SPECIAL
ARTICLE
Indian J Pediatr 1992; 59 : 555-559 i
C o m m u n i c a t i o n With M o t h e r s - Key to Child Survival A.K. Patwari
Kalawati Saran Children's Hospital and lady Hardinge Medical College, New Delhi Communication is one of the finest endowments of human life and is indispensable in the field of medicine. Since there is always a need for close interaction between the health provider and the recipient, the importance of effective communication in various child survival programmes can not be over-emphasized. Infact, the success of lhese programmes simply depend upon effective communication. Today fllere is a world-wide scientific consensus on essential child health information and families have a right to get this information) Therefore, there is an urgent need for evolving a communication system which serves as the most authoritative expression, in plain hmguage, of today's scientific consensus on practical, low cost, f~m~ily based ways of protecting children's lives and health. The basic requirements of a good communication system essentially include : availability of good communication material which consists of few simple and audience oriented messages; support of health personnel who are proficient in their communication skills; and development of proper "communication channels" to effectively disseminate knowledge and teach appropriate skills. Communication Material Awareness of people in general and mothers in particular can be improved widl the help Reprint requests: Dr. A.K. Patwari, 93, Chitra Vihar, Delhi-110 092.
of good communication material. However, all people are not alike in comprehending the educational material and therefore effective communication programmes ,are directed at specific subgroups of the total population. These subgroups designated as "target audience", include mothers, othcr caretakers of children under five years of age like grandmothers or older siblings, and other opinion leaders. Communication material should work well for most members of these target groups. Communication material needs to be designed to make the people understand the problem, and then address their concern and offer solutions. These ought to be a few, simple, meaningful, clear and uniform messages directed to target audience and action oriented. These messages have to be distilled from the available information as "Prime messages" and "Supporting information" Some of the ex,'unples of "Prime messages" which can be projected by various types of communication material are : (i) awareness about dreadful outcome of a disease if timely action is not taken, (e.g. death due to diarrheal dehydration); (ii) suggesting a positive intervention to prevent serious consequences, (e.g. immunization against vaccine preventable diseases); (iii) discouraging wrong practices, (e.g. bottle feeding); (iv) encourage traditional practices which are right and may be useful with minor modifications or additions, (e.g. use of home remedies for ordinary cough and cold).
556
THE INDIAN JOURNAL OF PEDIATRICS
Communication material which needs to be utilized for achieving the objective of improving awareness of mothers include messages which are "conceptual" in nature, and therefore a great deal of communication support can be provided by an effective radiofI'V spot, a useful flyer, visual aid or clinic posterior an effective public poster. It is of p~tramount import:race to ensure that the materials prepared ~re technically correct and well coordinated with other child survival programmes. Communication material should also be pretested before promoting it on a larger scale.
Communication Skills of Health Personnel Some of the child survival programmes may be immensely benefitted by enhancing the awareness of target audience, e.g. immunization programme. Development of good communication material helps a great deal in such programmes to achieve the expected outcome. However, in most of the child survival programmes mothers play a very 'active' role in case management and are given a lot more responsibility. Besides case identification and management at home, mother is the most important link in the referral system. Therefore, improvement in awareness alone cannot be expected to result in improvement in case managcment at home and prompt referral. Mothers have to understand some 'new and specific parameters' which have a vital role in the management, e.g. detection of early signs of dehydration, fast breathing and chest indrawing, growth faltering etc. She is also expected to 'learn new skills', e.g. correct preparation and administration of ORS, counting of respiratory rate etc. Therefore, the communication methods which ,are appropriate for fulfilling these objectives are aimed to induce 'performance based educa-
Vol. 59, No. 5
tion'. It is therefore mandatory that health personnel involved in child survival programmes are thoroughly proficient in these skills. Infact, some of these interventions cannot be successfully carried out without effective communication. In addition to appropriate communication material, interpersonal interaction of health workers and mothers is very essential for inducing performance based education. Some of the methods which are useful for improving the performance of mothers are asking checking questions using examples, demonstration, mother's pamphlet, motivation and giving support. 2 Asking checking questions. In order to make sure that the mother has understood what she is expected to know, checking questions (CQ) have to be framed in such a way that she has to either repeat what she has understood, or she has to give a specific answer instead of just saying 'yes' or 'no'. In order to make sure that the mother has understood what are the symptoms which indicate seriousness to seek help from a health facility, CQ can be "How will you know when your child should be taken to hospital ? " (instead of asking " D o you know when to bring your child to the hospital ?". Using examples and demonstration. The instructions which the mother needs to be given can be made more interesting and effective by using examples, e.g. story of a woman whose child is suffering from pneumonia was saved because of timely action by the mother. Demonstration is a powerful method of teaching a task, because visual images last longer than words. Learning certainly improves if the activity is demonstrated or the mother is asked to demonstrate to other mothers, e.g. demonstration
PATWARI : COMMUNICATIONWITHMOTttERS- KEY TO CHILDSURVIVAL of measurement of one litre of water and preparation of ORS. Using m o t h e r ' s pamphlet. Mother's pamphlet is a useful reminder for the mother to take home from the health facility. The card/ pamphlet should contain instructions about home management of a child with cough and cold, early home management of diarrhea, management of fever following immunization etc. Other messages regarding early detection of danger signs of pneumonia or diarrhea can also be incorporated in the card besides other health messages. Mother can refer to this card as and when her child has such symptoms. It will also simplify the task of the health personnel, since referring to the card reminds him of the main points he needs to cover during conversation with file mother. A mother's card/pamphlet should be printed in the local language, and main messages should be highlighted with die help of pictures.
Motivation and support. The ultimate outcome of teaching mothers about case identification, early home management and proper referral to a health facility will ultimately depend upon how motivated the mother is, and how efficiently she is able to perform in her domestic set up. There may be certain constraints which may come in her way to correctly follow the instructions at home, therefore it is necessary to show empathy and be an 'effective listener' to understand her problems. Effective listening enhances effective communication. The mother may have a genuine problem which may interfere in following file advice, e.g. a one litre container or home remedies like tulsi leaves etc. may not be available in her home. In such circumstances, alternatives have to be offeted.
557
Development of Communication Channels Proper communication channels need to be developed for effective dissemination of knowledge and teaching appropriate skills to mothers for the ultimate success of all child survival programmes. Some of these channels will be useful to improve awareness of public in general and educate tile target audience in particular, and others will enhance understanding of some of file new and specific parameters and learning new skills.
Communication channels for improving awareness. The communication network in the existing health delivery system is fully geared to cope up with the task of improving awareness of our target audience with emphasis on child survival strategies.
Radio, Television, Cinema. Mass media is file main channel which needs to be exploited to its maximum for educating people with a few, simple, meaningful, clear, uniform and action oriented health messages. Even though radio and cinema are reported to have maximum media reach in rural areas during mid eighties, 3 the mass media is likely to be led in a big way by television (TV) which already has more than 65% of the population in the 'catchment area' of the transmission capacity. The effectiveness of radiofI'V spots in improving awareness and educating the masses has already been established.
Print media. In some of the countries use of print media is an important and beneficial adjuvant to TV/radio coverage. However, with the rampant illiteracy in India and with a media reach of 4% and 11% of daily press and magazines respectively for women in the rural areas) this channel may not be very cost effective under the present circumstances. However, pictorial reproduction of
558
THE INDIAN JOURNAL OF PEDIATRICS
these messages is more helpful to catch the attention of even the most reluctant audience, because the image is more imperious than the written text in that it imposes its meaning at once, without analysis or dispersion. Pictures should be related to the local culture and can be in the form of a flyer, poster, flip chart etc. Strip cartoons are amongst the most vivid means of communication at our disposal, particularly for young mothers. 4 Strip cartoons are hybrids of text and image, they help to express a true account of a disease or a situation which can not be throug a graphic narration.
Social mobilization. Medical advice is only one of the many influences, therefore coopting of important influence groups and encouragement of community participation is another major activity that can be undertaken with a rapid pace. In this direction, child to child dissemination of knowledge, and concept of educating adults by their children 5 seems to be an optimistic approach for improving the awareness of adults, particularly illiterate mothers who look to their school going children with credence of wisdom. Extensive health education programmes to promote local inputs from the community have been tried in some countries 6 with a remarkable success. Such programmes are aimed to identify 'village teachers' from a society or a group who are women, preferably mothers with some basic level of education, leadership qualities, interest in improving the condition of their people and willing to speak in front of people and teach them. These village trainees after participating in health education programmes can be a good conduit to convey the health messages to the target audience. Most health workers can readily and ef-
Vol. 59, No. 5 fectively communicate with other members of similar socio-economic groups to which they themselves belong, yet many of their clients are from lower socio-economic strata. 7 These boundaries of social and cultural groups, unfortunately, tend to be barriers in good communication. Therefore, involvement of opinion leaders, decision makers, panchayat leaders, school teachers etc., is a must because they influence the effect of messages sent over mass media. Appropriate channels and messages have to be selected to reach these opinion leaders to further disseminate knowledge, and reinforce other channels of communication. A single message seldom leads to a 'change' or 'action' therefore, messages must be repeated several times by all possible means before it leads to a constructive change or action on the part of a recipient. "Media m i x " -- a combination of media - radio, TV, cinema, print and health providers etc. is ideally the best. Communication channels to induce performance based education. The present
healti~ infrastructure is not fully geared to induce performance based education to target audience. Lack of adequate communication skills of the health workers, and limited communication channels for this purpose make a strong case for development of these channels as broad as feasible. The communication channels which are already working in this direction or have a potential to be utilized for this purpose are :
Special sen, ice units in the hospitals. Special preventive and curative service areas like Diarrhea training and treatment units (DTUs), OR]" comers, ARI treatment cells, growth/nutrition clinics, immunization and family planning clinics etc., in some of tile larger hospitals are already rendering the required services and are actively participating
P A T W A R I : C O M M U N I C A T I O N WITH M O T H E R S - K E Y T O C H I L D S U R V I V A L
in child survival programmes. These special service areas need to incorporate 'Effective Communication with Mothers' in their routine activities on a priority basis. It would be imperative that the health workers in these units are proficient in communication skills. The facility is strengthened with adequate and correct teaching aids, and the physical lay out is suitable for communication with mothers and for demonstration of various skills which they are expected to learn. Health facilities which do not have such special service units, also need to be strengthened to impart performance based education with appropriate communication material.
559
other target audience is the key to child survival. As efforts are already underway to provide the necessary, correct health information and to stimulate good health practices, 'unlearning of incorrect information and poor health practices' may also be necessary. It may mean a change in the amount of information which the individual has, but often it also means a change in tile attitudes, habits or skills, or all three. Effective comnmnication is the right tool to influence all these components, and will strengthen our efforts to achieve the desired outcome of improved child survival. REFERENCES
Community outreach. Integrated Child De-
velopment Scheme (ICDS) has proved to be quite successful in promoting safe motherhood and child survival. With file passage of time, anganwadi workers have been given more responsibilities in several programmes even for curative interventions. Anganwadi workers need to be trained in proper communication skills and these 'flag bearers in the community' will certainly give an impetus to tile activities of these programmes. Face to face teaching by a team of experienced trainers ensures correct instructions to all households, which is almost impossible to attain through other methods. These 'community teams' can carry the technology to the doorsteps of the people, and help them to improve their awareness and teach them some of the essential skills of child survival. "'BRAC" model is one of the best examples to support this concept. Oral Therapy Extension Programme (OTEP) has been successfully implemented under BRAC programme in Bangladesh# Similar extension programmes can be designed for other activities. Learning about childhood problems and their rational remedies by file mothers and
1. Facts for Life -- A Community Challenge.
1st edn, Oxfordshire; UNICEF, WHO, UNESCO. 1989; i-ii. 2. Smith WA, Verzosa CC, Whitesell PH, Northrup RS. Leaders Guide : Talking with Mothers About Diarrhoea - A Workshop f o r Physicians. 1st edn. Virgina;
PRITECH, 1989; 9-13. 3. National Institute of Health & Family Welfare. Evaluation of Media Reach and Effectiveness. Technical Report Series I985; 9: 4. Videlier P, Piyas P. Health in strip cartoons. World Health Forum 1990; 11 : 14-31. 5. Saminathan P, Ravindranath MJ,. Rajaratham A. Health messages for adults from their children. World Health Forum 1986; 7 : 191-193. 6. Carr D. Village mothers on the West Bank learn about health. World Health Forum 1988; 9 : 245-249. 7. Wilbur MB. Educational Tools f o r health Personnel. ist edn. New York; The MacMilan Company, 1968; 21-31. 8. Abed FH. Household teaching of ORT in rural Bangladesh. In : Assignment children 61/61 - A Child Sur~,ival and Development Revolution, 2nd edn. Geneva; UNICEF
1983; 249-265.
ARTICLE
Indian J Pediatr 1992; 59 : 555-559 i
C o m m u n i c a t i o n With M o t h e r s - Key to Child Survival A.K. Patwari
Kalawati Saran Children's Hospital and lady Hardinge Medical College, New Delhi Communication is one of the finest endowments of human life and is indispensable in the field of medicine. Since there is always a need for close interaction between the health provider and the recipient, the importance of effective communication in various child survival programmes can not be over-emphasized. Infact, the success of lhese programmes simply depend upon effective communication. Today fllere is a world-wide scientific consensus on essential child health information and families have a right to get this information) Therefore, there is an urgent need for evolving a communication system which serves as the most authoritative expression, in plain hmguage, of today's scientific consensus on practical, low cost, f~m~ily based ways of protecting children's lives and health. The basic requirements of a good communication system essentially include : availability of good communication material which consists of few simple and audience oriented messages; support of health personnel who are proficient in their communication skills; and development of proper "communication channels" to effectively disseminate knowledge and teach appropriate skills. Communication Material Awareness of people in general and mothers in particular can be improved widl the help Reprint requests: Dr. A.K. Patwari, 93, Chitra Vihar, Delhi-110 092.
of good communication material. However, all people are not alike in comprehending the educational material and therefore effective communication programmes ,are directed at specific subgroups of the total population. These subgroups designated as "target audience", include mothers, othcr caretakers of children under five years of age like grandmothers or older siblings, and other opinion leaders. Communication material should work well for most members of these target groups. Communication material needs to be designed to make the people understand the problem, and then address their concern and offer solutions. These ought to be a few, simple, meaningful, clear and uniform messages directed to target audience and action oriented. These messages have to be distilled from the available information as "Prime messages" and "Supporting information" Some of the ex,'unples of "Prime messages" which can be projected by various types of communication material are : (i) awareness about dreadful outcome of a disease if timely action is not taken, (e.g. death due to diarrheal dehydration); (ii) suggesting a positive intervention to prevent serious consequences, (e.g. immunization against vaccine preventable diseases); (iii) discouraging wrong practices, (e.g. bottle feeding); (iv) encourage traditional practices which are right and may be useful with minor modifications or additions, (e.g. use of home remedies for ordinary cough and cold).
556
THE INDIAN JOURNAL OF PEDIATRICS
Communication material which needs to be utilized for achieving the objective of improving awareness of mothers include messages which are "conceptual" in nature, and therefore a great deal of communication support can be provided by an effective radiofI'V spot, a useful flyer, visual aid or clinic posterior an effective public poster. It is of p~tramount import:race to ensure that the materials prepared ~re technically correct and well coordinated with other child survival programmes. Communication material should also be pretested before promoting it on a larger scale.
Communication Skills of Health Personnel Some of the child survival programmes may be immensely benefitted by enhancing the awareness of target audience, e.g. immunization programme. Development of good communication material helps a great deal in such programmes to achieve the expected outcome. However, in most of the child survival programmes mothers play a very 'active' role in case management and are given a lot more responsibility. Besides case identification and management at home, mother is the most important link in the referral system. Therefore, improvement in awareness alone cannot be expected to result in improvement in case managcment at home and prompt referral. Mothers have to understand some 'new and specific parameters' which have a vital role in the management, e.g. detection of early signs of dehydration, fast breathing and chest indrawing, growth faltering etc. She is also expected to 'learn new skills', e.g. correct preparation and administration of ORS, counting of respiratory rate etc. Therefore, the communication methods which ,are appropriate for fulfilling these objectives are aimed to induce 'performance based educa-
Vol. 59, No. 5
tion'. It is therefore mandatory that health personnel involved in child survival programmes are thoroughly proficient in these skills. Infact, some of these interventions cannot be successfully carried out without effective communication. In addition to appropriate communication material, interpersonal interaction of health workers and mothers is very essential for inducing performance based education. Some of the methods which are useful for improving the performance of mothers are asking checking questions using examples, demonstration, mother's pamphlet, motivation and giving support. 2 Asking checking questions. In order to make sure that the mother has understood what she is expected to know, checking questions (CQ) have to be framed in such a way that she has to either repeat what she has understood, or she has to give a specific answer instead of just saying 'yes' or 'no'. In order to make sure that the mother has understood what are the symptoms which indicate seriousness to seek help from a health facility, CQ can be "How will you know when your child should be taken to hospital ? " (instead of asking " D o you know when to bring your child to the hospital ?". Using examples and demonstration. The instructions which the mother needs to be given can be made more interesting and effective by using examples, e.g. story of a woman whose child is suffering from pneumonia was saved because of timely action by the mother. Demonstration is a powerful method of teaching a task, because visual images last longer than words. Learning certainly improves if the activity is demonstrated or the mother is asked to demonstrate to other mothers, e.g. demonstration
PATWARI : COMMUNICATIONWITHMOTttERS- KEY TO CHILDSURVIVAL of measurement of one litre of water and preparation of ORS. Using m o t h e r ' s pamphlet. Mother's pamphlet is a useful reminder for the mother to take home from the health facility. The card/ pamphlet should contain instructions about home management of a child with cough and cold, early home management of diarrhea, management of fever following immunization etc. Other messages regarding early detection of danger signs of pneumonia or diarrhea can also be incorporated in the card besides other health messages. Mother can refer to this card as and when her child has such symptoms. It will also simplify the task of the health personnel, since referring to the card reminds him of the main points he needs to cover during conversation with file mother. A mother's card/pamphlet should be printed in the local language, and main messages should be highlighted with die help of pictures.
Motivation and support. The ultimate outcome of teaching mothers about case identification, early home management and proper referral to a health facility will ultimately depend upon how motivated the mother is, and how efficiently she is able to perform in her domestic set up. There may be certain constraints which may come in her way to correctly follow the instructions at home, therefore it is necessary to show empathy and be an 'effective listener' to understand her problems. Effective listening enhances effective communication. The mother may have a genuine problem which may interfere in following file advice, e.g. a one litre container or home remedies like tulsi leaves etc. may not be available in her home. In such circumstances, alternatives have to be offeted.
557
Development of Communication Channels Proper communication channels need to be developed for effective dissemination of knowledge and teaching appropriate skills to mothers for the ultimate success of all child survival programmes. Some of these channels will be useful to improve awareness of public in general and educate tile target audience in particular, and others will enhance understanding of some of file new and specific parameters and learning new skills.
Communication channels for improving awareness. The communication network in the existing health delivery system is fully geared to cope up with the task of improving awareness of our target audience with emphasis on child survival strategies.
Radio, Television, Cinema. Mass media is file main channel which needs to be exploited to its maximum for educating people with a few, simple, meaningful, clear, uniform and action oriented health messages. Even though radio and cinema are reported to have maximum media reach in rural areas during mid eighties, 3 the mass media is likely to be led in a big way by television (TV) which already has more than 65% of the population in the 'catchment area' of the transmission capacity. The effectiveness of radiofI'V spots in improving awareness and educating the masses has already been established.
Print media. In some of the countries use of print media is an important and beneficial adjuvant to TV/radio coverage. However, with the rampant illiteracy in India and with a media reach of 4% and 11% of daily press and magazines respectively for women in the rural areas) this channel may not be very cost effective under the present circumstances. However, pictorial reproduction of
558
THE INDIAN JOURNAL OF PEDIATRICS
these messages is more helpful to catch the attention of even the most reluctant audience, because the image is more imperious than the written text in that it imposes its meaning at once, without analysis or dispersion. Pictures should be related to the local culture and can be in the form of a flyer, poster, flip chart etc. Strip cartoons are amongst the most vivid means of communication at our disposal, particularly for young mothers. 4 Strip cartoons are hybrids of text and image, they help to express a true account of a disease or a situation which can not be throug a graphic narration.
Social mobilization. Medical advice is only one of the many influences, therefore coopting of important influence groups and encouragement of community participation is another major activity that can be undertaken with a rapid pace. In this direction, child to child dissemination of knowledge, and concept of educating adults by their children 5 seems to be an optimistic approach for improving the awareness of adults, particularly illiterate mothers who look to their school going children with credence of wisdom. Extensive health education programmes to promote local inputs from the community have been tried in some countries 6 with a remarkable success. Such programmes are aimed to identify 'village teachers' from a society or a group who are women, preferably mothers with some basic level of education, leadership qualities, interest in improving the condition of their people and willing to speak in front of people and teach them. These village trainees after participating in health education programmes can be a good conduit to convey the health messages to the target audience. Most health workers can readily and ef-
Vol. 59, No. 5 fectively communicate with other members of similar socio-economic groups to which they themselves belong, yet many of their clients are from lower socio-economic strata. 7 These boundaries of social and cultural groups, unfortunately, tend to be barriers in good communication. Therefore, involvement of opinion leaders, decision makers, panchayat leaders, school teachers etc., is a must because they influence the effect of messages sent over mass media. Appropriate channels and messages have to be selected to reach these opinion leaders to further disseminate knowledge, and reinforce other channels of communication. A single message seldom leads to a 'change' or 'action' therefore, messages must be repeated several times by all possible means before it leads to a constructive change or action on the part of a recipient. "Media m i x " -- a combination of media - radio, TV, cinema, print and health providers etc. is ideally the best. Communication channels to induce performance based education. The present
healti~ infrastructure is not fully geared to induce performance based education to target audience. Lack of adequate communication skills of the health workers, and limited communication channels for this purpose make a strong case for development of these channels as broad as feasible. The communication channels which are already working in this direction or have a potential to be utilized for this purpose are :
Special sen, ice units in the hospitals. Special preventive and curative service areas like Diarrhea training and treatment units (DTUs), OR]" comers, ARI treatment cells, growth/nutrition clinics, immunization and family planning clinics etc., in some of tile larger hospitals are already rendering the required services and are actively participating
P A T W A R I : C O M M U N I C A T I O N WITH M O T H E R S - K E Y T O C H I L D S U R V I V A L
in child survival programmes. These special service areas need to incorporate 'Effective Communication with Mothers' in their routine activities on a priority basis. It would be imperative that the health workers in these units are proficient in communication skills. The facility is strengthened with adequate and correct teaching aids, and the physical lay out is suitable for communication with mothers and for demonstration of various skills which they are expected to learn. Health facilities which do not have such special service units, also need to be strengthened to impart performance based education with appropriate communication material.
559
other target audience is the key to child survival. As efforts are already underway to provide the necessary, correct health information and to stimulate good health practices, 'unlearning of incorrect information and poor health practices' may also be necessary. It may mean a change in the amount of information which the individual has, but often it also means a change in tile attitudes, habits or skills, or all three. Effective comnmnication is the right tool to influence all these components, and will strengthen our efforts to achieve the desired outcome of improved child survival. REFERENCES
Community outreach. Integrated Child De-
velopment Scheme (ICDS) has proved to be quite successful in promoting safe motherhood and child survival. With file passage of time, anganwadi workers have been given more responsibilities in several programmes even for curative interventions. Anganwadi workers need to be trained in proper communication skills and these 'flag bearers in the community' will certainly give an impetus to tile activities of these programmes. Face to face teaching by a team of experienced trainers ensures correct instructions to all households, which is almost impossible to attain through other methods. These 'community teams' can carry the technology to the doorsteps of the people, and help them to improve their awareness and teach them some of the essential skills of child survival. "'BRAC" model is one of the best examples to support this concept. Oral Therapy Extension Programme (OTEP) has been successfully implemented under BRAC programme in Bangladesh# Similar extension programmes can be designed for other activities. Learning about childhood problems and their rational remedies by file mothers and
1. Facts for Life -- A Community Challenge.
1st edn, Oxfordshire; UNICEF, WHO, UNESCO. 1989; i-ii. 2. Smith WA, Verzosa CC, Whitesell PH, Northrup RS. Leaders Guide : Talking with Mothers About Diarrhoea - A Workshop f o r Physicians. 1st edn. Virgina;
PRITECH, 1989; 9-13. 3. National Institute of Health & Family Welfare. Evaluation of Media Reach and Effectiveness. Technical Report Series I985; 9: 4. Videlier P, Piyas P. Health in strip cartoons. World Health Forum 1990; 11 : 14-31. 5. Saminathan P, Ravindranath MJ,. Rajaratham A. Health messages for adults from their children. World Health Forum 1986; 7 : 191-193. 6. Carr D. Village mothers on the West Bank learn about health. World Health Forum 1988; 9 : 245-249. 7. Wilbur MB. Educational Tools f o r health Personnel. ist edn. New York; The MacMilan Company, 1968; 21-31. 8. Abed FH. Household teaching of ORT in rural Bangladesh. In : Assignment children 61/61 - A Child Sur~,ival and Development Revolution, 2nd edn. Geneva; UNICEF
1983; 249-265.
