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Communication: a guide for managers of national diarrhoeal disease control programmes. Planning, management and appraisal of communication activities.
Geneva, Switzerland, WHO, Diarrhoeal Diseases Control Programme, 1987. vii, 78 p.When the World Health Organization's Diarrheal Diseases Control Program (CDD) began in 1978, it concentrated on producers and providers of oral rehydration salts. Communication efforts were directed at informing health care providers and training them to treat patients. The time has come for CDD programs to put more emphasis on enduser-oriented approaches, and it is to facilitate that aim that this guide for CDD program managers on enduser-directed communication has been developed. The guide is divided into 3 parts. Part 1 deals with nature and scope of communication in a CDD program. The 1st step is research and analysis of the target population -- find out what the target audience does and does not know and what are some of their misconceptions about the use of oral rehydration therapy (ORT) and the Litrosol packets. Communication can teach mothers how and when and why to use ORT, but it cannot overcome lack of supply and distribution of the salts; it cannot be a substitute for trained health care staff; and it cannot transform cultural norms. Part 2 deals with the communication design process. Step 1 is to investigate the knowledge, attitude and practice of both the endusers and the health care providers; to investigate what communication resources are available; and to investigate the available resources in terms of cost, time, and personnel. Step 2 is communication planning, in terms of: 1) definition of the target audience; 2) identification of needed behavior modification, and 3) factors constraining it; 4) defining the goals of the communication program in terms of improving access to and use of the new information; 5) approaches to change, e.g., rewards, motivation, and appeal to logic, emotion, or fear; 6) deciding what mix of communications methods is to be used, i.e., radio, printed matter; 7) identifying the institutions that will carry out the communicating; 8) developing a feasible timetable, and 9) a feasible budget. Step 3 is to develop the message to be communicated and to choose the format of the message for different communications media. Step 4 is testing, using a sample of the audience, whether the messages are having their intended effect in terms of acceptance and understanding by the target audience, and revision of the messages as necessary. Step 5 is the actual implementation of the communication plan in terms of using a media mix appropriate to the audience, phasing the messages so as to avoid information saturation; and designing the messages so that they are understandable, correct, brief, attractive, standardized, rememberable, convincing, practical, and relevant to the target audience. Step 6 is to monitor the program to be sure the messages are reaching their intended audiences, to evaluate the program in terms of its actual effects, and to use the results of the monitoring and evaluation to correct instances of communication breakdown. Part 3 deals with the CDD manager's role in communication. The manager must select a suitable communications coordinator, who will have the technical expertise necessary and the ability to call upon appropriate government and private information resources and consultants. The manager must brief the coordinator in the scope and objectives of the CDD program; and he must supervise and monitor the work of the coordinator.
DEVELOPMENT FORUM. 1988 Mar-Apr; 16(2):11, 14.Facts for Life is a 50-page compilation of priority messages focussed on infant and child health and designed to reach parents directly, so that they will have the facts they need to keep their children alive and healthy. The "Facts for Life" initiative is expected to reach the parents through a grand alliance of communicators -- nongovernmental organizations and individuals -- who come directly into contact with parents. The initiative has the backing of the World Health Organization (WHO) and the UN Children's Fund (UNICEF). It is also supported by nongovernmental networks such as the Children, Rotary, and Junior Chambers of Commerce as well as officials of the International Pediatrics Association, London University Institute of Child Health, and the Johns Hopkins University School of Hygiene and Public Health. Topics covered in the "Facts for Life" messages include safe motherhood, breast feeding, immunization, acute respiratory infections, malaria, timing births, promoting child growth, diarrhea, home hygiene, and AIDS. The booklet is available in English, French, Spanish, Portuguese and Arabic for 25 cents (US) a copy from UNICEF.
New York, New York, United Nations Children's Fund, 1987 Jun. 62 p.Worldwide, oral rehydration therapy (ORT) still claims only a modest niche in the market alongside a vast array of modern drugs and traditional treatments of diarrhea, the majority of which are either ineffective or harmful. Often, ORT is used as an adjunct therapy for drugs, instead of as a replacement. Drugs are also several times more expensive than ORT. ORT is not yet seen for what it rally is: the most effective treatment for a major killer disease in the developing world. Recent research has identified a total of 25 different virsues, bacteria, and parasites that cause diarrhea, and more are still being found. Cholera accounts for <1% of all types of accute diarrhea. It can usually be treated with ORT alone. The progressive symptoms for diarrhea are identified, and how ORT replaces salt and water is explained. A 2-tier strategy is recommended by WHO and UNICEF--90-95% of patients can be treated with ORT alone; the remainder require intravenous therapy. Continuation of feeding during diarrhea and additional feeding afterward is recommended. A review of antibiotics, absorbents, antimotility drugs, and anti-emetics shows why they do not work or should not be used. Training in diarrhea management for doctors, nurses, and midwives is inadequate. Supply problems are significant. Yet because OR solution needs no refrigeration and local production is more feasible than vaccines, logistic do not have to be complicated. Effective use of ORT needs to be promoted through communication. Social marketing and information campaigns in Gambia, Haiti, and Egypt are reviewed. The issues concerning use of standardised ORT formula. Salt-and-sugar solution are addressed. The future for ORT includs finding a better formula that would also reduce the volume and duration of the diarrhea itself.
Horizons. 1983 Apr; 2(4):14-20.In Honduras and the Gambia the US Agency for International Development's (AID's) Bureau for Science and Technology and its contractors, working with the Ministry of Health in each country and drawing upon experts in health communications, anthropology, and behavioral psychology, have developed a health education methodology that integrates mass media and health providers. The project uses radio, graphics, and the training of village health workers to teach mothers how to treat and prevent diarrheal dehydration. The World Health Organization (WHO) and the AID assisted International Center for Diarrheal Disease Research in Bangladesh, have demonstrated that lost body fluid and electrolytes can be replaced with an orally administered solution. The treatment is known as ORT, oral rehydration therapy. AID efforts in Honduras and Gambia are showing that semi-literate persons, contacted primarily through the mass media, can be taught to mix and administer ORT. The campaign also includes a number of preventive measures. The Gambian government chose to use ORT packets prepared according to the WHO formula at health centers as a backup to the similar home mix solution. Honduras chose to package their own ORT salts, following the WHO formula, for use both at health centers and in the home. In Gambia the Ministry of Health created a national contest which kicked off with the distribution of 200,000 copies of a flyer carrying mixing instructions to nearly 2000 Gambian villages. Repeated radio announcements in Gambia's 2 major languages told mothers to gather and listen to contest instructions. The radio announcer led listeners through each panel of the color coded flyer which told them how to mix and administer ORT. 11,000 women attended the 72 village contests. Of the 6580 who entered the mixing competition, 1440 won a chance to compete and 1097 won prizes for correct mixing. After 8 months of campaign activities, the number of mothers who reported using a sugar-salt solution to treat their children's diarrhea rose from 3% to 48% (within the sample of some 750 households). The number of women who could recite the formula jumped from 1% to 64%. In Honduras a keynote poster for the campaign that featured a loving mother was distributed simultaneously with the airing of the 1st phase of the radio spots and programs. Within a year 93% of the mothers knew that the radio campaign was promoting Litrosol, the name of the locally packaged ORT salts; 71% could recite the radio jingle stressing the administration of liquid during diarrhea, and 42% knew that Litrosol prevented dehydration. 49% of all mothers in the sample had tried Litrosol at least once during the campaign.