PARTICIPANT MANUAL
THE GOOD FOOD TOOLKIT
This participant manual was first created in 2014.
Reviewed in 2017.
FOREWORD
FOREWORD (TRANSLATION)
The integration of HIV and nutrition activities in the health sector in Cambodia has been identified as a priority area in both the National Nutrition Strategy 2009-2015 and the National Strategic Plan for Comprehensive and Multi-sectoral Response to HIV/AIDS III (2011-2015). This is in keeping with global recognition that optimal nutrition plays a critical role in the health and wellness of all individuals, particularly people living with HIV (PLHIV).
HIV and nutrition are inextricably linked. HIV impacts the nutritional status of PLHIV, including children living with HIV (CLHIV) and orphans and vulnerable children (OVC). HIV compromises a person’s nutritional status by undermining their immune system, as well as their ability to assimilate nutrients. Malnutrition in turn further weakens the immune system increasing vulnerability to opportunistic infection and disease. HIV combined with pre-existing under nutrition makes it difficult for PLHIV to remain healthy and economically productive as well as support and provide for family members, particularly children.
Nutrition support is a critical component of comprehensive prevention, care and treatment for individuals with HIV. The provision of nutrition assessments, education, counselling and support can help to improve a person’s nutritional status, ensure adequate food intake, improve the effectiveness, tolerance and adherence to antiretroviral therapy, and enhance quality of life.
Recognizing the critical role that nutrition plays in the comprehensive care of PLHIV, the Good Food Toolkit has been developed for service providers together with an accompanying manual for trainers. This Toolkit is intended for use by professional staff working in health facilities and non-government organizations, home-based care team members, self-help groups who provide nutrition education and support for adults, children, and communities living and affected by HIV. It will also help facilitate nutritional assessments, counselling, education and support to address nutrition issues faced by PLHIV.
The Ministry of Health endorses this toolkit for training on HIV nutrition as an important tool to build the capacity of counsellors to provide effective nutrition counselling, care and support for PLHIV in Cambodia.
Phnom Penh 04 December 2014
(Signed and sealed)
Professor Eng Huot
Secretary of State
Ministry of Health
ACKNOWLEDGMENTS
The second edition of the Good Food Toolkit and Training Manual is a collaborative effort of numerous partners involved in HIV and nutrition work in Cambodia. Its printing marks the culmination of the considerable effort that has gone into updating and broadening this important manual to bring it in line with the latest HIV policies and thinking on HIV and nutrition. Coordination for this process has been led by the National Maternal and Child Health Center (NMCHC) in collaboration with the Core Group on HIV Nutrition, under the leadership of Dr. Prak Sophonneary and Dr. Lan Van Seng of the National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Infections (NCHADS). Technical support was provided by the United Nations World Food Programme (WFP) Cambodia, specifically Dessa Shuckerow and Seanglay Din, with support from World Food Programme Regional Bureau for Asia. This update would also not have been possible without the generous funding support from UNAIDS.
The first edition of the Toolkit and Training Manual was published in 2009. The 2014 revision reflects lessons learned from the implementation of the Toolkit, advances in evidence-based literature on HIV nutrition, and changes to HIV policy at national level. The content has also been expanded to include additional populations, including pregnant and lactating women living with HIV, HIV exposed infants, children with HIV (paediatric HIV) and orphans and children made vulnerable by HIV/AIDS.
Members of the Core Group on HIV Nutrition who contributed to the development of this second edition also include: National Nutrition Programme (NNP), Prevention of Mother to Child Transmission (PMTCT) Programme, Cambodian HIV/AIDS Education and Care (CHEC), Khmer HIV/AIDS NGO Alliance (KHANA), Caritas, Catholic Relief Service (CRS), Family Health International (FHI) 360, Clinton Health Access Initiative (CHAI), World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Particular acknowledgement is also extended to Lia Purnomo, Amanda Justice, Katherine Coote and Charmaine Turton of The Albion Centre in Australia, who provided their technical expertise in the revision of this second edition; and Chamroen Chim for the photographs, illustrations and design.
Special thanks are also expressed to numerous service providers, home-based care teams, self-help group members, and people living with HIV whose experiences and inputs formed the basis of the development of this second edition. Finally, sincere thanks are again extended to all those previously acknowledged for the development of the first edition of the Good Food Toolkit and Training Manual.
ACRONYMS AND ABBREVIATIONS
| AIDS | Acquired Immune Deficiency Syndrome |
| AHEAD | Action for Health and Development |
| ART | Antiretroviral Therapy |
| ARV | Antiretroviral |
| BCG | Bacillus Calmette–Guérin |
| BFCI | Baby Friendly Community Initiative |
| BDF | Buddhism for Development |
| BMI | Body Mass Index |
| CHAI | Clinton Health Access Initiative |
| CHC | Community Health Cambodia |
| CHEC | Cambodian HIV/AIDS Education and Care |
| CRS | Catholic Relief Services |
| DNA | Deoxyribonucleic Acid |
| H/A | Height-for-Age |
| HC | Health Centre |
| HCW | Health Care Workers |
| HIV | Human Immunodeficiency Virus |
| HKI | Helen Keller International |
| FANTA | Food and Nutrition Technical Assistance |
| FAO | Food and Agricultural Organization |
| FHI 360 | Family Health International 360 |
| KHANA | Khmer HIV/AIDS NGO Alliance |
| LBW | Low Birth Weight |
| MoH | Ministry of Health |
| MSG | Mother Support Group |
| MUAC | Mid-Upper Arm Circumference |
| NCHADS | National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Infections |
| NGO | Non-Governmental Organization |
| NAA | National AIDS Authority |
| NMCHC | National Maternal and Child Health Centre |
| NNP | National Nutrition Program |
| OI/ART | Opportunistic Infection/Antiretroviral Therapy Clinic |
| OI | Opportunistic Infection |
| ORS | Oral Rehydration Solution |
| OVC | Orphans and Children Made Vulnerable by HIV/AIDS |
| PC | Partners in Compassion, Cambodia |
| PCR | Polymerase Chain Reaction |
| PLHIV | People Living with HIV |
| PMTCT | Prevention of Mother to Child Transmission |
| SCC | Salvation Centre Cambodia |
| SHG | Self-Help Group |
| SIT | Save Incapacity Teenagers |
| TOT | Training of Trainers |
| WAO | West Area Office |
| W/A | Weight-for-Age |
| W/H | Weight-for-Height |
| WFP | World Food Programme |
| WHO | World Health Organization |
TRAINING SCHEDULE
DAY 1 | ||
Time | Duration (minutes) | Topic |
8.00 – 8.40 | 40 | Opening Session (formal opening, overview, ice breaker) |
8.40 – 9.00 | 20 | Pre-test |
9.00 – 9.30 | 30 | Lesson 1: Introduction to the Good Food Toolkit – Purpose of the Toolkit |
9.30 – 9.45 | 15 | Break |
9.45 – 10.00 | 15 | Lesson 1: Introduction to the Good Food Toolkit – Target groups & primary target for nutrition counseling |
10.00 – 10.15 | 15 | Lesson 1: Introduction to the Good Food Toolkit – Contents of the Toolkit |
10.15 – 10.30 | 15 | Lesson 2: Nutrition Basics – Basic nutrition terms |
10.30 – 11.30 | 60 | Lesson 2: Nutrition Basics – Three food groups |
11.30 – 13.30 | 120 | Lunch Break |
13.30 – 14.00 | 30 | Lesson 2: Nutrition Basics – Energy requirements |
14.00 – 15.00 | 60 | Lesson 2: Nutrition Basics – Nutrition throughout the lifecycle |
15.00 – 15.15 | 15 | Break |
15.15 – 16.00 | 45 | Lesson 2: Nutrition Basics – Nutrition throughout the lifecycle |
16.00 – 16.30 | 30 | Lesson 3: Nutrition and HIV – Relationship between HIV and nutrition |
16.30 – 17.00 | 30 | Conclusion of the day and daily training evaluation |
17.00 | End | |
DAY 2 | ||
Time | Duration (minutes) | Topic |
8.00 – 8.15 | 15 | Recap Day 1 |
8.15 – 8.45 | 30 | Lesson 3: Nutrition and HIV – Energy requirements and percentage increase for PLHIV |
8.45 – 9.30 | 45 | Lesson 3: Nutrition and HIV – Cycle of HIV, poor nutrition and infection |
9.30 – 9.45 | 15 | Break |
9.45 – 10.30 | 45 | Lesson 3: Nutrition and HIV – Some common misinformation about nutrition for PLHIV |
10.30 – 11.30 | 60 | Lesson 4: Anthropometry – Assessment for malnutrition in adults |
11.30 – 13.30 | 120 | Lunch Break |
13.30 – 15.00 | 90 | Lesson 4: Anthropometry – Assessment for malnutrition in children |
15.00 – 15.15 | 15 | Break |
15.15 – 16.30 | 75 | Lesson 4: Anthropometry – Assessment for malnutrition in children |
16.30 – 17.00 | 30 | Conclusion of the day and daily training evaluation |
17.00 | End | |
DAY 3 | ||
Time | Duration (minutes) | Topic |
8.00 – 8.15 | 15 | Recap Day 2 |
8.15 – 9.30 | 75 | Lesson 5: How to use the Good Food Toolkit – Five steps for nutrition counseling |
9.30 – 9.45 | 15 | Break |
9.45 – 11.00 | 75 | Lesson 5: How to use the Good Food Toolkit – Using small food cards |
11.00 – 11.30 | 30 | Lesson 5: How to use the Good Food Toolkit – Using large food cards |
11.30 – 13.30 | 120 | Lunch Break |
13.30 – 13.40 | 10 | Energizer |
13.40 – 15.00 | 80 | Lesson 5: How to use the Good Food Toolkit – Filling out monitoring forms |
15.00 – 15.15 | 15 | Break |
15.15 – 16.30 | 75 | Lesson 5: How to use the Good Food Toolkit – Filling out monitoring forms |
16.30 – 17.00 | 30 | Conclusion of the day and daily training evaluation |
17.00 | End | |
DAY 4 | ||
Time | Duration (minutes) | Topic |
08.00 – 08.15 | 15 | Recap Day 3 |
08.15 – 9.30 | 75 | Lesson 6: Positive Living for PLHIV – Positive Living Cards |
9.30 – 9.45 | 15 | Break |
9.45 – 11.30 | 105 | Lesson 6: Positive Living for PLHIV – Positive Living Cards |
11.30 – 13.30 | 120 | Lunch Break |
13.30 – 13.40 | 10 | Energizer |
13.40 – 15.00 | 80 | Lesson 6: Positive Living for PLHIV – Introduction to communication skills |
15.00 – 15.15 | 15 | Break |
15.15 – 16.15 | 60 | Supervised Field Practice preparation |
16.15 – 16.35 | 20 | Post-test |
16.35 – 17.00 | 25 | Conclusion of the day |
17.00 | End | |
DAY 5 | ||
Time | Duration (minutes) | Topic |
08.00 – 11.30 | 210 | Supervised Field Practice |
11.30 – 13.30 | 120 | Lunch Break |
13.30 – 14.30 | 60 | Debriefing |
14.30 – 15.00 | 30 | Final Training and Field Practice Evaluation |
15.00 – 15.15 | 15 | Break |
15.15 – 16.00 | 45 | Certificate Ceremony |
16.00 – 17.00 | 60 | Conclusion and closing |
17.00 | End | |