each demonstration and observe them to ensure they are doing it correctly • Participants should use their SMC Job Aid to guide them which each step ROLE PLAY: • Read the scenarios out loud and assign roles for participants to play • Rotate and observe the participants during the role play • Debrief by asking participants to comment what was done correctly • Correct any misunderstandings 4

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  6. Suggestions for Good Training • Use the flip book with the training manual, tools and job aids • People learn best when they are engaged, feel supported, can ask questions and receive clear answers, and are involved in practical activities • As much as possible, use group discussions with questions and answers • When you ask a question, allow the participants to attempt the answer before you provide the answer • Remember to commend correct answers and gently correct wrong answers • Don’t make fun of any participant – no matter how wrong the person is! 6

  7. Module 1: Introduction to SMC Introduction to SMC 7

  8. Trainer View Introduction to SMC Training Introduction to SMC Training Self-introductions: Each participant should introduce themselves as follows: • Name • Community • Favourite colour Explain the purpose of SMC training is to learn how to: • Identify eligible children and treat them correctly with SMC drugs • Refer sick children to the health facility • Record treatment of children on the Tally Sheet • Communicate with caregivers to complete the SMC blister packet at home and when to go to the health facility 8

  9. Introduction to SMC SP AQ 9

  10. Trainer View Introduction to SMC Introduction to SMC— —definitions definitions ASK: What is SMC? • SMC means Seasonal Malaria Chemoprevention • SMC is a combination of 2 antimalarial medicines given to eligible children 3 to 59 months during the rainy season to prevent malaria • SMC is given in combination with other malaria prevention measures, such as sleeping inside an LLIN every night ASK: Why is SMC given? • It is given to prevent malaria • SMC is not a cure for malaria • SMC medicines should not be given to treat malaria ASK: When is SMC given? • SMC is given during the 4 months with highest amount of rain in the Sahel region when malaria transmission is highest ASK: What are the 2 drugs that are given for SMC? • Sulfadoxine-pyrimethamine or SP and amodiaquine or AQ • SP is given once each month, for 4 months • AQ is given once a day for 3 days, each month, for 4 months 10

  11. SMC Delivery Approach 11

  12. Trainer View Introduction to SMC Introduction to SMC— ASK: What is an SMC Course? • The period of 3 days a full course of SPAQ is given • Each child is given 1 course of SMC drugs each cycle ASK: What is an SMC Treatment Cycle? • A period of 3-4 days in which SMC drugs are delivered each month • There are 4 cycles of SMC each year during the rainy season ASK: What is an SMC Round? • One transmission season during which SMC is given each year • There are 4 cycles in each round ASK: What is the SMC delivery period? • The SMC delivery period is the number of days in each cycle when SPAQ is administered ASK: Who delivers SMC to children? • SMC is delivered by community health workers trained in SMC ASK: How is SMC delivered? • SMC is delivered door-to-door by trained community health workers in the child’s house or compound —delivery approach delivery approach 12

  13. Module 2: : Children Eligible for SMC Healthy children 3 to 59 months Child 3 to <12 months Child 3 to <12 months Child 12 to 59 months Child 12 to 59 months 13

  14. Trainer View Children eligible for SMC Children eligible for SMC • SMC is given only to healthy children between 3 and 59 months of age to prevent malaria • Children who are 60 months (5 years) or older are not eligible for SMC • Children who are 59 months in Cycle 1 should receive ALL 4 cycles of SMC. They will not be eligible for SMC the following year. • Infants who are younger than 3 months during cycle 1, should not get SMC, but will be eligible during another cycle once they are 3 months old • Children under five are the most vulnerable to malaria illness and likely to die from severe infection 14

  15. Determining the Child’s Age Child 3 to <12 months: Child 3 to <12 months: Can hold head and neck steady when upright Can grasp object in hand and bring to mouth Has few lower teeth Child 12 to 59 months: Child 12 to 59 months: Can sit without help Can stand or walk Child 60 months or older: Child 60 months or older: Can stand on 1 foot for 10 seconds Can raise arm and touch opposite ear Can jump on 1 foot 15

  16. Trainer View Children eligible for SMC Children eligible for SMC— —how to determine age Only healthy children aged 3 to 59 months are eligible for SMC DISCUSS: What are ways to determine the age of a child? • Ask for vaccination card • Ask caregiver the age of the child ASK: How do you know if an infant is older than 3 months? • Can hold head and neck steady when held upright • Can grasp and hold an object such as a spoon and bring to mouth • Has a few lower teeth ASK: How do you know if a child is 1 year or older? • Can sit without help • Can stand or walk ASK: How do you know if a child is older than 5 years? • Can jump on one foot • Can stand on one foot for more than 10 seconds • Can raise arm above head and touch opposite ear 16

  17. Children NOT Eligible for SMC Do NOT Give SPAQ Child is very sick Child has fever Taken SP, AQ, cotrimoxazole (Septrin / Bactrim) in last 4 weeks Child has allergy to SP or AQ or cotrimoxazole or Septrin or Bactrim 17

  18. Trainer View Children NOT eligible for SMC Children NOT eligible for SMC Do NOT GIVE SPAQ to children who are VERY SICK or have FEVER • Advise the caregiver to go to the health facility for a blood test for malaria • Complete the SMC Referral Form and give to the caregiver to take to the health facility • Tell the caregiver if the child does NOT have malaria, the child will get SPAQ and a Child Record Card at the health facility • Do NOT give the caregiver SMC Child Record Card. Do NOT GIVE SPAQ to children who are ALLERGIC to SPAQ or SULFA DRUGS Ask the Caregiver: • Does the child get very after eating certain foods or taking some medicines like sulfa or cotrimoxazole, (Bactrim or Septrin)? • Has the child ever taken SMC drugs, or AQ or SP, before? • If so, did the child get very sick after taking SMC drugs such as a rash or swelling, or difficulty breathing? Do NOT GIVE SPAQ to children who have taken SP or AQ or COTRIMOXAZOLE in last month Ask the Caregiver: • Has the child taken any medicines in the last 28 days/4 weeks? • If yes, What medicines has the child taken in the past month? • If possible, ask to see the blister packets of medicine to confirm what the child has taken 18

  19. Summary of SMC Eligibility ELIGIBLE REFER Between 3 to 59 months Child is very sick Child has fever Child has allergy to SP or AQ, or cotrimoxazole, or Septrin, Bactrim Taken SP, AQ, cotrimoxazole (Septrin or Bactrim) in last 4 weeks 19

  20. Trainer View Summary of SMC eligibility Summary of SMC eligibility ASK: Who can receive SMC? • SMC is given only to healthy children between 3 and 59 months of age • Children under five are the most vulnerable to malaria illness and likely to die from severe infection ASK: Who should not receive SMC? • Infants younger than 3 months • Children 60 months or older at Cycle 1—if a child reaches 5 years of age after Cycle 1, they can receive all 4 Cycles of SMC, but they will not be eligible for SMC the following year • Children who are allergic to sulfa medication such as cotrimoxazole (Septrin or Bactrim) • Children who are allergic to either SP or AQ • Children who are very sick. • Children with a fever or confirmed positive RDT for malaria • Children who have received a dose of either SP or AQ in the past 4 weeks • Children who are currently taking a sulfa medication such as cotrimoxazole (Septrin or Bactrim) • Children who are unable to take oral medications • Children who are HIV-positive and receiving cotrimoxazole prophylaxis 20

  21. Module 3: Referring children REFER Child is very sick Child has fever Child has allergy to SP or AQ, or cotrimoxazole, or Septrin/Bactrim 21

  22. Trainer View When to refer children to the health facility When to refer children to the health facility 1) The child is very sick or has a danger sign: • Convulsion • Difficulty breathing • Difficulty staying awake • Vomiting everything • Not able to drink or feed • Severe pain or bleeding • Neck pain or severe headache 2) The child has a fever: • Children with fever need to be tested for malaria with an RDT or with microscopy • A child who has a fever must NOT get SP+AQ until it is determined that they do not have malaria • If the child has malaria, he/she needs to be treated with an ACT 3) The child has a suspected adverse reaction to SP or AQ (during the current cycle or previous cycle): • Swelling of the face, mouth, tongue or parts of the body • Severe vomiting for more than 2 hours • Skin rash or itching for more than 2 days • Rash over the body or blistering of the skin • Severe weakness • Child moves strangely • Yellow eyes 22

  23. Referral STEPS 23

  24. Trainer View Referral STEPS Referral STEPS • Do NOT give SPAQ • Know where the nearest referral health facility is located • Explain to the caregiver the reason for referral and the importance of going right away • Tell the caregiver where the nearest health facility is and how long it will take to get there • Complete the top portion of the SMC Referral Form • Give the SMC Referral Form to the caregiver to take to the health facility • Confirm the caregiver understands by asking her to repeat back the instructions • The HFW will evaluate the child at the health facility 24

  25. SMC Referral Form Name of child: Age Gender:   3 – <12 mos.   Female   12 – 59 mos.   Male State: LGA: Ward: Settlement: Date of referral: Name of Health Facility referred to: ___ ___ / ___ ___ / ___ ___ ___ ___ Reason for referral:   Sick   Fever   Side effect SPAQ today   Side effect SPAQ previous cycle Name of CHW: Signature: 25

  26. Trainer View Completing top of SMC Referral Form Completing top of SMC Referral Form • Each CHW Team will get a booklet of 50 Referral Forms which are double carbon copy ASK: What is the purpose of the SMC Referral Form? • To track the number of children referred to the health facility • To track the number of children who actually go to the health facility DEMONSTRATION and PRACTICE: • Show how to complete each part of the top portion of the SMC Referral Form for the State, LGA and Ward the CHWs will be working in • Have CHWs practice completing the form ROLE PLAY: • Instruct CHWs to role play how to give the caregivers referral instructions for these scenarios: • The child is 2 years old and has had a high fever for 2 days. The caregiver believes SMC is treatment for malaria. • The child is 6 months old and has not been breastfeeding. The mother is worried the child has malaria and wants to get SMC. 26

  27. Module 4: Administering SPAQ to Eligible Children Dose for Dose for 12 to 59 months 3 to < 12 months 27

  28. Trainer View Administering SPAQ to Eligible Children • The child must be eligible for SPAQ • There are two blister packets of SPAQ: • Orange: for 3 to <12 months, has a baby on the box • Red: for 12 to 59 months, has a child on the box and the tablets are bigger • SP and AQ tablets are dispersible in a small amount of clean water • Do not use more than a big spoonful of water • SP and the first dose of AQ MUST be given under direct observed therapy (DOT) • Don’t be in a hurry to administer the SMC drugs 28

  29. Administering One Course of SPAQ Day 1 Day 2 Day 3 1 SP tablet + 1 AQ tablet 1 AQ tablet 1 AQ tablet SP AQ 29

  30. Trainer View Administering One Course of SPAQ • One course of sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) consists of: • 1 tablet of sulfadoxine / pyrimethamine (SP) given once and • 1 tablet of amodiaquine (AQ) given once a day for 3 consecutive days • SP and the first dose of AQ MUST be given under direct observed therapy (DOT) ASK: What does DOT mean? • Dispersing the 1 tablet of SP and 1 tablet of AQ with water • Giving the dispersed medicine to the child in front of the caregiver • Waiting 30 minutes to ensure the child does not spit up all of the medicine 30

  31. STEPS to Administering SPAQ 1 2 3 4 31

  32. Trainer View Steps to Administering SPAQ Step 1: Wash hands Step 2: Gather materials (SPAQ, clean cup, spoon and water) Step 3: Remove 1 tablet SP and 1 tablet AQ from blister pack Step 4: Place both tablets inside a clean cup, or on a spoon and cover with water:  Slowly add a small amount (5-10 ml) of clean water to fully cover both tablets.  Wait for both tablets to completely disperse—about 30 seconds  If needed, softly stir with a spoon to aid dispersion  Never cut or crush dispersible tablets  Never give dispersible tablets to swallow 32

  33. STEPS to Administering SPAQ 5 33

  34. Trainer View Steps to Administering SPAQ Step 5: Give the dispersed SPAQ to the child:  Ensure the child is awake  Sit the child upright to avoid spitting and vomiting  Give medicine slowly with a small spoon or cup  Ensure the child drinks ALL the medicine by rinsing the cup or spoon with a small amount of water and give to swallow again Do not force the child to swallow the medicine by holding the Do not force the child to swallow the medicine by holding the child’s head and neck back or pinching their nose child’s head and neck back or pinching their nose DEMONSTRATION and PRACTICE: • Demonstrate steps 1 though 5 • Distribute materials and have each CHW practice steps 1-5 with the SMC job aid • Observe and correct any mistakes 34

  35. Giving a second dose of SP + AQ 35

  36. Trainer View When and how to give a second dose SP+ AQ • Ask the caregiver to notify the CHW if the child vomits or spits up ALL of the medicine within 30 minutes If the child vomits ALL of the medicine within 30 minutes of the first dose, repeat the dose of both SP and AQ Record on the SMC Tally Sheet and SMC Child Record Card Clean your tools • • • 36

  37. Give caregiver 2 doses of AQ and Child Record Card 37

  38. Trainer View Day 2 and 3 instructions for caregiver Give the caregiver instructions to give AQ tablets at home: • Give the child 1 tablet tomorrow morning and 1 tablet the day after tomorrow. • Put 1 tablet in a cup and cover tablet with small amount of clean water. • Dispersible AQ can also be dispersed with a small amount of breast milk. • Wait for it to dissolve, never cut or crush dispersible tablets. • Never give dispersible tablets to swallow. • Give medicine slowly with spoon or cup. • If the child vomits all of the Day 2 medicine within 30 minutes, give Day 3 AQ and go to the Health Facility to get another dose of AQ for Day 3. • If child vomits all of the Day 3 AQ go to the Health Facility to get another dose of AQ for Day 3 • Do not share medicines with other children 38

  39. Adherence to 3-day course each cycle 39

  40. Trainer View Ways to encourage adherence for caregiver Ways to encourage adherence to a 3-day course of SMC each month: • Always give the first dose of SP and AQ by directly observed therapy (DOT) • Ensure the caregiver understands how and when to give AQ on Day 2 and Day 3 and why it is important to prevent malaria • Ensure caregiver understands what to do if the child vomits AQ within 30 minutes • Ensure the caregiver keeps the empty blister pack to show at the next cycle • Ensure the caregiver understands the importance of giving the child all 4 cycles of SMC for the child to be fully protected 40

  41. Completing the SMC Record Card Child’s name:  3 - <12 mos.  12 - 59 mos. Gender:  Female  Male Age: State: LGA: Ward: Settlement: Not Day 1 Day 2 AQ Day 3 AQ Given at HF Year Cycle Date Treated Refer SPAQ 1 _ _ / _ _ / _ _ _ _ 2 _ _ / _ _ / _ _ _ _ 20_ _     3 _ _ / _ _ / _ _ _ _     4 _ _ / _ _ / _ _ _ _     41

  42. Trainer View Completing the SMC Child Record Card • The SMC Child Record Card is used to show when each course of SPAQ was given to the child • The card is given to the caregiver to keep • The card can be used to show the health facility when SPAQ was given in the household • The card can also show CHWs if SPAQ was given at the health facility • Caregivers should use the card to mark when the two doses of AQ are given at home • Only children who are eligible for SMC and received SPAQ the first cycle will get an SMC Child Record Card • One SMC Child Record Card is given each year • One card per child DEMONSTRATION and PRACTICE: • Show CHWs step by step how to complete SMC Child Record Card • Ask CHWs to complete the card for 2 different children with different ages and gender 42

  43. Completing the SMC Tally Sheet 43

  44. Trainer View Steps to Completing the SMC Tally Sheet The SMC Tally Sheet is used to record the number of: • Children seen each day who received SPAQ (column A) • Doses of SPAQ administered by age and gender • Children given a second dose of SPAQ because of vomiting or spitting out all of the medicine. (column B) • Children referred to the HF (column D) • Tablets or blister packets which were damaged or dropped and contaminated (column C) • Children excluded from SMC because not eligible (column E) • Adverse reactions reported • Cycles of SMC received (back of sheet) DEMONSTRATION and PRACTICE: • Show CHWs step by step how to complete SMC Tally Sheet • Ask CHWs to complete the SMC Tally Sheet for 8 different children with different ages, gender and redosing • Show how to complete the back of the SMC Tally Sheet to track number of Cycles received 44

  45. House Marking 45

  46. Trainer View House marking • Every house must be marked with chalk after each SMC visit each cycle ASK: Why is it important to mark houses during the SMC campaign? • Marking houses helps CHWs and SMC Supervisors keep track of the houses visited each cycle so no child is missed • If a child 3 to 59 months or their caregiver is not present during the visit, or if the head of the household is not present to give permission for SMC, the CHW should return during the cycle to visit the house again • The CHW should re-visit the house each day of the cycle until the visit is completed 46

  47. How to mark houses SMC /year /cycle/CHW team code/status of visit • Mark C if visit was completed • Mark R if needs to be re-visited • Mark E if excluded SMC / 019 / 1 / 5678 / C SMC / 019 / 2 / 5678 / R SMC / 019 / 2 / 5678 / R / C SMC / 019 / 3 / 5678 / E 47

  48. Trainer View House marking • Each house should be marked with: • SMC • The year SMC is given • The cycle number (1, 2, 3, and 4) • The CHW Team code • Whether the visit was completed (C), needs to be revisited (R), or excluded (E) ASK: What do each of these house markings mean? (point to each) • SMC / 019 / 1 / 5678 / C Completed visit in 2019 during Cycle 1 • SMC / 019 / 2 / 5678 / R • House needs to be revisited in 2019 during Cycle 2 • SMC / 019 / 2 / 5678 / R / C • Visit completed after a re-visit in 2019 during Cycle 2 • SMC / 019 / 3 / 5678 / E • House visited in 2019 during Cycle 3 but child was excluded 48

  49. Module 5: Safeguarding children 49

  50. Trainer View Safeguarding children during SMC • SMC is only available for eligible children 3 to 59 months • NEVER give SPAQ to children younger than 3 months • NEVER give SPAQ to children who are 5 years and older • Never give SPAQ to children with a history of allergy to sulfa-based drugs (such as cotrimoxazole, Bactrim, Septrin), or to amodiaquine • Do NOT give SPAQ if the child became very sick after taking SP or AQ the last cycle (severely unwell with a skin rash over the whole body, or swelling, or difficulty breathing). Refer them to the clinic for assessment • Do NOT give SPAQ to children who have fever and test positive for malaria • Do NOT give SPAQ to children who have taken SP or AQ in the past 28 days • Do NOT give SPAQ to children taking cotrimoxazole or sulfa medicines for HIV prophylaxis or treatment of infection • Refer any child who becomes very sick after giving SP+AQ during SMC delivery (this may occur only very rarely) • Give all the medicine slowly • Do NOT force children to swallow SPAQ • Do NOT spank children in an attempt to make them take SMC 50

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