ANNEX
1. PRE-/POST KNOWLEDGE TRAINING TEST
Date: ___________ Position/Title: ______________ Place of work: ______________
In the following multiple choice question, please circle the correct answer. Some questions have more than one correct answer.
1. Which of these is NOT considered a macronutrient?
- Vitamin and minerals
- Protein
- Fat
- Carbohydrate
2. Which of these foods are body-building foods?
- Rice, noodles, bread
- Water lily, eggplant, beansprouts
- Fish, chicken, eggs, beans
- Mango, banana, papaya
3. Exclusive breastfeeding means giving a baby:
- Breast milk and solids
- Breast milk with water, vitamins, and minerals
- Breast milk only — excluding other fluids and drinks, unless medically indicated
- Breast milk with water occasionally
4. What are TWO suggestions you can give to an adult HIV patient with weight loss?
- Increase intake of soft drinks
- Avoid skipping meals
- Eat snacks and desserts after and between meals
- Avoid spicy foods
5. What are THREE signs of a person being risk of malnutrition?
- Low Body Mass Index (BMI)
- Trouble hearing
- Recent weight loss
- Severe diarrhea lasting more than one month
6. What are some of the ways of preparing safer food?
- Clean all raw vegetables and fruits thoroughly with safe water before use or consumption
- Wash hands before handling food
- Throw away any food that has gone bad
- All of the above
7. What are TWO ways that you can communicate to clients during nutrition counseling?
- Provide practical suggestions and recommendations
- Immediately tell the client if he/she is doing something wrong
- Work with clients to identify potential barriers
- Give advice to the client on what to do
Read each of the following statements; decide if they are true or false (mark the appropriate box with a )
Statements | True | False | |
8 | PLHIV are more vulnerable to malnutrition than other people | ||
9 | Good nutrition will improve the effects of antiretroviral therapy helping PLHIV recover their body’s immunity and stay well | ||
10 | PLHIV should avoid certain food groups | ||
11 | PLHIV need to consume more energy every day than people who do not have HIV of the same age, gender, and level of physical activity | ||
12 | Malnourished people are less able to fight infection and therefore they become sick easily | ||
13 | PLHIV should avoid eating animal products | ||
14 | Body Mass Index (BMI) is the best indicator of nutritional status of pregnant women | ||
15 | A child with a Mid-Upper-Arm Circumference (MUAC) of 12.6 cm is growing well | ||
16 | A baby with HIV who is sick and losing weight should be fed twice as much compared with a healthy baby | ||
17 | National Guidelines for the Prevention of Mother-to-Child Transmission of HIV recommends all women including HIV-positive mothers are encouraged to exclusively breastfeed their infants for the first 6 months of life | ||
18 | Pregnant women should avoid eating more food because it can make her baby much bigger, which will lead to a difficult delivery | ||
19 | Telling a client what to do is the best way to change his or her behaviour | ||
20 | Physical activity such as walking, bike riding, and gardening are of |
2. DAILY TRAINING EVALUATION FORM
Date: ____________
Listed below are questions about today’s training sessions. Please answer the questions as honestly as possible – All responses and information are confidential and anonymous.
Please rate today’s training on the following items: (Mark the box using ‘’)
Item | Poor | Fair | Good | Excellent |
Logistics | ||||
Training organization | ||||
Training venue and facilities | ||||
Lunch (if applicable) | ||||
Refreshments (if applicable) | ||||
Teaching and facilitation | ||||
Pace of delivery | ||||
Length of training | ||||
Involvement of participants | ||||
Knowledge of the trainer/s | ||||
Keeping the sessions interesting | ||||
Quality of training materials | ||||
Training content | ||||
Overall information and skills sessions | ||||
Meeting my learning needs | ||||
To what extent do you think you can apply the information presented today to your work? (Circle one)
| Not at all | A little bit | Some | Quite a bit | A lot |
| 1 | 2 | 3 | 4 | 5 |
Individual sessions – Please comment on individual sessions if you wish
Session title | Comment |
What I found most useful was:
Any other comments?
Thank you for taking the time to help us improve our training.
3. FIELD PRACTICE EVALUATION FORM
Date: ____________
Listed below are questions about field practice. Please answer the questions as honestly as possible – All responses and information are confidential and anonymous.
Please rate the field practice on the following items (mark the box using ‘’)
Item | Poor | Fair | Good | Excellent |
Logistics | ||||
Transportation (if applicable) | ||||
Site / target group selection | ||||
Length of field practice session | ||||
Field Practice Supervision | ||||
Overall supervision | ||||
Feedback and support provided | ||||
Meeting my learning needs | ||||
Field Practice Activity | ||||
Opportunity to practice nutrition assessment skills | ||||
Opportunity to practice nutrition counseling skills | ||||
Usefulness to my work | ||||
Meeting my learning needs | ||||
As a result of this field practice activity, how confident are you to conduct (mark the box using ‘’).
Not confident | A little confident | Confident | Very confident | |
Nutrition assessments | ||||
Nutrition counselling session |
What can be done to improve the field practice activity?
Any other comments?
Thank you for taking the time to help us improve our training.
4. FINAL TRAINING EVALUATION
Description | This is a final training evaluation; to be conducted at the end of final day of the training using a participatory evaluation tool. |
Purpose | It is intended to provide overall feedback to the trainers on aspects of the training and gauge participants’ learning experience. This evaluation enables participants to address the strengths and weaknesses of the training. |
Time | 30 minutes |
Materials | Flip chart papers, three coloured cards and thick black markers for participants, tape / glue for putting the cards up on flipcharts |
How to | Prepare a blank matrix (see example below) and draw up ‘smiley faces’ for rating (one smiling face, one sad face, one puzzled face). Give each participant 3 coloured cards e.g. green, red and yellow and ask them to write on their own, one thing for each of the following: (One comment per card)
Collect all cards, read them out to the group and cluster the cards with input from the group based on the key areas to be evaluated. The areas are; general feedback, training content, teaching and facilitation and learning experience. Recap and summarize the comments. |
Example discussion prompts and topic areas | These questions can be used to prompt the group, if they are having problems thinking about what comments to write. General feedback
Training content
Learning experience
These are some of the types of questions that could be found under each topic area (shown in the table below). It is up to the facilitator to group the comments into topic areas, and these prompts may help in that process. |
Positives | Unsure | Negatives | |
General feedback | |||
Training content | |||
Teaching and facilitation | |||
Learning experience |
8. BMI TABLE FOR ADULTS
9. BMI-FOR-AGE CHART FOR CHILDREN AND
ADOLESCENTS AGED 5-19 YEARS OF AGE (LESSON 4)
10. BMI LOOK-UP TABLE FOR DETERMINING BMI FOR CHILDREN AND ADOLESCENT 5-18 YEARS OF AGE
11. OTHER IDEAS FOR USING THE GOOD FOOD TOOLKIT (LESSON 5)
This Training Manual teaches the recommended standard method of nutrition counseling using the Good Food Toolkit. The primary goal of nutrition counseling is to help PLHIV maintain good nutrition status. It is important for HBCT counselors to complete the Nutrition Counseling Monitoring Form at each visit. The form will help counselors give appropriate advice, and it will help them follow-up on PLHIV behavior over time. The standard method of counseling should be conducted about once per month. There will be other opportunities between these counseling visits to use the Toolkit in other creative ways.
Below are some suggestions for other ways to use the Good Food Toolkit materials. Organizations using the Toolkit are also encouraged to come up with their own creative ideas for new ways to use the materials.
1. Plan Snacks
Plan snacks during home visits, use the small cards to help PLHIV and their families plan snacks for the coming week. Easy snacks for many people are bananas and papaya. What other snacks can be made using the foods that are available to the family?
- Sweet potato, boiled or fried
- Fried taro
- Peanuts*
- Cashews*
- Peanut sauce for satay or vegetables
- Snails
*Whole nuts not to be given to children under 5, can be broken into small pieces or into a paste
2. Plan Desserts
Plan desserts during home visits, use the small cards to help PLHIV and their families plan desserts for the coming week. Many desserts are made with coconut milk, fruit and rice or rice flour. What are all of the different fruits or vegetables that can be prepared as desserts with these other ingredients?
- Banana
- Pumpkin
- Sweet potato
- Mango
- Mung beans
- Corn
- What else?
3. Create New “Recipes”
Organizations are encouraged to create small recipe books and organize cooking demonstrations with PLHIV groups to teach how to make soups and dishes more nutritious. Show how the foods in the “purple” family of small cards (enhancers) can be used in the new recipes.
- Add soya beans or mung beans to soup
- Add coconut milk to soup
- Add peanuts or cashews to soup or fried dishes
- Add oil to soup or porridge
4. Support PLHIV mentally and emotionally
HBCT counselors understand that PLHIV are sometimes depressed and sad. This affects many aspects of their life, including their appetite. If a patient is feeling depressed, this is the time to be a good listener. Encourage PLHIV to talk about what worries them. Remind them that they must take good care of their bodies and keep eating even when they are not hungry.
- Use Positive Living card 14, “Enhancing appetite”.
- Use Positive Living card 5, “Exercise”.
- Use Positive Living card 11, “Danger signs of weight loss/poor growth”.
- Let the patient choose their favorite foods from the small cards and make a plan for obtaining them.
5. Food Group Games
Use the small cards to teach PLHIV and their families about the three food groups and why each group is important for health.
Let patients and their families sort the small cards into the different color groups. Practise making “meals” that contain foods from all three groups. Remind participants that every meal should contain at least one food from each of the three food groups.
Color of small cards | Food Group | Function in the body |
Red | Body-Building Group | Helps the body repair itself, build muscle, and keep us strong |
White | Energy Group | Gives energy to live an active life |
Yellow | Protective Group | Provides vitamins and minerals, which help to protect from illness |
Green | Protective Group | Provides vitamins and minerals, which help to protect from illness |
6. Food safety
Use Positive Living card 1 “Hand Washing” and card 2 “Food Safety”. Ask to see the kitchen, and the place where the family usually washes hands, and the area where the family usually defecates.
- Is there soap in the hand-washing place?
- Is there soap and water near the latrine or other place of defecation?
- Is the kitchen in a clean condition?
- Are cooked foods covered?
Suggest ways to correct any problems that are identified with the above questions. Demonstrate correct hand-washing using soap or ash. Show patients and their families how to wash the front and back of hands, between fingers and under fingernails. Wash hands for at least 20 seconds – show patients how to count from 1 to 20 before rinsing off the soap or ash.
7. Increasing iron absorption
Use the small cards to ask PLHIV to identify foods with a lot of iron from animal and plant sources, iron helpers and iron blockers. Draw two circles that intersect and overlap to create a Venn diagram (see picture) and ask PLHIV to place small food cards in the right circle.
8. Meal planning for babies and children – making good complementary feeding
Use Positive Living card 22 “Starting foods with your baby (6-24 months)” and the small cards to help mothers and their families plan good complementary food.
12. MONITORING FORMS –COMMUNITY BASED ASSESSMENT (LESSON 5)
Home-Based Care Name of counselor: ________________________ | Next appointment date:___/____/____ |
Counselor’s Monitoring Form – Adults
(both gender and over 6 months post-partum women)
General Information | |||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. Name of client: | ||||||||||||||||||||||||||||
3. Age (years): | 4. Gender (tick): Male Female | 5. Address of client: | |||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | |||||||||||||||||||||||||||||
Health and Body Measurements | |||||||||||||||||||||||||||||
6. Problem told by client: | 7. a. Is the client taking ARV medication? b. Is the client taking OI medication? c. Missed taking ARV doses since last visit? | ||||||||||||||||||||||||||||
8. a. Client’s weight today = ______kg b. Client’s height =___________cm c. Client’s BMI found: ________ | 9. Nutritional status: Underweight/malnourished, BMI less than18.50 Normal, BMI 18.50–24.99 Overweight, BMI 25.0 or more | ||||||||||||||||||||||||||||
Dietary Intake | |||||||||||||||||||||||||||||
10. a. What does the client eat typically each day? Put a tick in the appropriate box.
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b. Number of meals consumed per day: c. Number of snacks consumed per day: d. Number of liquids drank per day: | e. Are the three food groups (energy, protective and body building) eaten with each meal? f. Does the client eat iron rich foods (e.g. red meat, chicken, fish, egg, beans, green leafy vegetables)? | ||||||||||||||||||||||||||||
11. Diet is:
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Step 3 & 4: Suggest & Negotiate | |||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor:
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Step 5: Follow Up | |||||||||||||||||||||||||||||
13. Monitoring and Follow up: | |||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: Home Based Care (HBC) workers, and Self Help Group (SHG) members. May be also used by trained counselors, community workers, who are working with PLHIV, and case managers.
Key targets: People living with HIV who are over the age of 19 years, including HIV positive post partum women over 6 months after delivery.
Home-Based Care Name of counselor: ________________________ | Next appointment date:___/____/____ |
Counselor’s Monitoring Form –
Adults pregnant and post-partum women within 6 months after delivery
General Information | |||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. Name of client: | ||||||||||||||||||||||||||||
3. Age (years): | 4. Pregnancy status (tick): Pregnant, gestational age: ______months Post delivery (up to 6 months): Breastfeeding Non breastfeeding; | 5. Address of client: | |||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | |||||||||||||||||||||||||||||
Health and Body Measurements | |||||||||||||||||||||||||||||
6. Problem told by client: | 7. a. Is the client taking ARV medication? Yes No b. Is the client taking OI medication? Yes No c. Missed taking ARV doses since last visit? Yes No | ||||||||||||||||||||||||||||
8. Client’s Mid Upper Arm Circumference (MUAC):_______cm | 9. Nutritional status: | ||||||||||||||||||||||||||||
Dietary Intake | |||||||||||||||||||||||||||||
10. a. What does the client eat typically each day? Put a tick in the appropriate box.
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b. Number of meals consumed per day: c. Number of snacks consumed per day: d. Number of liquids drank per day: | e. Are the three food groups (energy, protective and body building) eaten with each meal? f. Does the client eat iron rich foods (e.g. red meat, chicken, fish, egg, beans, green leafy vegetables)? | ||||||||||||||||||||||||||||
11. Diet is:
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Step 3 & 4: Suggest & Negotiate | |||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor:
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Step 5: Follow Up | |||||||||||||||||||||||||||||
13. Monitoring and Follow up: | |||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: Home Based Care (HBC) workers, and Self Help Group (SHG) members. May be also used by trained counselors, community workers, who are working with PLHIV, and case managers.
Key targets: HIV positive pregnant women who are over the age of 19 years, and HIV positive post partum women who are over the age of 19 years within 6 months post baby delivery.
Home-Based Care Name of counselor: ________________________ | Next appointment date:___/____/____ |
Counselor’s Monitoring Form – Children and adolescents (0-19 years)
General Information | ||||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. a. Name of child: __________________________________________ | |||||||||||||||||||||||||||||
3. Name and relationship of parent/carer: | 4. Address: | |||||||||||||||||||||||||||||
5. a. HIV status: Positive Negative HIV exposed Unknown Child has had HIV status withheld b. Date of last medical checkup: __/___/___ | ||||||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | ||||||||||||||||||||||||||||||
Health and Body Measurements | ||||||||||||||||||||||||||||||
6. Child’s problem told by parent/carer: | 7. a. Is the client taking ARV medication? Yes No b. Is the client taking OI medication? Yes No c. Missed taking ARV doses since last visit? Yes No | |||||||||||||||||||||||||||||
8. If child is 0-6 months: | If child is aged 6-59 months: Child’s MUAC* is: _______cm *Mid Upper Arm Circumference | If child is aged 5-19 years: Child’s height: ____meters Child’s weight: ______kg Child BMI-for-age: ________ In comparison with previous weight ( ___kg, Date:__/__/__) the recent weight is: | ||||||||||||||||||||||||||||
9. Nutritional status | Physical assessment | MUAC (6-59 months) | BMI-for-age (5-19 years) | |||||||||||||||||||||||||||
Normal | No edema | More than 12.5 cm | Equal or more than -2 SD | |||||||||||||||||||||||||||
Moderately malnourished | No edema | Equal or more than 11.5 to equal or less than 12.5 cm | Between -3 and -2 SD | |||||||||||||||||||||||||||
Severely malnourished | Bilateral pitting edema (Refer to health centre) | Bilateral pitting edema OR Less than 11.5cm | Equal or less than -3 SD | |||||||||||||||||||||||||||
Dietary Intake | ||||||||||||||||||||||||||||||
10. What does the child eat/drink typically each day? Put a tick in the appropriate box If child is 0-6 months: Exclusively breastfed: Yes No Replacement feeding: Yes No If the child is cup fed, is the formula prepared correctly? Yes No Hygienically? Yes No | ||||||||||||||||||||||||||||||
If child is aged 6-59 months or child/adolescent is aged 5-19 years:
Number of meals per day: 0-1 2 3 4 5 Number of snacks consumed per day : 0-1 2 3 or more Number of liquids other than water drank per day (liters): 0-1 2 3 or more Number of cups of water drank per day: ______ cups/bowls If child is aged 6 -59 months: Specify the liquid (milk, infant formula):______cups | ||||||||||||||||||||||||||||||
11. Diet is: | ||||||||||||||||||||||||||||||
Diet of child under six months of age Poor, No exclusive breastfeeding or unsafe replacement feeding Good, Exclusive breastfeeding or safe replacement feeding | ||||||||||||||||||||||||||||||
Diet of child 6-59 months of age Poor, per day: <2 meals or snacks, 1 food groups, 0-1 cup of milk if 6-24 months and no breastfeeding Fair, per day: 2 meals & 1-2 snacks, 1-2 food groups, 1-2 cups of milk if 6-24 months and no breastfeeding Good, per day: at least 3 meals & 1-2 snacks, ≥3 food groups, ≥2 cups of milk if 6-24 months and no breastfeeding | ||||||||||||||||||||||||||||||
Diet of child or adolescent 5 – 19 years of age
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Step 3 & 4: Suggest & Negotiate | ||||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor
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Step 5: Follow Up | ||||||||||||||||||||||||||||||
13. Monitoring and Follow up: | ||||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: Home Based Care (HBC) workers, and Self Help Group (SHG) members. May be also used by trained counselors, community workers, who are working with PLHIV, and case managers.
Key targets: Children and adolescent living with HIV who are under the age of 19 years, and children part of a family who is affected by HIV .
13. MONITORING FORMS –FACILITY BASED ASSESSMENT (LESSON 5)
General Information | |||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. Name of client: | ||||||||||||||||||||||||||||
3. Age (years): | 4. Gender (tick): Male Female | 5. Address of client: | |||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | |||||||||||||||||||||||||||||
Health and Body Measurements | |||||||||||||||||||||||||||||
6. Problem told by client: | 7. a. Is the client taking ARV medication? b. Is the client taking OI medication? c. Missed taking ARV doses since last visit? | ||||||||||||||||||||||||||||
8. a. Client’s weight today = ______kg b. Client’s height =___________cm c. Client’s BMI found: ________ | 9. Nutritional status: Underweight/malnourished, BMI less than18.50 Normal, BMI 18.50–24.99 Overweight, BMI 25.0 or more | ||||||||||||||||||||||||||||
Dietary Intake | |||||||||||||||||||||||||||||
10. a. What does the client eat typically each day? Put a tick in the appropriate box.
| |||||||||||||||||||||||||||||
b. Number of meals consumed per day: c. Number of snacks consumed per day: d. Number of liquids drank per day: | e. Are the three food groups (energy, protective and body building) eaten with each meal? f. Does the client eat iron rich foods (e.g. red meat, chicken, fish, egg, beans, green leafy vegetables)? | ||||||||||||||||||||||||||||
11. Diet is:
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Step 3 & 4: Suggest & Negotiate | |||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor:
| |||||||||||||||||||||||||||||
Step 5: Follow Up | |||||||||||||||||||||||||||||
13. Monitoring and Follow up: | |||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: facility-based health care workers (including nurses and doctors), health centre staff, and OI/ART clinic staff.
Key targets: People living with HIV who are over the age of 19 years, including HIV positive post partum women over 6 months after delivery.
Name of facility: _________________________ Name of counselor: ________________________ | Next appointment date:___/____/____ |
Counselor’s Monitoring Form – Adults pregnant and post-partum women within 6 months after delivery
General Information | |||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. Name of client: | ||||||||||||||||||||||||||||
3. Age (years): | 4. Pregnancy status (tick): Pregnant, gestational age: ______months Post delivery (up to 6 months): Breastfeeding Non breastfeeding; | 5. Address of client: | |||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | |||||||||||||||||||||||||||||
Health and Body Measurements | |||||||||||||||||||||||||||||
6. Problem told by client: | 7. a. Is the client taking ARV medication? Yes No b. Is the client taking OI medication? Yes No c. Missed taking ARV doses since last visit? Yes No | ||||||||||||||||||||||||||||
8. a. Today’s MUAC: _______cm b. Today’s Weight = _____ kg c. If pregnant, pre pregnancy weight ____kg How much weight did the client gain to date? ____kg | 9. Nutritional status: | ||||||||||||||||||||||||||||
Dietary Intake | |||||||||||||||||||||||||||||
10. a. What does the client eat typically each day? Put a tick in the appropriate box.
| |||||||||||||||||||||||||||||
b. Number of meals consumed per day: c. Number of snacks consumed per day: d. Number of liquids drank per day: | e. Are the three food groups (energy, protective and body building) eaten with each meal? f. Does the client eat iron rich foods (e.g. red meat, chicken, fish, egg, beans, green leafy vegetables)? | ||||||||||||||||||||||||||||
11. Diet is:
| |||||||||||||||||||||||||||||
Step 3 & 4: Suggest & Negotiate | |||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor:
| |||||||||||||||||||||||||||||
Step 5: Follow Up | |||||||||||||||||||||||||||||
13. Monitoring and Follow up: | |||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: facility-based health care workers (including nurses and doctors), health centre staff, and OI/ART clinic staff.
Key targets: HIV positive pregnant women who are over the age of 19 years, and
HIV positive post partum women who are over the age of 19 years within 6 months post baby delivery.
Name of facility: _________________________ Next appointment date:___/____/____
Name of counselor: ________________________
Counselor’s Monitoring Form –
Children and adolescents (0-19 years)
General Information | ||||||||||||||||||||||||||||||
1. Date of visit: __/___/___ | 2. a. Name of child: __________________________________________ | |||||||||||||||||||||||||||||
3. Name and relationship of parent/carer: | 4. Address: | |||||||||||||||||||||||||||||
5. a. HIV status: Positive Negative HIV exposed Unknown Child has had HIV status withheld b. Date of last medical checkup: __/___/___ | ||||||||||||||||||||||||||||||
Step 1 & 2: Assess & Analyze | ||||||||||||||||||||||||||||||
Health and Body Measurements | ||||||||||||||||||||||||||||||
6. Child’s problem told by parent/carer: | 7. a. Is the client taking ARV medication? Yes No b. Is the client taking OI medication? Yes No c. Missed taking ARV doses since last visit? Yes No | |||||||||||||||||||||||||||||
8. If child is 0-6 months: | If child is aged 6-59 months: Child’s MUAC* is: _______cm *Mid Upper Arm Circumference | If child is aged 5-19 years: Child’s height: ____meters Child’s weight: ______kg Child BMI-for-age: ________ In comparison with previous weight ( ___kg, Date:__/__/__) the recent weight is: | ||||||||||||||||||||||||||||
9. Nutritional status | Physical assessment | MUAC (6-59 months) | BMI-for-age (5-19 years) | |||||||||||||||||||||||||||
Normal | No edema | More than 12.5 cm | Equal or more than -2 SD | |||||||||||||||||||||||||||
Moderately malnourished | No edema | Equal or more than 11.5 to equal or less than 12.5 cm | Between -3 and -2 SD | |||||||||||||||||||||||||||
Severely malnourished | Bilateral pitting edema (Refer to health centre) | Bilateral pitting edema OR Less than 11.5cm | Equal or less than -3 SD | |||||||||||||||||||||||||||
Dietary Intake | ||||||||||||||||||||||||||||||
10. What does the child eat/drink typically each day? Put a tick in the appropriate box If child is 0-6 months: Exclusively breastfed: Yes No Replacement feeding: Yes No If the child is cup fed, is the formula prepared correctly? Yes No Hygienically? Yes No | ||||||||||||||||||||||||||||||
If child is aged 6-59 months or child/adolescent is aged 5-19 years:
Number of meals per day: 0-1 2 3 4 5 Number of snacks consumed per day : 0-1 2 3 or more Number of liquids other than water drank per day (liters): 0-1 2 3 or more Number of cups of water drank per day: ______ cups/bowls If child is aged 6 -59 months: Specify the liquid (milk, infant formula):______cups | ||||||||||||||||||||||||||||||
11. Diet is: | ||||||||||||||||||||||||||||||
Diet of child under six months of age Poor, No exclusive breastfeeding or unsafe replacement feeding Good, Exclusive breastfeeding or safe replacement feeding | ||||||||||||||||||||||||||||||
Diet of child 6-59 months of age Poor, per day: <2 meals or snacks, 1 food groups, 0-1 cup of milk if 6-24 months and no breastfeeding Fair, per day: 2 meals & 1-2 snacks, 1-2 food groups, 1-2 cups of milk if 6-24 months and no breastfeeding Good, per day: at least 3 meals & 1-2 snacks, ≥3 food groups, ≥2 cups of milk if 6-24 months and no breastfeeding | ||||||||||||||||||||||||||||||
Diet of child or adolescent 5 – 19 years of age
| ||||||||||||||||||||||||||||||
Step 3 & 4: Suggest & Negotiate | ||||||||||||||||||||||||||||||
12. Key suggestions provided by the counselor
| ||||||||||||||||||||||||||||||
Step 5: Follow Up | ||||||||||||||||||||||||||||||
13. Monitoring and Follow up: | ||||||||||||||||||||||||||||||
Usage Notes:
The key administrators/users of this tool are: facility-based health care workers (including nurses and doctors), health centre staff, and OI/ART clinic staff.
Key targets: xhildren and adolescent living with HIV who are under the age of 19 years, and children part of a family who is affected by HIV.
14. ROLE PLAY SCENARIO AND OBSERVER CHECKLIST (LESSON 5)
SCENARIO – Client
You are a 30 year old female (not pregnant) with low literacy. You were diagnosed with HIV 7 years ago. You have been on ART for 3 months. You attend the OI/ART clinic today because you have loose bowel motions, nausea and find it difficult to eat because of mouth sores. During your last visit to the clinic the doctor told you that you have to eat well in order to benefit from the ART medications.
You live with your husband and your family in rural village. You have one daughter. In your garden you grow bananas, morning glory, pumpkin and tomato and have 3 chickens. You don’t know if you have lost any weight recently but you are feeling weaker and people tell you that you look sick and thin. You are weighed by the health staff and your weight is 44kg and your height is 155cm.
Your typical food intake the last 2 weeks has been:
- Breakfast:
- Rice porridge/plain borbor (1/2 bowl)
- Tea
- Lunch
- Rice with fish and vegetables, chilli
- Coffee – black
- Dinner
- Nil to eat as feels more nauseous at night
- Snack
- Occasionally banana
Observer Checklist
Health/Community Worker
Indicate if the health/community worker covered these topics:
Step 1 – Assess: health and nutrition assessment conducted
Step 2 – Analyse: problem areas identified
Step 3 – Suggest: options/solutions provided to client
Step 4 – Negotiate: negotiation conducted to overcome barriers
Step 5 – Follow up: ongoing monitoring and follow up is planned
Please list nutrition assessment conducted:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Nutrition counseling provided based on health and nutrition assessment
Address eating habits
Address individual situation
Promote positive nutrition
Provide non-judgmental counseling
Please list nutrition counseling provided:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Use of appropriate Positive Living cards, please specify Positive Living card/s used
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Client
Indicate if the client understands these points:
Healthy eating
Symptoms management
Other comment:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
15. CARD SELECTION TABLE AND INSTRUCTIONS FOR USING POSITIVE LIVING CARDS
Who will be counseled | General Situation Card (Positive Living – Health Maintenance) | Card # | Specific Situation Card (Positive Living – Symptoms Management) | Card # |
Adult PLHIV (man and non pregnant woman) | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Manage side effects of ARV | 10 | |
Oral hygiene | 3 | Danger signs of weight loss | 11 | |
Plan ahead for security | 4 | Enhancing appetite with “comfort foods” | 14 | |
Exercise | 5 | Managing diarrhea | 15 | |
Limit alcohol, avoid smoking | 6 | Managing nausea and vomiting | 16 | |
Health and weight check every month | 7 | Managing thrust | 17 | |
Take medicine as directed | 9 | Managing fever | 18 | |
Drink plenty of fluids | 12 | Anemia | 19 | |
Three meals, two snacks every day | 13 | |||
Eating well | 20 | |||
Pregnant woman living with HIV | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Manage side effects of ARV | 10 | |
Oral hygiene | 3 | Danger signs of weight loss | 11 | |
Plan ahead for security | 4 | Enhancing appetite with “comfort foods” | 14 | |
Exercise | 5 | Managing diarrhea | 15 | |
Limit alcohol, avoid smoking | 6 | Managing nausea and vomiting | 16 | |
Health and weight check every month | 7 | Managing thrust | 17 | |
Take medicine as directed | 9 | Managing fever | 18 | |
Drink plenty of fluids | 12 | Anemia | 19 | |
Eat well when you are pregnant or breastfeeding | 21 | |||
Mother with HIV who has chosen exclusive breastfeeding for the first six months | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Manage side effects of ARV | 10 | |
Oral hygiene | 3 | Danger signs of weight loss | 11 | |
Plan ahead for security | 4 | Enhancing appetite with “comfort foods” | 14 | |
Exercise | 5 | Managing diarrhea | 15 | |
Limit alcohol, avoid smoking | 6 | Managing nausea and vomiting | 16 | |
Health and weight check every month | 7 | Managing thrust | 17 | |
Take medicine as directed | 9 | Managing fever | 18 | |
Drink plenty of fluids | 12 | Anemia | 19 | |
Eat well when you are pregnant or breastfeeding | 21 | |||
Tips for breastfeeding | 25 | |||
Mother/father/grandparent/caregiver with | ||||
Child 0 – 6 months living with HIV and exclusively breastfed | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Take medicine as directed | 9 | Danger signs of weight loss | 11 | |
Tips for breastfeeding | 25 | Managing diarrhea | 15 | |
Managing nausea and vomiting | 16 | |||
Managing thrust | 17 | |||
Managing fever | 18 | |||
Child 6 up to 24 months living with HIV | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Danger signs of weight loss | 11 | |
Oral hygiene | 3 | Enhancing appetite with “comfort foods” | 14 | |
Take medicine as directed | 9 | Managing diarrhea | 15 | |
Starting foods with your baby (6-24 months) | 22 | Managing nausea and vomiting | 16 | |
Promoting good growth for children living with HIV | 24 | Managing thrust | 17 | |
Managing fever | 18 | |||
Anemia | 19 | |||
Child 2 up to 5 years living with HIV | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Danger signs of weight loss | 11 | |
Oral hygiene | 3 | Enhancing appetite with “comfort foods” | 14 | |
Take medicine as directed | 9 | Managing diarrhea | 15 | |
Promoting good growth for children living with HIV | 24 | Managing nausea and vomiting | 16 | |
Managing thrust | 17 | |||
Managing fever | 18 | |||
Anemia | 19 | |||
Child >5 years and adolescents living with HIV | Hand washing | 1 | Eat well when you are pregnant or breastfeeding | 8 |
Food safety | 2 | Danger signs of weight loss | 11 | |
Oral hygiene | 3 | Enhancing appetite with “comfort foods” | 14 | |
Take medicine as directed | 9 | Managing diarrhea | 15 | |
Drink plenty of fluids | 12 | Managing nausea and vomiting | 16 | |
Three meals, two snacks every day | 13 | Managing thrust | 17 | |
Eating well | 20 | Managing fever | 18 | |
Feeding school age children and youth | 23 | Anemia | 19 | |
Instructions for using the Positive Living Cards
This set of cards is for use by HBCT members, health workers, counselors, self help group members, and others who counsel adult PLHIV, HIV-positive pregnant and breastfeeding women, HIV-exposed infants, children living with HIV and OVC.
Counselors using these cards should have received a full training on using the Good Food Toolkit. These cards are supported by “Card Selection Table” which provides guidance about possible cards to be used in counseling according to the target groups. There are 25 cards in the set that include:
- “General Situation cards” – practical strategies to enhance health of PLHIV
- “Specific Situation Cards”– practical strategies to manage symptoms of HIV
The cards are illustrated on one side and have questions and discussion points on the other side. The discussion points are a guide to help counselors create two-way conversations with PLHIV while allowing the opportunity to modify the advice to meet a PLHIV situation and current practices. The illustrations allow the client/caregivers/family members to visualize key behaviors.
General counseling guidelines
- Organize your counseling tools before beginning a counseling session.
- Greet the client (and caregiver(s)/family members) and establish confidence.
- Select the appropriate Positive Living card/s
- Ask questions and LISTEN!! People trust others who show interest in their lives
- Provide correct information (Key Messages)
- Discuss what is possible. Help PLHIV and their caregivers/families find the realistic solution and make plan for it
- Focus on one or two practices that are feasible for their situation that they agree to practice in a session.
- Keep a record of the topics you have discussed. Write on the Counselor Monitoring Form which cards you discussed and choose the key suggested actions that the PLHIV will take to solve his/her problem.
Listening and learning skills
- Use helpful non-verbal communication
- Ask open questions
- Use responses and gestures
- Reflect back what the client/caregiver(s) says
- Empathize – show that you understand how the client feels
- Avoid judging words.
16. NUTRITION COUNSELING SKILLS CHECKLIST (LESSON 6)
Did the counselor | Yes | No |
Greet the client (and caregivers) and established confidence? | ||
Communicate in language based on the client’s knowledge, cultural, values and beliefs? | ||
Listen to what the client (and caregivers) says? | ||
Identify key difficulties, if any, and select with the client (and caregivers) the most important one to address? | ||
Discuss options? | ||
Recommend and negotiate do-able actions, helping the client (and caregivers) select the best option to try depending on their context and resources? | ||
Help the client (and caregivers) agree to try one or two of the options? | ||
Ask the client (and caregivers) to repeat the agreed do-able action? | ||
Give the client (and caregivers) an opportunity to ask questions? | ||
Respond to the client (and caregivers)’s questions? | ||
Make an appointment for the follow up visit? |
17. FIELD PRACTICE GUIDE
On the fifth day of the Training, participants should have an opportunity to practice the skills that they have learned. The facilitator(s) should organize a field visit, which is a time for each participant to practice giving a complete counseling session to at least one (or if possible, two) PLHIV. If participants will be working with pregnant or breastfeeding women or children, please ensure the field visit includes at least one individual from this group. A family counseling experience would be most useful.
General considerations:
- As with all home-based care services to PLHIV, confidentiality of the client’s status must be protected and respected in the supervised field practice. This is why we call it the “Good Food Toolkit” and not the “Good Food Toolkit for PLHIV”. Neighbors and other community members will be curious to see the food cards in the Toolkit, and hear what the counselors have to say. It is enough to explain that the counseling is for how to use good foods to eat well and stay healthy. Encourage neighbors and others to continue with their daily activities and to give privacy to the counselors and the person/family receiving counseling.
- Facilitators should observe each participant’s practice counseling session, and use the “Supervision Check List” that is provided. Facilitators will need one supervision checklist per participant.
- A good Supervisor/Facilitator provides feedback and suggestions to the participants as they practice counseling, but also allows them to continue leading the counseling visit. A good Supervisor/Facilitator does not take control of the counseling session away from the counselor. This does not help the participant to learn. Provide specific guidance, as suggestions, during the counseling session, when it is necessary to keep the process moving forward, in the correct and complete sequence. Save general feedback until after the counseling session.
- Facilitators should review the Supervision Checklist with participants before the supervised field practice. This way, participants can know what will be expected of them in the practice exercise.
- Facilitators should review the completed Supervision Checklist with participants after the practice counseling session. This will help the participant understand how they can improve their skills in the future.
- Schedule the supervised field visit in the morning. In the afternoon of the same day, debrief with all participants on their experience. You can use the following questions to stimulate group discussion and sharing of experience:
a. Did you find it easy or difficult to use the Toolkit in the real situation? Why easy? Why difficult?
b. Did you find it easy or difficult to complete the Monitoring Form in the real situation? Why easy? Why difficult?
c. What was one new thing that you learned in the field practice that you did not already learn or understand from the training?
d. What do you think will be a challenge in using the Toolkit in the future? Does anyone have ideas for how to overcome this challenge?
- Following the debriefing on the afternoon of the fourth day of Training, the facilitators should organize a small “Certificate Ceremony”. Present certificates to all participants. Congratulate them on their new knowledge and skills, and wish them luck in their work in the future.
Counselor Nutrition Assessment and Counseling Checklist
The following checklists can be used to encourage, monitor and improve the quality of nutrition assessment and counseling to PLHIV carried out by a counselor. This form can be used by supervisors / mentors as a guide to provide focused and constructive feedback as well as a self- or peer-assessment instrument.
Name of Counselor: _______________________ Position: _____________________________
Name of Supervisor / Mentor / Peer: ____________________________________________________
Location: ________________________________ Date of observation: ___________________
Type of client (please tick appropriate box)
adult
pregnant
less than 6 months post delivery: o breastfeeding o non breastfeeding
breastfeeding (more than 6 months post delivery)
child aged 0-6 months
child aged 6-59months
child or adolescent aged 5-19 years
Place under the correct box for each observation.
N/A | Not Achieved | Partially Achieved | Fully Achieved | Comments/observation | |
Did the Counselor / your peer / you | |||||
Preparation and Introduction | |||||
Greet the PLHIV/children/OVC and family in a friendly manner? | |||||
Explain the purpose of the visit to PLHIV and family? | |||||
Completely and correctly fill in all information in the first box at the top page of the Counselor’s Monitoring Form? | |||||
Identify the client’s BMI and any recent weight loss, if applicable? | |||||
Assessment and Analysis | |||||
Health and nutrition assessment | |||||
Correctly assess the client for signs of illness or infection? | |||||
Correctly identify any recent weight loss, if applicable? | |||||
Anthropometry assessment | |||||
Non pregnant adult: | |||||
Accurately weigh and measure the height? | |||||
Accurately calculate and/or interpret BMI? | |||||
Pregnant and post partum woman within 6 months after delivery or child (6-59 months) | |||||
Accurately measure and interpret the MUAC? | |||||
Child or adolescent aged 5-19 years | |||||
Accurately weigh and measure the length/ height and interpret BMI-for-age? | |||||
Infant 0-6 months | |||||
Accurately check for edema? | |||||
Accurately assess and classify nutritional status of the client? | |||||
Dietary assessment | |||||
Assess and correctly interpret correctly typical meals, snacks and liquids consumed by the client? | |||||
Assess and correctly interpret the client’s frequency of typical meals, snacks and liquids consumed? | |||||
Behavior Change Negotiation and Follow up | |||||
Use good non-verbal communication? | |||||
Listen to what the client (and caregivers) says? | |||||
Identify key difficulties, if any, and select with the client (and caregivers) the most important one to address? | |||||
Recommend and negotiate do-able actions, helping the client (and caregivers) select the best option to try depending on their context and resources? | |||||
Give the client (and caregivers) an opportunity to ask questions and respond appropriately? | |||||
Schedule a follow up appointment with the client/parent/care giver? | |||||
Use of the Good Food Toolkit’s job aids | |||||
Correctly use the small food cards in assessment? | |||||
Correctly use the large food cards in assessment? | |||||
Correctly use the small food cards to negotiate the selected behavior change? | |||||
Correctly use the large food cards to negotiate the selected behavior change? | |||||
Use appropriate Positive Living cards in the counseling session, depending on the client’s circumstances? | |||||
18. TEST QUESTIONS
Test questions for Lesson 1
Q1. Choose the correct target audience for the “Good Food Toolkit”:
(There maybe more than one answer)
- HC staff who provide nutrition education to PLHIV
- Adult PLHIV and their families
- Commercial sex workers who have not yet been tested for HIV
- HIV-positive children
- HIV-positive pregnant and breastfeeding women
Q2. Circle the items that are included in the “Good Food Toolkit”:
- Pictures of spoons
- “Positive Living” counselling cards
- “Small food cards” with pictures of many different foods
- Monitoring form for “Nutrition Counselling”
- “Large food cards” with pictures of plates of rice, soup, desserts, etc.
- Vitamin supplements for PLHIV
Test questions for Lesson 2
Q1. What are the three food groups?
Q2. For each of the following foods, write down the correct food group:
Rice | ____________ |
Pumpkin | ____________ |
Fish | ____________ |
Sugar | ____________ |
Green leaves | ____________ |
Papaya | ____________ |
Egg | ____________ |
Ground Nuts | ____________ |
Pineapple | ____________ |
Beans | ____________ |
Q3. What is a calorie? Circle the correct answer.
- An ingredient that makes food taste delicious.
- A measurement of a person’s body weight in relation to their height.
- A unit of measuring energy in the food that we eat.
Q4. True or False – PLHIV need to eat more energy every day than people who do not have HIV.
Q5. True of False – PLHIV who are sick do not need to eat more energy per day than when they are not sick.
Q6. At what age should a child begin to eat foods in addition to breast milk?
Q7. What food is more nutritious- breast milk or plain bobor?
Q8. Name one ingredient that can be added to make “enriched bobor”? (This question can be asked to more than one participant).
Q9. How many meals should breastfeeding women with HIV eat in one day?
Q10. True or False – Pregnant adolescents are at greater nutritional risk than pregnant adults.
Test questions for Lesson 3
Q1. Why is it difficult for PLHIV to get out of the cycle of malnutrition and illness? (Fill in the blanks with the correct words from the list).
Being sick causes people to feel _______________, which causes them to eat less, leading to __________ and malnutrition. Malnourished people are less able to fight ________ and therefore become sick more easily.
- infection
- not hungry
- weight loss/poor growth
Q2. Circle the seven recommended strategies for PLHIV to gain weight:
- Eat more meals
- Avoid chili and spicy food
- Eat more food at each meal from the three food groups
- Sleep as much as you want, whenever you want
- Eat snacks or desserts between or after meals
- Add “enhancers” like coconut milk, oil, peanuts, or soya beans to your food/soup and thicken your soup.
- Drink more water
- Have infections and illnesses treated quickly and properly
- Have drinks with energy in them
- Increase milk feeds (breast milk or safely and appropriately prepared infant formula) for infants and young children
Q3. TRUE or FALSE:
- It is okay, and often beneficial for PLHIV to eat fresh vegetables as long as they are well-cleaned.
- It is okay for PLHIV to eat seafood as long it is fresh and well cooked.
- PLHIV with severe diarrhea should take fried or fatty foods out of their diet temporarily.
- PLHIV should not eat sour or fermented foods.
- It is o.k. for PLHIV to eat chili as long as it does not irritate their stomachs.
- If a PLHIV has an open wound he/she should not eat chicken.
- If a PLHIV has fever he/she should not eat sweet foods.
- It is okay for pregnant women to eat one meal per day.
- Adequate rest and eating well is required for post-partum women to recover quickly.
- Breastfeeding women should not eat uncooked vegetables.
- A sick child should not eat Samlor koko.
Test questions for Lesson 4
Q1. True or False: Body Mass Index (BMI) is a ratio of a person’s weight relative to his/her height, expressed as a number.
Q2. If a person is 1.5 meters tall, how many centimeters tall is that person?
- 150 centimeters
- 1500 centimeters
- 15 centimeters
Q3. True or False: When we choose a place to measure height, the tape measure must be securely fastened to the wall, but the wall does not have to be perfectly flat.
Q4. True or False: When fastening the tape measure to the wall, it is acceptable if the zero mark is not all the way down to where the floor meets the wall.
Q5. Which of the following should you do before taking weight of an adult?
- Set scales on hard surface, in good light
- Zero the scales
- Ask the client to remove heavy outer clothing such as jackets, vests etc
- Keep sandals on
Q6. What is the BMI for a person that is 154 cm and 47 kilograms? Is this PLHIV underweight, overweight, or normal?
Test questions for Lesson 5
Q1. When should a counselor begin to prepare the information in the top box of the front page of the Monitoring Form?
- When they arrive to the home of the PLHIV
- After they have completed the visit with the PLHIV
- Before visiting PLHIV
Q2. What do the colors on the backs and borders of the small food cards represent? Match the color to its meaning by drawing a line from the color to the food group that it represents:
Q3. Circle 7 improvements can be negotiated with the client:
RED | Energy Group |
WHITE | Body-building Group |
YELLOW | “Enhancer” foods |
GREEN | Protective Group |
PURPLE |
Q3. Circle 7 improvements can be negotiated with the client:
- Eat more food (rice and thicker soup) during the meal.
- Eat meals more often during the day (at least 3 times per day).
- Drink coffee 3 times a day.
- Eat snacks / deserts more often during the day (at least 2 times per day).
- Eat only white foods (energy) group per day.
- Drink 2 liters (4 – 6 glasses) of fluid per day.
- Drink alcohol at every ceremony and party.
- Eat from all the colors / food groups every day.
- Add “enhancers” to meals.
- Skip meals when you do not feel like eating.
- Seek medical care immediately for infections, illness, and weight loss. Increase food intake until the weight loss during illness is regained and maintained.
Q4. How many improvements should the HBCT/counselor negotiate at one visit?
- All seven Improvements
- 3 – 4 per visit
- 1 – 2 improvements per visit
Q5. What would you do if a client did not eat red foods (body building) at every meal?
Test questions for Lesson 6
Q1. Put the following steps for using the positive living cards in the correct order. In the space next to the step, write the numbers 1 to 5.
___ Ask PLHIV what they see in the picture (and other questions) and LISTEN
___ Select the appropriate cards
___ Discuss what is possible
___ Keep a record of the cards you’ve discussed on the Monitoring Form and choose the key suggested actions
___ Provide correct information
Q2. True or False: When we give information, one person talks and the other person listens. But when we give counseling, two people talk and listen to each other, in order to solve the problem.
Q3. True or False: Counseling is more effective than only giving information.
Q4. How will you decide which Positive Living Card to use with the PLHIV you are visiting?
Q5. How many Positive Living Cards will you use with one PLHIV at one visit?
Q6. What are some examples of effective verbal communication? (Select all that apply)
- a. Closed questions
- b. Open questions
- c. Paraphrasing
- d. Remove barriers
19. TEST ANSWERS
- LESSON 1 TEST ANSWERS
Q1. (b), (d) and (e).
Q2. (b), (c), (e), (d), and (f). The items shown in (a) and (g) are not included in the “Good Food Toolkit.”
- LESSON 2 TEST ANSWERS
Q1. (1) Energy Group, (2) Protective Group, and (3) Body-building Group.
Q2. (a) Rice – Energy, (b) Pumpkin – Protective, (c) Fish – Body-building, (d) Noodles – Energy, (e) Sugar – Energy, (f) Green leaves – Protective, (g) Papaya – Protective, (h) Egg – Body-building, (i) Ground Nuts – Body Building, (j) Pineapple – Protective, and (k) Beans – Body-building
Q3. (c). A calorie is a unit of measuring energy in the food that we eat.
Q4. True.
Q5. False. PLHIV who are sick should consume more calories per day when they are sick, to help their body fight the illness.
Q6. 6 months
Q7. Breast milk
Q8. Dark green leafy vegetables, cooked pumpkin, oil, iodized salt, egg, fish, meat, coconut, etc
Q10. 3 meals and 2 snacks or at least 4 meals
Q11. True
- LESSON 3 TEST ANSWERS
Q1. Being sick causes people to feel not hungry, this causes them to eat less, leading to weight loss and malnutrition. Malnourished people are less able to fight infection and therefore become sick more easily.
Q2. (a), (c), (e), (f), (h), (i), (j)
Q3. 1. True, 2. True, 3. False, 4. False, 5. True,
6. False, 7.False, 8.False, 9.True, 10. False
- LESSON 4 TEST ANSWERS
Q1. TRUE
Q2. (a) 150 centimeters.
Q3. FALSE. The wall must be perfectly flat all the way down to the floor.
Q4. FALSE. The zero point on the measuring tape measure MUST be at the exact point where the floor and the wall meet.
Q5. (a), (b) and (c).
Q5. The BMI is 19.5 – this PLHIV’s weight is normal but is on the low side of normal and the PLHIV should be counseled on the five ways to gain weight from lesson 3.
- LESSON 5 TEST ANSWERS
Q1. (c). The TOP BOX of FRONT PAGE the Monitoring Form should be prepared before visiting PLHIV.
Q2. The correct answer:
RED — Body-building Group
WHITE — Energy Group
YELLOW AND GREEN — Protective Group
PURPLE — “Enhancer” foodsQ3. Numbers 1, 2, 4, 6, 8, 9, 11 should be circled.
Q4. (c) 1 – 2 improvements per visit. It is more difficult for the client to remember more than 1 – 2.
Q5. Answer is circle Improvement 6 on the monitoring form. Show the clients the red cards that the client identified that were available and affordable. Negotiate with the client ways to try and add these foods to their meals such as gathering these foods from the rice field and also trying to introduce new foods to their soups like beans. Eggs are a great red food that are affordable. Negotiate having them eat ½ an egg at lunch and ½ at dinner.
Participants maybe have other ideas for answers to Q5, so answers may vary.
- LESSON 6 TEST ANSWERS
Q1. The correct answers are (in this order):
2 Ask PLHIV what they see in the picture (and other questions) and LISTEN
1 Select the appropriate cards
4 Discuss what is possible
5 Keep a record of the cards you’ve discussed on the Monitoring Form and choose the key suggested actions
3 Provide correct informationQ2. TRUE
Q3. TRUE
Q4. Chose the card depending on the immediate situation of the PLHIV at the time of the visit.
Q5. One or two depending on the situation.
Q6. (b) and (c).