School Health and Nutrition: Water, Hygiene, and Health Education, Summaries of Nutrition

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The School Health and Nutrition

Health Education Manual

DIORO TOWN, SEGOU DISTRICT, MALI: From left, Howa Keita, 13, Aminata Touré, 10, Elizabeth Coulibaly, 15, Katija Fofana, 12, Minta Sangaré, 12, Miram Diawara, 13, wait for school in Dioro, Mali, January 4, 2010.

Joshua Roberts

6 year-old Jasmin follows along with her teacher Roberto Cuj Tun. He is leading an interactive exercise in their kindergarten class at the Panimanquip School.

Rick D’Elia

Over the past several years, Save the Children has developed tools for country offices to use in their School Health and Nutrition (SHN) programs. The implementation tools include: our Common Approach to School Health and Nutrition Programs; a Knowledge, Attitudes, and Practices Questionnaire; School Water, Sanitation, and Hygiene Checklists; sample Operations Manuals; and several other tools. Although these tools have been helpful to many SHN Program Managers, we have heard from colleagues around the world that there’s been something missing: A health education manual.

The School Health and Nutrition Health Education Manual is an answer to this gap. It is a collection of lesson plans on 23 topics that make up a comprehensive SHN curriculum. The lessons have been grouped into like topics: Water, Sanitation, and Hygiene Infectious Diseases, Including Neglected Tropical Diseases (NTDs) Taking Care of Our Bodies Preventing Disease and Injuries Nutrition Sexual and Reproductive Health, Including HIV and AIDS Prevention

Not all SHN programs will use all 23 topics, but these lessons represent priority topics for most programs and should be included in a comprehensive health curriculum. Each SHN program may choose to elaborate more on key topics, based on its country office’s SHN strategy and what is appropriate for their country and the children they’re teaching. Similarly, SHN programs may choose to not include some topics.

The lesson plans have been written as examples that can be used as they are. They have been written to be given in about 60 minutes and to be appropriate for children aged eight to ten. SHN Program Managers should modify the lessons to take an appropriate amount of classroom time for the schools they work with, and they should modify the activities so that they are appropriate for the ages their program is targeting. These lessons can also be used in afterschool or extracurricular settings with appropriate changes.

Furthermore, the lessons can also be divided into smaller lessons so that one “lesson” can be used over the course of a week or month. Some of these lessons have steps, based on the basics of child-to-child methodology, that require children to collect data at home, analyze the findings at school with the assistance of the teacher, and to take action with the findings. These steps could also become individual lessons.

Additional modifications should be made to respond to each impact area. For example, stories should contain names that are common to the geographical location. Foods that are listed in the manual should be foods that are commonly available. References to diseases, vegetables, fruits, soap, toothbrushes, and other objects should also include the local names.

This manual has very little in the way of art and graphics. This choice was intentional. Art and graphics are best when they’re specific to their locations. Therefore, we encourage each country office to work with a local designer to create images that resonate with the children in their impact areas.

Lesson Plan Structure Health Topic Background This handbook contains lesson guidance on 23 health topics. The lessons start with a section on background information. This background section is designed to equip teachers with the basic information on the health topic that forms the focus of the lesson. It ensures teachers have the knowledge and understanding they need to teach the lesson with confidence. Most of the section contains factual information, and there is a final section in most lessons on what schools teachers and children can do to collect further information and help to spread the information throughout the community.

About this Manual

Question Box: Many topics suggest using the Question Box. When health lessons focus on actual problems that children may be facing, the children may be reluctant to share a particular problem or to ask a question openly. The Question Box is a way for children to ask anonymous questions to the teacher. The teacher should mention the Question Box before each lesson and encourage children to put questions there that they do not feel comfortable asking in class. The teacher should make a habit of checking the Question Box regularly and making time in class for questions to be read and answered aloud for the whole class (keeping the identity of the child asking the question hidden). Students feel highly motivated when the teacher responds to the questions placed in the box.

Campaign Development In the lesson on malaria, there is an additional section on how to run a malaria health campaign. This campaign framework follows a six-step process 1 :

1. Understand the topic
2. Find out more
3. Plan action
4. Take action
5. Reflect on action
6. Act again

This six-step process can be applied to any campaign topic. Schools might focus on one campaign topic per term (or per year) and get each class involved in different activities focused on this topic. The campaign should be linked to a specific need in the community or to a broader campaign, such as community-led total sanitation. As a result, children will recognize their roles as important agents of change.

We are grateful to so many people who helped to prepare this manual: Colleagues from country offices who provided examples from their own health education syllabi and lesson plans; our colleagues in Washington and Westport with technical expertise and assistance; colleagues from partner organizations with suggestions and great ideas; and a special thanks to Clare Hanbury-Leu who spent countless hours getting these lessons prepared.

We look forward to receiving your feedback on the manual. Please let us know how you use the manual – what works and what doesn’t work, what modifications you’ve made, what’s missing? We hope to include these suggestions and modifications in future versions of the manual. We would also love to receive a copy of your final manuals so that we can share them with others.

Happy teaching!

The School Health and Nutrition Team

(^1) Child-to-Child Trust. http://www.child-to-child.org/

Hatiabo Haji Somir Uddin Community Primary School. Gazipur District, Bangladesh. Proteeva Project-Pre-primary school student Kawser uses a bottle and funnel to pour water during an exercise designed to promote numeracy.

Jeff Holt

8

Most children will have little control over how to use water, the purchasing and use of soap, the amount of water that can be used to wash with or to drink, how and when clothes are cleaned, or how water is made cleaner and safer (methods such as filtering, boiling or using sunshine). It is important that children are not stigmatized for their own poor hygiene. Often it is through no fault of their own and other children and teachers need to be aware of this, behave in a sensitive way and find ways to support them.

At school, children can work with teachers and other adults to make an important contribution to improving the conditions for practicing good hygiene, raising awareness in the community, and supporting families who have less access to water or who do not have a latrine. Once better conditions for families are in place, children can help by raising awareness and monitoring their own and others’ hygiene practices.

Lesson Plan on Hygiene

Lesson aim

Children will be able to identify sources of germs and adopt health practices that prevent germs from spreading. Children can set up a hygiene club.

Lesson objectives

By the end of the lesson, children must:

• Understand what germs are, that they are invisible, where they may be hiding and how they are spread,
• Be able to state three ways that germs an get inside our bodies,
• Feel motivated to set up a hygiene club,
• Demonstrate appropriate hand washing steps,
• Demonstrate knowledge of the four key times to wash hands: before eating and preparing food, and after defecating or cleaning someone who has defecated.

Lesson preparation

Read these notes:

• This is the first lesson in a series of four specific hygiene related lessons. This lesson focuses on general hygiene issues, the next on safe water, the third on personal hygiene and the fourth on school and community hygiene. Each lesson has distinct and related activities. Other lessons also focus on hygiene as a preventative strategy, including the lessons on: worms, trachoma, and looking after our teeth and our eyes.
• This lesson does^ not^ include a quiz or question and answer activities at the beginning of the lesson.
• There is a chance for the teacher to collect information about the children’s actual hygiene practices during activity two. Two interesting questions to address in the lesson are: “why children do not follow good hygiene practices?” and “what can be done to change this?” With the help of the children, and if possible health workers, the teacher can collect information about general hygiene issues in the family, school and community before the lesson. When the lesson is used with older girls, it may be useful to find out about menstrual hygiene practices and explore issues relating to these in activity two. Adapt the questions for the concluding activity on the basis of what you found out.
• It may be useful to set up a ‘hygiene club’ with the children. Before the lesson decide if and how a hygiene club could function smoothly in your school (or if extra hygiene related activities could be incorporated into the activities of other clubs – such as the Guides or the Scouts).

Lesson materials

• For activity one: Prepare a glass (or plastic bottle) of dirty water and a glass (or bottle of) of clean water.
• For activity two: Cut out 24 squares of paper big enough to be visible to the class. On 4 pieces of paper write 1 and on 20 write 0. These numbers can be made using fingers if paper and pens are in short supply.

How to conduct a 60-minute lesson on Hygiene for 8-10 year olds

1. Question box: Remind the children that they can put any questions they like about hygiene into the Question Box. Questions can be answered during a future health lesson. 2. Activity one: Germs are invisible (10 minutes) - Show the children the glass of dirty water and the glass of clean water. Ask the children:^ Which of these glasses of water has germs in it? They will probably reply: The dirty one! Shake your head and ask them to try again! Let them guess. The correct answer is that we do not know, as germs are too small to be seen without a microscope. Add these points: Most dirt will contain germs, but an example of “clean” dirt is ash, as it is what is left from burning and burning kills germs. - Pass around a pencil or pen. Get all the children to pass it one to another in silence. When it comes back to you. Ask the children: Does the pencil have germs on it? Answer: yes! Ask: Where have the germs come from? Answer: from all of us! 3. Activity two: (30 minutes) Keeping Ourselves Clean - Hand out the squares of paper to 24 of the children in your group. - Tell the children to look at their thumb. Tell them that one gram of feces would sit inside your little fingernail. In that one gram you can find: - 100 worm eggs (Make this number from one child holding up a 1 and another two holding up 0’s.), - 1000 parasite cysts (1 + three 0’s), - One million bacteria (1 + six 0’s), and - 10 million viruses (1+ seven 0’s) (By the end you will have 24 children holding up these four numbers) Ask the children: What do you think about the number of viruses and bacteria and worm eggs and parasite cysts in a small amount of feces? Answer: Feces is very dangerous. - Teach the children the well-known song “head, shoulders, knees and toes.” The words of the song are as follows.

Head, shoulders, knees, and toes, knees and toes Head, shoulders, knees, and toes, knees and toes And eyes, and ears, and mouth, and nose Head, shoulders, knees, and toes, knees and toes

Sing the song once though. As you sing it, tap each part of the body mentioned in the song with your hands. Sing it again, leaving out the word “‘head” and replacing it with “Mmm,” Sing it again, leaving out the words “head” and “shoulders” and replacing both with “Mmm.” Continue until all you are singing is “Mmm” as you point to the 8 parts of the body.

• Ask the children:^ Where on the body can we find germs?^ Answer: Everywhere! Ask:^ How do germs spread? Answer: Through touching with the mouth, hands or clothes; by using the same objects as others (like the pencil or sharing cups and plates); and through sneezing and coughing.
• Divide the children into eight groups. Give each group the task of working out how to demonstrate how they should keep one of the following parts of their bodies clean every day: nails, face, eyes, ears, toes, body, hair, teeth. After 10 minutes, ask the children to arrange themselves around the room and have each group do their demonstrations. After each demonstration, have the children comment on the demonstration. Then, ask the children to show their hands if they always follow this practice. If they don’t, ask why not. Write down their responses.

Hygiene homework activity

1. Ask the children to teach the “Head, Shoulders, Knees, and Toes” song to other children at home and then explain how to keep all parts of our bodies clean to prevent diseases. 2. Ask the children to collect questions about hygiene from their family members to put in the questions box.

Ideas to develop the lesson on hygiene Hygiene is a very good topic to use to develop a school-community campaign. See the lesson on malaria for ideas on how to run a campaign. The same steps can be used to design a campaign with the children on hygiene in the home, school, and community.

Clean, safer water as a topic in other subjects

Social Studies

Science

Language

Music

Art

Use a small pile of charcoal or soot, paper and a fruit. Several children come to the front of the class. The teacher asks them to imagine that one of their hands is a fly. They can make buzzing noises! The ‘fly’ lands in the soot. They then ‘walk’ their fingers on the paper and on some food. Ask: What do you see? Answer: Black specks. Tell: These black specks represent the germs that the fly has carried on his feet. Ask: In real life can we see the germs? Answer: No. Ask the children to ‘walk’ with their fingers on the fruit and then give pieces of the fruit out to other children in the class. Ask: Do you want to eat it? Answer: No! Why not? Answer: Because it has germs! Discuss why germs are dangerous.

Use a powder like chalk, baby powder or flour. The children put powder on their hands and then blow on them pretending they are coughing and sneezing. Afterwards, discuss how we can stop germs from our throats and noses from spreading when we cough and sneeze. (Answer: Use an elbow or cloth in front of the face and wash hands often)

Act out a story about how a cold spread through a class by a child sneezing.

Practice singing the head, shoulders, knees and toes song. Ask the children to teach it to other children and explain what it has to do with hygiene.

Make a poster on how to wash and dry utensils properly.

Water that comes from a protected source – a well, a tap, or an enclosed spring – is often both clean and safe, as long as the source is well-maintained. Water that comes from a pond, stream, lake, or river may look clean but it is not necessarily safe. The water may have germs in it even if it looks clean. Dirty water can be safe but it is unpleasant to use.

There are several ways to make water safe for use. Water can be boiled for one to three minutes to destroy all of the germs inside the water. Boiling water is a very good way to make it safe. However, it is also expensive and uses limited wood and charcoal resources. In areas with lots of sunshine, filtered water can be poured into a transparent plastic bottle and left in the sun for six hours. In this method – called solar disinfection or SODIS – the heat and light kill the germs and make the water safer to drink. There are also chemicals that can be used to make water safe. A small amount of chlorine can be used to purify water. Chlorine comes in different strengths. It also comes in liquid, tablet, and powder form. When using chlorine, it’s best to follow the directions on the package to make water safe for drinking. Chlorine is an inexpensive and effective way of making water safe.

There may be other locally relevant ways in which people in your communities clean and purify water. It is important to use locally sustainable methods, provided that they are safe and advised by health workers.

Even if your water comes from a protected source, it is good practice to treat your water by boiling it, heating it in the sun, filtering, or adding chlorine to it – just to be sure!

Everyone should drink safe water all the time. It is essential that children under five are given only safe water.

Lesson Plan on Safe Water

Lesson aim

Children can identify safer water, explain what makes it safer, and know a locally sustainable way to make water safer.

Lesson objectives

By the end of the lesson, children must be able to:

• Know the difference between clean and safer water
• Identify safer water sources
• Be able to make water safer
• Know how to store water safely

Lesson preparation

Before teaching this lesson, the teacher must gain an understanding of the various water sources in the community. In addition, the teacher must gain an understanding of the measures that are taken at the household level to ensure that water is safe to drink. Teachers can get information about water practices from schoolchildren and health workers. This lesson should be taught in a cluster with the lessons on hygiene, personal hygiene, and hand washing and the lessons on school and community sanitation.

Lesson materials

Prepare two glasses of water. One glass should have water that was taken from a source known to contain germs, like a pond or a river. The water should be filtered through a cloth so that it appears clear, but it should not be treated. The other glass should have water that was treated or boiled for one to three minutes, but which looks cloudy (add flour if needed).

Clean, safer water quiz (hands up if ‘yes’ is the answer)

1. Is clean water always safe water? (NO) 2. Can water be made safe by boiling? (YES) 3. Can water be made safe by leaving it in the sun? (YES – and add: in a transparent bottle for 6 hours) 4. Can water have germs in it that cause disease? (YES) 5. Can chemicals make water safe? (YES) 6. Is it safe to share a drinking cup? (NO) 7. If animals go into water, does this make the water unsafe? (YES) 8. Does water for drinking need to be covered? (YES) 9. It is safe to touch water before drinking it? (NO) 10. If people throw rubbish or defecate on the ground, can germs go into the water? (YES)

How to conduct a 60-minute lesson on safe water for 8-10 year olds

1. Question box: Remind the children that they can put any questions they like about clean, safer water into the question box. Questions can be answered at the beginning of another class period. 2. Quiz (5 minutes) Conduct this 10-question quiz before and after the lesson. Read each question aloud. Ask for a show of hands and note down the numbers of hands shown. The quiz should be very quick. When conducting the quiz before the lesson, do not give the answers. 3. Activity one: The safe water trick (10 minutes) Place two glasses of water in front of the class of children. Ask them these questions: _- Which of these glasses of water is safe to drink? Why?

• If I asked you to come up and drink one of these, which would you choose? Why?_ Make the point that it is not the look of the water that makes it safe. Then stir the safe, cloudy water and take a mouthful. Do not let anyone drink the clear, but unsafe water. 4. Activity two: The water pathway (15 minutes) - Ask the children to tell the group where the water they drink at home comes from.^ For example: a well, a tap, or a river.
  • Ask the children to tell the group about how the water is collected. For example: a pot, a can, or a bottle.
  • Ask the children how the water is stored. For example: in a pot or a bottle.
  • Ask the children how the water is taken from its container to where it is used. For example: poured from one container to another, a cup is dipped into the container, or a ladle is dipped into the container.
  • Ask the children if there is any point on that pathway where germs could get in. For example: at the source, when the water is collected, where the water is stored, or when the water is used.
  • Ask the children if their family uses a method to make the water safer (even if this is just for the young children to drink). For example: boiling, sunshine, filtering or chemicals.

Clean, safer water as a topic in other subjects

Mathematics

Science

Language

Art

• If children in the school are collecting water from a number of sources (taps inside and outside, rain water, tanks, springs, rivers, ponds, etc.), they can collect information and then make a bar chart to show where they gather the water. List water sources on the x-axis and the number of children collecting from each source on the y-axis. If water sources vary between seasons then collect data for both seasons and compare. Discuss the dangers in the water at each source and in each season.
• More mathematics lessons:
  • Statistics on water use: how much water we use, and how do we use it.
  • Survey how water is made safe in different households.
  • Volume and weight conversions of water containers.
• Ask the children to work with you to design and make a water filter that could work at the household level. You will need to adapt this activity for your context. Water can be filtered through sand, through fine cloth, or through muslin. Each filter will need its own design. Find a local craftsperson that can help you and the children with the design.
• More science lessons:
  • Collect different chemical methods of treating water available in the community. Teach children to make water safe using each method. Discuss what the chemicals do to make the water safe.
• Children can retell a story from activity three or a locally relevant story and act it out during a school assembly or community gathering.
• Children can draw a “what is wrong with this picture” poster demonstrating places in the community where water is contaminated. The children can then discuss the picture with younger children. For example, a picture may include a child defecating near the river, animals bathing in the river, water containers without lids, etc.