Implementation of ORT: some problems encountered in training of health workers during an operational research programme
Gupta, D.N.; SenGupta, P.G.; Sircar, B.K.; Mondal, S.; Sarkar, S.; Deb, B.C.
Indian Journal of Public Health 38(2): 69-72
1994
ISSN/ISBN: 0019-557X PMID: 7836000 Document Number: 286389
In India, the National Institute of Cholera and Enteric Diseases implemented an operations research project on oral rehydration therapy in the rural block of Polba of Hooghly district in West Bengal. Its physicians used lectures and slides to train grassroot level health workers about dehydration signs, management of diarrhea, referral of patients with diarrhea to the Primary Health Center, and how to educate mothers in the community about early management of diarrhea. Each health worker received a reference booklet, prepackaged oral rehydration salts (ORS), and a 1-liter standard plastic container. Two months after the initial training, their knowledge was reevaluated and they underwent retraining. A module in Bengali was used for the retraining. It consisted of individual readings, examples and exercises of simulated conditions, discussions, role playing, and demonstration of ORS preparation. The workers were reevaluated at 3 months and 1 year post-retraining. Other than preparation of ORS (80%), few grassroot workers retained the messages delivered via the lecture and slides approach (5-25%). For example, only 5% could correctly identify the signs of dehydration. On the other hand, many more health workers retained the messages delivered via the modular approach 3 months after retraining (47-98%). At 12 months post-retraining, dosage of ORS, referral, and use of home fluids were more difficult to recall than were signs of dehydration, indication of ORS, and preparation of ORS (18-29% vs. 48-87%). These results show that periodic refresher training increases knowledge to a sustained level. The researchers concluded that simple booklets in local scripts facilitate efficient training of health workers in diarrheal treatment services. Each worker should have his/her own personal copy.