Previous Page Table of Contents Next Page

Chapter 5

Background information

Common diarrhoea is one of the major killers of children. The loss of water and food from the body results in rapid dehydration and often in malnutrition, if not treated. Diarrhoea is especially dangerous for children under two, as they can become dehydrated very quickly.

Yet common diarrhoea can easily be prevented by good sanitation and hygiene (personal, environmental and food). Children who have common diarrhoea can also recover quickly if the lost water and food are replaced.

There is a lot of ignorance about diarrhoea. Many people do not realize how dangerous it can be; many believe that it cannot be prevented; some believe it is best to stop feeding children when they have diarrhoea. These misconceptions need to come to light in class.


This chapter deals with common diarrhoea, not with the major diarrhoeal diseases such as cholera and typhoid. Children need to be aware that common diarrhoea is dangerous and why, and know how to treat it, what causes it and how to avoid it. This chapter introduces these four points.


Lesson 1

discusses what diarrhoea is.


Lesson 2

suggests the best way to treat diarrhoea.


Lesson 3

looks at the causes of diarrhoea and how it is spread.


Lesson 4

presents the hygiene precautions needed to avoid diarrhoea.


Lesson 5

discusses how to stop diarrhoea spreading in the family, and reviews the previous lessons.


Background information for teachers

Diarrhoea is the passing of loose or watery stools many times a day. Water and food are continuously lost from the body, so there is dehydration and often malnutrition. This process happens especially quickly in small children. This is why the disease is dangerous. If the diarrhoea continues for more than two or three days without water and food being replaced, small children may die.


Pupils should be able to:

Time: 30 minutes

Teaching/learning aids

Feedback on homework

Pupils tell the class about the rubbish they picked up for homework. Ask Who picked up the most rubbish? What happened to the rubbish? Why is it good to get rid of rubbish?


Ask pupils if they recognize the disease in the picture. Discuss what it is called and (if they don’t know) give them the name diarrhoea and get them to practise saying it and counting the (four) syllables.

Activity 33

Discuss the questions after the picture. Make sure that pupils can describe all the symptoms. They should be able to do this from their own experience. Help them with vocabulary (e.g. watery, stools). At the end, summarise the main features:

Point out that your body loses food and water when you have diarrhoea.

Reading 1

Ask pupils to find the following words in the text: diarrhoea, stools, food, body. Pupils read silently. Ask if the text mentions all the things you have discussed (it is good if you have also mentioned other things).

Activity 34

This activity shows what happens when someone has diarrhoea. Take the class outside. Go through the steps of the experiment with the help of a pupil. If you have enough containers, ask the pupils to do the same in groups. Make sure that the pupils answer the questions in the experiment.

Reading 2

Back in class, read out the text to the pupils to reinforce the message of the experiment.

Ask yourself

These questions recap the symptoms. Discuss the answers with all the class, then let them copy and complete the box for themselves. Go round to check - one or two good reasons will be enough.


Ask for a volunteer to write the Remember message on a piece of paper, display it in the classroom and read it out. On the opposite side write the title of the lesson. Ask pupils to explain the message (i.e. to say how the body loses food and water). Store the message or display it permanently.


Ask pupils to show the experiment to their families, explain what happens during diarrhoea. They also ask what should be done to treat it.


Background information for teachers

When you have diarrhoea, you become weak, and the body loses a lot of food and water. If these are not replaced you can die. It is essential to eat and drink to replace the lost food and water.[5] The messages for children at this age are:

  • drink a lot of clean, safe water
  • drink other drinks like munkoyo and ORS
  • eat some clean, safe food
  • go to the clinic if the diarrhoea is severe or prolonged.


Pupils should be able to:

Time: 30 minutes

Teaching/learning aids

Introduction/Activity 35

The preliminary questions establish that diarrhoea is serious and dangerous. Pupils read them and discuss answers in groups. Say that in addition to a YES or NO we need to know why. Write up on the board

"YES BECAUSE......................" "NO, BECAUSE..............."

When groups report, emphasize that diarrhoea is a killer. If possible, give examples from your own experience.

Activity 36/Homework feedback

Ask pupils what is the best thing to do when you have diarrhoea.

Help them read the speech bubbles and say which they think are good advice.

Let them work out for themselves that diarrhoea takes away food and water, so we need to put back the food and water. With severe diarrhoea it is also a good idea to go to the clinic.

N.B. The advice about ORS (oral rehydration solution) is very good! If children want to know about it, explain that this is a special drink which is very good for putting back the water in the body.


Say that the Reading tells you what to do if you have diarrhoea, and why. What do they think it will say? Get some good predictions from the class. Ask Does the Reading say this? Pupils read the text in pairs and say if it says what they predicted.

Ask yourself

This is a knowledge check. Demonstrate asking yourself these questions and answering them. Pupils ask each other the same questions in pairs, and agree on the answers. Then they copy and complete the box.


Ask for two volunteers to write the Remember messages on two pieces of paper, display them in the classroom and read them out. On the opposite side write the title of the lesson. Ask pupils to explain the messages (i.e. Diarrhoea can kill - how? Drink and eat if you have diarrhoea - why?). Store the messages so they can be used again, or display them permanently. Children take the messages home.


Choose one of the two homeworks, or let pupils choose one. If you think families will resent being told what to do, choose the second one!


Background information for teachers

Diarrhoea is caused by bacteria (germs) found in contaminated water and food. Dirty hands are the main agents of contamination, together with insects and animals, especially houseflies, cockroaches and mice. These can all carry the diarrhoea bacteria to water or food, or directly to mouths.

The idea that dirt causes disease, and can be transferred by hands and insects, was established in Chapter 4. As regards understanding, this lesson is therefore mainly revision. But as regards practical behaviour, there is a need to emphasize that it is pupils’ own actions that can cause diarrhoea for themselves and others, or help to prevent it.


Pupils should be able to:

Time: 30 minutes

Teaching/learning aids

Feedback from previous lesson.

Ask what pupils’ families said about how people get diarrhoea. Be careful not to criticize mistaken answers - let pupils come to their own conclusions as the lesson goes ahead.


a) Show pupils the food, fruit and water. Say this is our food, our fruit, our water. We are going to share the food and drink the water.

b) Tell them this story:

There is a little boy outside in the bush. His name is X (invent a name).
He is not feeling well. He has diarrhoea.
Now he has defecated on the ground outside.
The dirt he has made is full of diarrhoea. He has touched it with his hand. His hand is dirty.

c) Hold up a glove and say that this is X’s hand. You cannot see the dirt, but it is there. Hold up the "fly" and remind children what it is.

d) Ask who can show how X’s dirt can get to our food. Give the glove and the "fly" to volunteers. They should show that the dirt can:

It is important that children actually show how this can happen and don’t just talk about it. Every time they show the connection, say (or get the class to say) "And that’s how we get diarrhoea!" (You may even ask for a round of applause!)

Activity 37

Use the pictures for reinforcement. Get pupils to give names to the two children. In small groups pupils explain the pictures to each other. Go round to listen and help. Make sure pupils interpret the pictures correctly, making the cause and effect connections (e.g. ask what the flies are doing or why the child in picture 3 is sick). At the end, one group holds up the pictures and explains the story to all.

Ask pupils to give examples of things we do that can give us diarrhoea e.g. eating uncovered food, eating food on which flies have walked, preparing food or touching drinking water without washing hands.


Call on a volunteer to read the reading aloud. Then do ONE of these:

Ask yourself

Demonstrate asking yourself these questions and answering them - e.g. Well, today I washed my hands before eating, and after going to the toilet. I drank clean water. But I bought a snack which was not wrapped... I must be careful about this. What about you? Pupils check their own behaviour in the same way to see the danger points. They then individually choose one piece of advice for themselves, and copy and complete the box. Circulate to see if there are any good answers.


Ask for a volunteer to write the Remember message on a piece of paper, display it in the classroom and read it aloud. On the opposite side write the title of the lesson. Ask pupils to give examples.


Tell pupils to show their families the pictures and explain what is happening.


Background information for teachers

We can prevent a lot of diarrhoea in the home, school and community by keeping our surroundings, homes and school clean, by making our drinking water clean and safe, and by washing our hands. We can also make sure that our food is clean and not contaminated.[6] The message for young children is to cover food, or wash it before eating.

Make sure that pupils are REALLY aware of the health dangers in their own environments - not that they can just repeat the lesson.


Pupils should be able to:

Time: 30 minutes

Teaching and learning aids

Paper/cardboard for the Remember message

Introduction and feedback from homework

Books closed.

a) Write up the words wash, cover, boil, eat and drink. Say the words aloud as you do so. Ask one pupil at a time to choose a word and mime it. Other pupils have to guess the action and also what is being washed, covered and so on.

b) Ask pupils what families said about the pictures from the last lesson.

c) Ask how we can avoid diarrhoea. Pupils should be able to produce a lot of ideas independently, based on the previous lesson and the previous chapter.

Activity 38

a) Open books. Tell pupils that all the actions in the pictures help to prevent diarrhoea. Pupils discuss what is happening in each picture:

1 covering food
2 washing hands
3 washing fruit
4 boiling drinking water
5 going to the toilet
6 washing hands after the toilet

b) Find out which things pupils do every day. Also ask them to take one picture and compare how they do it themselves.

c) Ask a pupil to read the sentence following the pictures. Repeat to emphasize that pupils should practise what is shown in the pictures.

d) Let the class practise giving advice. Say "I am your little brother/sister. I’m going to eat this nice piece of fruit" - open mouth wide..... Class calls.... "Have you washed it? Go and wash it!" Say "OK I’m going to wash it." Class says "Is the water clean? Are your hands clean?" etc.


The reading repeats the advice in the pictures. Use it as a quick reinforcement. In pairs, pupils find the pictures which correspond to each sentence in the text (5, 6, 4, 2, 3, 1). Go round to do spot checks: point to a picture and ask individuals to find and read the matching sentence.

Ask yourself

Pupils ask themselves general questions about their habits. Demonstrate asking yourself these questions and answering them. Encourage honesty by admitting some gaps in your own hygiene precautions (e.g. I don’t always wash fruit. I must do this. How about you?). Pupils should go through all the questions for themselves, then choose two things that they personally need to remember. They then copy and complete the box.


Ask for a volunteer to write the Remember message on a piece of paper, display it in the classroom and read it aloud. On the opposite side write the title of the lesson. Store the message so it can be used again. Ask the pupils how they will protect themselves from diarrhoea.


Pupils should ask at home how to protect the family if someone has diarrhoea.


Background information for teachers

If someone in the family has diarrhoea, some basic hygiene precautions are necessary to avoid spreading the disease. Children should now be able to understand why these are necessary. This lesson also acts as a general test of understanding for the whole chapter.


Pupils should be able to:

Time: 30 minutes

Teaching/learning aids

Feedback from homework

Ask how to protect the whole family when one member has diarrhoea.

Introduction/Activity 39

a) Explain the situation in the picture to the class. Make it clear that Mule has to avoid giving her diarrhoea to the rest of the family.

b) What should Mule do and not do? Get a few ideas from the class before going on to the Reading.


Read out the questions in the Reading and get the class to give a firm Yes or No answer for each (the answers are below) and explain Why or How. OR Form small groups. Each group chooses one question from the Reading and prepares to explain Why or How, then reports back. Expand answers where necessary.

What should Mule do?

  • drink a lot? Yes, because she has to replace lost water.

  • eat some food? Yes, because she has to replace food.

  • go to the latrine? Yes, definitely. But if she can’t get there someone must make sure the dirt is buried so that flies can’t find it, and it isn’t washed by rain into the water supply.

  • wash her hands afterwards? Definitely - every time - with soap and running water.

  • help to feed the baby? Definitely not - she could give him diarrhoea too, which could be very dangerous.

  • help to prepare food for the family? Definitely not - she could pass on the diarrhoea bacteria with her hands.

  • wash her hands before she eats? Definitely - with soap and running water.

  • wash her hands separately? If everyone washes hands in the same bowl, then Mule should wash her hands separately.

  • use her own plate at meals? Definitely - it will make sure that she doesn’t infect other people’s food.

  • carry water for the family? Definitely not - she could dirty the water with her hands.

  • go to the clinic? Yes, if the diarrhoea is severe and goes on for a long time.

Ask yourself

Look at the question and discuss with pupils what they plan to write. They should have plenty of ideas. Ask them to decide on one good answer, then copy and complete the box. Go round to check.


Ask for volunteers to write the Remember messages on pieces of paper or cardboard. Display it in the classroom and read them aloud. On the opposite side write the title of the lesson. Ask pupils to give examples of Be clean...


If you think that families are ready to accept all the ideas in this lesson, and to hear them from their children, choose the first homework. If not, choose the second.


Ask the pupils responsible for the previous Remember messages to come to the front of the class. Revise Chapter 5 by asking them to read out the messages, and ask pupils to expand and explain each message.

Event track (optional)

You may wish to organize a final "event" to recycle and publicize the messages of the lessons. This can be a performance in class, or for families or other classes, or be part of an Open Day. Here are some ideas relating to this chapter.

  1. Develop Lessons 1 and 2 into a three-scene mini-drama. In scene 1, a child comes in complaining of diarrhoea. S/he is worried because of missing school. Several people discuss what is the best thing to do. Then the mother (or older sister) asks the audience which is the right advice. In scene 2, children demonstrate the experiment with the container and explain to the mother/older sister that this is what happens when a child has diarrhoea. She should therefore give the child food and drink. In Scene 3, this advice is followed and the child recovers and goes back to school.
  2. Make a poster on why we get diarrhoea. Get some pupils to copy the pictures in Lesson 3 onto a poster and then to practise standing by the poster and explaining it to visitors.
  3. Act out Mule’s story from Lesson 5. A presenter explains the situation. Mule is lying down, while two of her family argue about what she should do. E.g.

The presenter appeals to the audience on each question. Members of the class explain what is the right answer and why. Meanwhile, Mule exits frequently to go to the toilet, comes back to wash her hands etc.

[5] Oral rehydration solution (ORS) is ideal for replacing fluids, and it is important for mothers to know how to prepare ORS by themselves. It is dealt with in detail in Grade 4 lessons. If children already know about ORS, they can explain to other children.
[6] It is particularly important that already prepared food is reheated to boiling point (not just warmed through) before it is eaten. This is dealt with in Grade 4.

Previous Page Top of Page Next Page