Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
Peace Corps Guide:
Pregnant Women’s Support Group
Program
(also known as FARN/G--- Le Foyer d’Apprentissage et de Reinforcement
Nutritionnel pour Gestante)
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Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
Acknowledgements
The Foyer d’Apprentissage et de Renforcement Nutritionnelle des Femmes en Grossesses
(FARN/G) (also known as the pregnant women’s support group) approach was created in Guinea in
2001. The approach was developed by staff from Helen Keller International (HKI), Guinea under a
subgrant from USAID/Food for Peace, in collaboration with Africare-Guinea and the Ministry of Health
in Dinguiraye, Guinea. The approach was adapted from the Positive Deviant (PD)/Hearth Nutrition (for
malnourished children) model, which is based on identifying local women in communities who use
positive nutritional practices to feed their children. The PD/Hearth model is used to teach mothers how
to rehabilitate moderately malnourished children. In the FARN/G approach, positive deviant role
models are identified to improve the nutritional practices of pregnant women, to promote information
sharing and sharing experiences on safe motherhood practices, and community cohesion. The
FARN/G approach was originally pilot tested in Guinea, and has been modified and expanded in Sierra
Leone. Although the PD/Hearth nutrition approach and the FARN/G approach share a similar
philosophical basis (the idea that you can identify resident role models within a community to teach
others how to improve practices using local resources), the objectives and components of a FARN/G
program and the way such a program is implemented are fundamentally different from a PD Hearth
program. Hopefully this manual will explain those differences, as well as illuminate some of the benefits
and difficulties inherent in the approach, and lessons learned during program implementation in Guinea
and Sierra Leone.
This manual was drafted by Cathleen Prata (Peace Corps Guinea 2006 and 2008, Mali 2007).
It is an adaptation of the FARN/G manual used by HKI/Guinea, and incorporates elements from PD
Hearth manuals used in Guinea and Mali. There are many people who helped in the creation of this
manual and deserve recognition.
Thanks are due to HKI staff members Dr. Lanfia Toure, Dr. Appolinaire Delamou, Dr. Midiaou
Bah and Aliou Bah who work closely with communities and Ministry of Health teams throughout Guinea,
and whose experiences, hard work and dedication resulted in the current success of the FARN/G
program. A special thanks to Dr. Lanfia, who provided technical assistance for the development of this
manual.
Thank you to Jennifer Peterson (HKI/Guinea and Sierra Leone), who not only shared many HKI
documents to create this manual, but also her support and expertise.
Thank you to Dr. Mohamed Lamine Keita, Dr. Fodé Konaté, Lynn Morin and Aurélien
Barriquault for their studies on the FARN/G approach. Their work provided insights for the creation of
this manual.
As this manual was requested by Agnieszka Sykes (Community Health Specialist, Peace
Corps, Washington DC), it is necessary to acknowledge not only her pushing for such a manual to
exist, but her enthusiasm for the project, as well as her input and editing.
Since this manual uses many concepts from the Mali Hearth manual, it is necessary to thank
Ariel Wagner, who created the Mali Hearth Manual and provided input for this manual (Peace Corps
Mali 2005-2008).
It is also necessary to thank Annaliese Limb (APCD Peace Corps, Guinea 2005-2008) for her
editing and suggestions.
Special thanks to Ryan Derni (Peace Corps Guinea, 2005-2007), who facilitated the
preparatory steps for a FARN/G program and was able to share his experiences with us.
It is also necessary to thank the CORE group, who continues to revamp, based on experiences
from all over the world, the CORE PD/Hearth manual.
Finally, a huge thank you to all of the extraordinary mothers, fathers, district health staff and
community health volunteers that have made FARN/G a successful program in Guinea.
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Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
Acronymes
FAF
FARN/G
FGD
GF
HKI
NGO
PD/HEARTH
PNC
TBA
UNICEF
VAD
WHO
Fer Acide Folique (Iron/Folic Acid supplement)
Foyer d’Apprentissage et de Renforcement Nutritionnelle pour Gestantes
Focus Group Discussion
Guinean Franc
Helen Keller International
Non-governmental Organization
Positive Deviant/Hearth
Prenatal Consultation
Traditional Birth Attendant
United National Children’s Fund
Vitamin A Deficiency
World Health Organization
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Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
TABLE OF CONTENTS
Acknowledgements
Acronyms
PREGNANT WOMEN’S SUPPORT GROUPS (FARN/G) ...................................................................... 1
I. INTRODUCTION .................................................................................................................................. 1
1. MATERNAL AND CHILDHOOD MALNUTRITION ......................................................................................... 1
2. BACKGROUND ............................................................................................................................... 2
3. OBJECTIVES .................................................................................................................................. 2
4. PROGRAM IMPACTS ..................................................................................................................... 3
5. FARN/G AND VOLUNTEER SERVICE............................................................................................ 3
II. STRATEGY ......................................................................................................................................... 4
1. KEY PLAYERS ................................................................................................................................ 4
2. IMPLEMENTING A PREGNANT WOMEN’S SUPPORT GROUP PROGRAM ................................ 5
2.1 Communicate with Local Health Officials .................................................................................. 5
2.2 Mobilize Communities ............................................................................................................... 5
2.3 Train TBA's, Health Center Staff and Village Health Committee ............................................... 5
Conduct a village census of pregnant women................................................................................. 6
2.5 Identify and Train Model Mother ............................................................................................... 7
2.6 Prepare Monthly Support Group Logistics ................................................................................ 7
2.7 Conduct Monthly Support Group Sessions ............................................................................... 8
2.8 Monitoring and Evaluation......................................................................................................... 9
III. FUNDING ......................................................................................................................................... 10
IV. TROUBLESHOOTING ..................................................................................................................... 11
V. CONCLUSION .................................................................................................................................. 12
APPENDICES ....................................................................................................................................... 13
APPENDIX A ........................................................................................................................................ 13
APPENDIX B ........................................................................................................................................ 14
APPENDIX C ........................................................................................................................................ 22
APPENDIX D ........................................................................................................................................ 23
APPENDIX E ........................................................................................................................................ 27
3. LIST OF THOSE PRESENT DURING FARN/G ................................................................................ 28
APPENDIX F ........................................................................................................................................ 30
APPENDIX G ......................................................................................... ERROR! BOOKMARK NOT DEFINED.
SOURCES ............................................................................................................................................. 35
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Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
Pregnant Women’s Support Groups (FARN/G)
I. INTRODUCTION
▪ Some 1,400 women die every
day from problems related to
pregnancy and childbirth.
Pregnancy and Safe motherhood
Many women in developing countries risk death and disability
▪The dangers of childbearing
every time they become pregnant. Complications before,
can be greatly reduced if a
during, and after childbirth can often be fatal in the developing
woman is healthy and well
world. Some 1,400 women die every day from problems
nourished before becoming
related to pregnancy and childbirth. Tens of thousands more
pregnant.
experience complications during pregnancy, many of which
are life-threatening for the women and their children – or leave them with severe disabilities. The vast
majority of these deaths could have been prevented through good quality care during pregnancy,
delivery, and the postpartum period.
The dangers of childbearing can be greatly reduced if a woman is healthy and well nourished before
becoming pregnant, if she has a health check-up by a trained health worker at least four times during
every pregnancy, and if the birth is assisted by a skilled birth attendant such as a doctor, nurse or
midwife (UNICEF; Facts for Life on Safe Motherhood http://www.unicef.org/ffl/02/).
Maternal and Childhood Malnutrition
Maternal and child malnutrition remain key public health challenges that merit particular attention in the
context of safe motherhood. The principal nutritional challenges are insufficient energy and protein
consumption, iodine deficiencies, anemia due to iron
deficiency and vitamin A deficiency. Although the
▪ Maternal and child under nutrition
consequences of malnutrition can be serious, it is often an
is the underlying cause of 5 million
invisible problem. In general, there are no exterior signs, and
deaths and 35% of the disease
burden in children younger than 5
those malnourished themselves are not aware of the problem.
years1
Between 5 to 20 percent of women in various African countries
are underweight. Low weight for height, low pregnancy weight
gain, and low birth weight reflect inadequate food intake in
women. Maternal malnutrition can lead to low birth weights for
infants, as well as micronutrient deficiencies.
▪Poor fetal growth or stunting in the
first 2 years of life leads to
irreversible damage, including
shorter adult height, lower attained
schooling, reduced adult income,
and low birth weight1
Many of the health risks associated with maternal malnutrition are the following:
Health risks associated with poor maternal nutrition2
For Maternal Health
For Infant Health
• Increased risk of maternal death
• Increased infections
• Anemia
• Compromised Immune Systems
• Lethargy and weakness
• Lower productivity
Increased risk of fetal and neonatal death
• Intrauterine growth retardation
• Low birth weight
• Compromised Immune Systems
• Premature birth
• Birth defects
• Cretinism1 and reduced IQ
1
The condition that results from inadequate secretion of thyroid hormones during fetal life or early infancy (caused by iodine
deficiency). The brain and skeleton fail to develop properly, resulting in mental retardation and dwarfism.
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Many women display not one but several micronutrient deficiencies. Improving micronutrient status
through diet diversification and micronutrient supplementation is an important step to reducing maternal
malnutrition and consequently reducing rates of maternal morbidity and mortality. Minimal intake of
micronutrient-rich foods and the body’s inability to absorb and efficiently use certain micronutrients both
account for the prevalence of multiple deficiencies. Multiple deficiencies in zinc, iron, iodine, vitamin A,
folic acid, vitamin B6, vitamin B12, vitamin D, calcium, and magnesium can increase the risk of low birth
weight, preterm births, premature rupture of membranes, and fetal death. See Appendix B for
Micronutrient Information.
2. BACKGROUND
In an effort to address high rates of both maternal, neonatal, and infant morbidity and mortality, the
Community-based Pregnancy Surveillance Program (FARN/G or Le Foyer d’Apprentissage et de
Renforcement Nutritionnel pour Gestantes) was inspired by the Positive Deviant Hearth Nutrition Model
(originally designed for malnourished children). The original concept of the Positive Deviance (PD) /
Hearth Nutrition Model was introduced in the 1980s in Haiti and has since been replicated in countries
as various as Vietnam, Bangladesh, Mozambique and Guinea. In contrast to traditional nutrition
interventions which tend to look for problems in the community that need to be solved, the Positive
Deviant approach looks for positive behaviors and strengths that exist in the community and can be
built upon. It is based on the belief that despite poverty, there are local practices, knowledge, and
resources that can be exploited to promote positive health practices.3 The FARN/G approach utilizes a
woman who has successfully given birth to healthy children as a positive deviant model and trainer for
women who are currently pregnant, while also providing women with proper prenatal care
(vaccinations, medication, vitamin/micronutrient supplements and referrals when necessary). It is an
approach designed to improve the nutritional status of mothers and children by changing mothers’
attitudes and practices. The approach uses social support, self-efficacy and culturally acceptable and
financially feasible alternatives to sustain behavior change.
In the FARN/G approach, the community is ultimately responsible for the care of these pregnant
mothers. The program involves district level health officials, community leaders, traditional birth
attendants, community health committees, community health volunteers, and pregnant women and their
husbands in its preparation and its implementation. By involving community leaders and heads of
households, including husbands and mothers-in-law, the program builds local support for pregnant
women. Once the program is implemented, a Pregnant Women’s Support group meets once a month.
3. OBJECTIVES
The goal of the FARN/G program is to reduce maternal and infant mortality by decreasing infant and
maternal malnutrition. The objectives of the program are to reduce anemia through improved nutrition
practices, deworming, malaria treatment and Iron/Folic Acid supplementation; to improve vitamin A
status through improved nutrition practices and post partum vitamin A supplementation; and to improve
prenatal care coverage, especially in the 9th month of pregnancy. The program seeks to attain these
objectives by implementing the following strategies during women’s monthly support group meetings
and home visits:
th
1) Assure each pregnant mother has at least 3 prenatal consultations, including one in the 9 month,
through prenatal care outreach sessions;
2) Facilitate Iron/Folic Acid supplementation and administration of anti-malarials, deworming
medication and post partum vitamin A supplementation during prenatal care outreach;
3) Inform pregnant women of pregnancy danger signs for referral to health centers or hospitals, and
help women, their families and communities prepare for safe delivery;
4) Sensitize women on good food and hygiene practices, immediate and exclusive breastfeeding and
the importance of getting rest to increase the chances of a healthy pregnancy and delivery;
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5) Bring pregnant women together to share their experiences and problems related to pregnancy,
and encourage community support for and care of pregnant women;
6) Facilitate and encourage contact and communication between health center staff, traditional birth
attendants, and pregnant women and their husbands to promote positive pregnancy practices, and
to encourage increased demand for health care services.
4. PROGRAM IMPACTS 4
In 2007, Guinea’s Ministry of Health in conjunction with HKI conducted a study on the impacts and
effects of the FARN/G approach. The study is based on interviews with 400 participants and 202 nonparticipants. Dr. Mohmed Lamine Kieta analyzed the results. He found that women were more
knowledgeable about proper pre and post natal care and as a result experienced healthier and safer
pregnancies than those who did not participate. Women who participated in the program were more
likely to have received tetanus vaccination, Iron/Folic Acid supplements, deworming medication and
treatment for malaria during pregnancy than those who did not participate. 86% of the women
participating in FARN/G received a post partum Vitamin A supplement as opposed to 51% for those
who did not participate.
The study shows that those who participated in the program benefited from the nutritional messages
given during FARN/G sessions. The program teaches that the first hour after birth is a critical time as
the first milk or colostrum is high in vitamin A and serves as the child’s first immunization. Children born
to mothers who participated in the program (71%) were more likely to be breastfed within the first hour
after birth than those children whose mothers did not participate (50.7%). 80% of children born to
participants were breastfed exclusively, while the rate was only 59% for non-participants. In addition,
participants were more likely to be able to identify signs of anemia, Vitamin A deficiency and iodine
deficiency than non participants. They were also more able to name foods rich in iron, Vitamin A and
iodine.
The study collected information on the nutritional status of the women and the children they gave birth
to between 2003 and 2006. The study found that women participating in the program were less likely to
suffer from anemia (27.7%), whereas the rate of anemia among non-participant was 43.8%. Recovery
time for women who participated in the program was about 4 days, as opposed to 8 days for those not
participating. Children born to women who participated were less likely to suffer from malnutrition than
those who did not participate. Anemia and morbidity rates among children, as well as rates of children
suffering from illness were all almost 10% higher for those who did not participate in the program.
5. FARN/G AND VOLUNTEER SERVICE
FARN/G can help give a volunteer’s service direction. The first three months of service are generally
spent focused on language, learning the dynamics of your community, and building relationships.
FARN/G can help you in this process. Your involvement in this program will help you understand local
cultural practices that have direct impacts on child health, identify valuable work counterparts, and help
you demonstrate your professional skills. As soon as you feel comfortable, you can begin by organizing
small focus group meetings to discuss pregnancy practices, leading up to the implementation of a full
FARN/G program. Pregnancy is something that everyone cares about, and which affects everyone’s
life. Using the results of your focus group discussions, you can identify the most important components
of a positive pregnancy program in your community, and map out a communication strategy to support
it. After you organize a FARN/G group in your community, you can conduct FARN/G trainings with
local community health volunteers or health agents in order to expand the program and establish it in
areas where Peace Corps Volunteers are not currently working. Regardless of how you choose to
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integrate FARN/G into your service, the approach is an excellent way to increase people’s confidence
in you and your visibility in the community regardless of your assigned Peace Corps sector.
FARN/G groups can also lead to secondary projects, such as kitchen gardens or gardening for
nutrition, building mud stoves, income-generating activities with women’s groups, discussions of
women’s and children’s rights, and special FARN/G groups for families living with HIV/AIDS. Not only
will new ideas come up, but FARN/G also provides you with potential counterparts. You will be able to
continue working with community health volunteers and FARN/G participants to spread health and
nutrition messages to other audiences.
II. STRATEGY
This section outlines the key players, steps for implementing a Pregnant Women’s Support Group
program, the main activities that take place during a monthly support group meeting and the follow-up
of women post delivery. See Appendix A for a simple formula of elements to keep in mind when
conducting a FARN/G program.
1. KEY PLAYERS
Role
District level health officials
To supervise the implementation of the FARN/G program on at least a quarterly basis, and
to provide constructive feedback to health center staff and community health committees.
To collect, summarize and analyze FARN/G data and send it to the regional level.
Health Center staff member
(usually a vaccination agent)
To train the village health committee, community health volunteer, the TBA's and the model
mothers regarding their roles and responsibilities in the FARN/G program, and to provide
regular (monthly) outreach visits to FARN/G communities. To help FARN/G sites overcome
supply constraints through improved planning and management. To encourage women in
their ninth month to deliver their babies at the health center, with a trained midwife. To
promote immediate and exclusive breastfeeding.
Traditional Birth Attendant
To take pregnant women to health centers for their first prenatal exam, to stay with women
during delivery, to facilitate post partum VA distribution, and to take newborn babies to
health centers to be weighed and documented. Share nutritional advice, mobilize women
for FARN/G events, and conduct household visits to FARN/G participants.
Village Health Volunteers
To conduct a census of all the pregnant women in the area, share nutritional advice,
mobilize women for FARN/G events, conduct household visits to FARN/G participants, and
weigh the participants.
Village elders, traditional and
religious leaders
To mobilize or encourage pregnant women and their husbands to participate in the FARN/G
program. To oversee the implementation of the program, and report any problems to health
center staff or the DPS. To facilitate the identification of a location for the women to meet.
Model Mother (positive deviant
mother)
To encourage women to participate in the FARN/G program, share nutritional recipes and
pregnancy tips with participants, and to cook nutritious meals for FARN/G participants.
Pregnant women
To attend at least three FARN/G sessions; to apply lessons learned during these sessions
(be willing to give them a try); to take the medications which are distributed; and to discuss
openly their problems related to child birth and pregnancy, and try to solve them. To
contribute financially to the FARN/G program (for lunch), and to prenatal care costs.
Husbands of pregnant women
To accompany their wife to prenatal consultations, support increased consumption of
micronutrient rich foods during pregnancy, help their wives locate the resources they need
to participate in the FARN/G and to purchase their prenatal consultation cards, and to
encourage them to take it easy, get rest, and take their medications
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2. IMPLEMENTING A PREGNANT WOMEN’S SUPPORT GROUP PROGRAM
2.1 Communicate with Local Health Officials
Make sure to let the Health Officials of the district you are working in know that you are
implementing a FARN/G program. Not only is it good for protocol, but if they see positive
results they may want to expand the program.
2.2 Mobilize Communities
Meet with Health Center Staff
Because health center staff will be intimately involved in all aspects of program implementation,
it is critical that they see how the program will meet a felt need, save lives, and lead to
increased use of their health facilities. This sensitization process requires a Training of
Trainers; trained health center staff will later train community members.
Meet with Village Elders and Traditional and/or religious leaders.
Explain the importance of the program, and the benefits of the program to the community.
Their support is essential to mobilize the community to participate in the program. Moreover,
as a result of this process, village elders and traditional leaders are able to reinforce nutrition
messages, and continually encourage women to participate in the program. If your village has a
low understanding of the importance of good nutrition and growth monitoring activities, it may
be helpful to discuss their importance with community leaders before asking them to help
mobilize the community. In Guinea, one Peace Corps Volunteer confronted with this situation
decided to set up a series of evening sessions on the importance of nutrition activities, inviting
the director of her health center, the local vaccinator, and a community health agent as
speakers. Community leaders who understand the importance of good nutrition practices and
the potential benefits of implementing a FARN/G project in their village will be more effective
convincing people to participate and will be more motivated themselves to promote the project.
Because protocol is important in most of the countries volunteers are working, please be sure
to continue to keep this group informed of what is happening with the FARN/G.
Organize or strengthen a village health committee
During community meetings, the goals and objectives of the program are discussed, and a
village health committee is either selected or identified (if one already exists). A village health
committee generally consists of at least six members, and includes traditional birth attendants
(TBA’s) and community health volunteers (one man and one woman), as well as village elders.
It is helpful if at least one member of the village health committee can read and write. On
resources and advice on how to start a health committee contact your Associate Peace Corps
Director for see the CORE PD/Hearth Guide (Chapter 2) or refer to the following website
http://www.coregroup.org/working_groups/Hearth_Book.pdf
2.3 Train TBA's, Health Center Staff and Members of the Village Health Committee
There are two training programs - one for TBA's, and one for health committee members
(including community health volunteers). TBA’s and Health Center Staff are given a refresher
course in prenatal care, pregnancy danger signs, and appropriate nutrition for pregnant
women. Traditional nutritional taboos are discussed, and local foods rich in vitamin A, iron and
other essential micronutrients are identified. Immediate and exclusive breastfeeding is
promoted, and its importance is stressed throughout the training program. Health committee

The traditional FARN (HEARTH) model includes a Positive Deviance Inquiry, 24-hour dietary recall and a market study. The R in the
FARN/G approach represents “Renforcement” or “Reinforcement” as opposed to “Rehabilitation”. Thus, FARN/G reinforces a certain
number of activities that women should be practicing (i.e. attending prenatal exams, receiving vaccinations and micronutrient
supplements). However, it may still be beneficial to include some Hearth activities in your training, such as focus group discussions,
market studies and recipe preparation. See APPENDIX F: PD/Hearth exercises for an explanation of activities
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members participate in a more general training program, which emphasizes the communication
of nutritional messages (behavior-change communication techniques), and the potential
benefits and impacts of the program on maternal and infant health. It is the TBA’s, Health
Center Staff and Community Health Agents who will be transmitting the FARN/G messages to
participants, so be sure to do comprehension checks and have people prepare and practice
presenting what they have learned. See Appendix B: For information on the Essential
Nutrition Actions.
2.4 Conduct a village census of pregnant women
In addition, you may want to
consider the following during the
identification process:
Women already coming to health
center for prenatal visits
Personal characteristics of the mother:
Well-respected, outgoing mothers that
are leaders in your community may be
helpful additions to a FARN/G group.
Not only do such women animate the
women over the course of the FARN/G,
they are often most likely to educate
others outside of FARN/G sessions.
Additionally,
including
influential
women can lend the program greater
credibility.
Interest:
Even after mothers have
given birth, many choose to continue
participating in FARN/G sessions for
social support.
Recommendations:
Personal
recommendations
from
your
counterpart, community leaders and
friends are another effective way to
identify pregnant women.
Local
women often know who is pregnant in
the community, and they may be out of
view from you and health center staff.
Identifying such women may be a
crucial way to draw them and their
families into the local health care
system.
Personal observations:
Do not
discount
your
own
personal
observations. Walk around your site
and look for pregnant women. Have
they had a prenatal visit, yet?
Political considerations:
In some
cases, it may be appropriate (or
unavoidable) for the chief of the village
or other village leader to weigh in on
the selection of participants. While this
is not inherently a bad thing, you need
to make sure that certain political
considerations do not jeopardize the
objectives of the project.
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Identify participants.
Along with Health Center Staff, Traditional Birth Attendants,
Paves and their counterparts should identify all pregnant women
in the community, and encourage them to participate. All
pregnant women in a community should be encouraged to
participate, after first having their pregnancy confirmed at the
local health center. Women with specific risk factors (height
below 1.45 m or women who have had previous miscarriages)
should be encouraged to make frequent visits to the health
center during their pregnancy, to closely monitor their health
status.
Conduct initial prenatal exam.
During the initial prenatal exam at the health center, women
purchase a “prenatal care package”, which includes a pregnancy
monitoring form (or, if none are available, they receive a regular
notebook from the market), vitamin and/or iron/folic acid
supplements, and associated health care elements. The cost of
the pregnancy package depends on the country where you are
serving. Generally, the price and protocol of the pregnancy
package is established by the Ministry of Public Health. See
Appendix C: Example of Prenatal Package
Once a critical number of women have been identified and their
pregnancies confirmed, they are asked to join a pregnant
women’s support group, called a FARN/G (foyer d’apprentissage
et renforcement nutritionnelle des femmes gestants). You can
make up a more locally appropriate name in your community. In
Sierra Leone, the program is called “bella women support
groups” (the Krio word for pregnancy is bella women, for women
with big bellies!), and in Malinke, it is referred to as “Gbaboni”
(the local word for cooking place).
Participation
It is crucial that both the pregnant woman and her husband
agree to participate in the program. The community agent,
member of the Health Committee, or the PCV and their
counterpart meet with the husband and wife and outline a set of
conditions that the couple must agree to prior to participating.
Here is an example of a list of agreements used in one of HKI's
programs:
a. Continue the sessions until delivery (ideally the
husband should be there for the health
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education activities, but he does not have to stay the whole time. It may be beneficial
to have messages reared specifically for men);
b. Receive home consultative visits (usually when women miss meetings, or after
delivery);
c. Supply ingredients and/or monthly contributions for monthly meetings;
d. The husband must acknowledge, understand and agree to his wife getting adequate
rest and nutritious foods during pregnancy.
2.5 Identify and Train Model Mother
A Model Mother or positive deviant mother is a member of the group who is considered a role
model for other women in her community and helps give the trainings during FARN/G sessions.
The positive deviant mother is a woman who has the same standard of living as her neighbors,
yet has successfully given birth at least twice, whose children are in good nutritional health, and
whose prenatal practices promote safe pregnancy. She can be either someone who is
pregnant now (a member of the group), or someone who has been identified as a good mother
in the community. The community health volunteer and the health center staff will choose the
volunteer mother based on the following criteria:
a. Has had at least one previous pregnancy
b. Participated in at least three prenatal visits during her last pregnancy (preferably gave
birth in a health center, supervised or assisted by a trained midwife if possible)
c. Two-year birth spacing between her children
b. Practices immediate (within 1 hour) and exclusive breastfeeding for six months
c. Shows care seeking behaviors in the prevention of illness (such as using mosquito
nets, washing hands with soap, practices good personal and environmental hygiene)
d. Be able to communicate health/nutrition messages
e. Resident of the community, stable
f.
Well-respected by members of her community
g. The birth weight of her previous child/children must have been at or above 2,500
grams (not mandatory as women participating for the first time may not have a record
of previous births).
The village health committee, volunteer, and health center staff choose the Model Mother prior
to the first FARN/G group meeting. Because FARN/G sessions are on-going (once you start
them, they are held every month, with new mothers joining and pregnant mothers delivering), if
you choose a model mother who is a member of the group, she will eventually give birth and
may no longer be able to continue to attend FARN/G meetings. If this is the case, two months
before she is to give birth, the model mother and the group identify a new Model Mother. The
current model mother will train the new model mother during the two months prior to her birth.
The very first model mother is trained by community health agents/volunteers and health center
staff.
2.6 Prepare Monthly Support Group Logistics
Hold a meeting to manage logistics
a. Date and time. Once the FARN/G participants are identified, then they along with the
Model Mother and the TBA’s choose a regular date to meet on a monthly basis, such
as the last Friday or the last Sunday of the month. Inform the health center staff of
the date chosen, so that staff members (usually the vaccination agent) can participate
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in FARN/G sessions. FARN/G sessions are generally not held on market days, and if
there are weddings, funerals or other events which fall on the same day, the
community health volunteer informs health center staff that community members are
not available to meet.
b. An appropriate location Sometimes groups choose to meet in a covered public
meeting place, a classroom, or under a tree. In some cases, women choose to meet
at the health center itself, depending on its distance from the community. In many
programs the community is required to build a hanger as community contribution in
order to demonstrate their desire for and commitment to the program.
c. Financial contribution and In-kind contribution The group determines what they will
need to bring, either in cash or in-kind, to pay for food preparation during monthly
meetings. Readily available household items like rice, green leafy vegetables and
salt are generally contributed in kind, whereas a nominal cash contribution (which
varies from 500 – 2000 Guinean Francs or 10– 40 cents) is used to purchase fish, oil
and fruit. If women are unable to bring a financial contribution the group can decide
that this person is in charge of supplying firewood, fetching water, cleaning up, or
whatever activity/contribution they deem appropriate.
2. 7 Conduct Monthly Support Group Sessions
During monthly meetings, the following events occur:
Vaccinations and pre-natal outreach
A health center staff member comes to the community on FARN/G meeting days, as part of
their routine vaccination program (stratégie avancée). Once they have finished vaccinating
children, they vaccinate all new FARN/G participants for tetanus, take their vital statistics
(weight, height and check to see if they are anemic), and give them a monthly supply of
Iron/Folic Acid supplements. The components of each prenatal care outreach session vary
depending on national protocols. For example, in Guinea women are also treated for malaria,
and dewormed at 6 and 8 months during their pregnancy (using directly observed therapy). An
example of a national prenatal care (from Guinea) protocol is given in Appendix C
Education
While health center staff work with individual participants (one by one), the rest of the women
remain together, and prenatal messages are shared. Community health agents use visual aids
or other support materials (i.e., Boite D’Image/Flipcharts, Cartes des conseilles/teaching aids)
to reinforce prenatal messages. Sometimes local youth will perform a skit, to reinforce prenatal
messages. Other times the model mother will discuss nutritional practices and tips, with
support from TBA's or Community Health Volunteers. A communal meal is prepared while the
health worker finishes with each participant. See Appendix D: Prenatal Messages
Meal Preparation
Once the health worker has finished vaccinating new members and monitoring the health of
each participant (and referring those who need follow up to the health center), a communal
meal is prepared. The positive deviant mother gathers the ingredients the women brought and
leads the cooking demonstration. The recipe should be approximately 500 Kcal, rich in
micronutrients and composed of locally available foods. The meal should reinforce nutritional
messages shared during FARN/G meetings and prenatal consultations. The recipes are
presented to the women in a manner that allows them to be repeated at home. They are simple
and practical recipes that promote dietary diversity and do not require more than an hour for
preparation. See Sample Recipes See Appendix G:
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Rest
After the meal, participants are encouraged to rest for at least one hour, and to continue to talk
and share ideas and discuss issues related to safe pregnancy and motherhood. Before each
participant leaves, she is given her nutritional supplements (iron/folic acid tablets).
Home visits
Monthly sessions are complimented by household visits, where the Traditional Birth Attendant,
the Model Mother and/or the Community Health Volunteer meets with the family to verify that
the participants are in fact taking their medications, eating right, and getting enough rest. It is
also an opportunity to discuss any health problems the pregnant woman might be experiencing,
discuss delivery with the husband and wife and chart the mother’s weight before giving birth.
At 9 months
Women who are eight or more months pregnant are referred to the nearest health center for
their final prenatal consultation, and encouraged to deliver their children in a health center or
hospital, with trained health staff. An extra effort is made to discuss the importance of
immediate and exclusive breastfeeding, post partum vitamin A supplementation and continued
iron/folic acid supplementation during the last month of pregnancy.
Monitoring
A register log (which may be as simple as a notebook kept at the Health Center) and health
card (again, as simple as a notebook or pieces of paper stapled together) is completed for each
woman on whom the following information is noted: mother’s weight prior to delivery, weight of
newborn, and monthly weight gain for mother and child.
**The mother’s final weight is taken in the 9th month. The newborn’s weight is only valid if
taken within a week of delivery.
Post-delivery
After the baby is born, data is recorded on FARN/G monitoring forms (Appendix E) or
whatever type of monitoring tools you are using. It may be simply that you have a notebook
and the mother has a notebook. Either way, the data should be available at the Health Center,
as well as sending the mother home with a copy.
*** Women who begin with the group and experience a miscarriage may choose to continue the
group for social support and education for subsequent pregnancies. The choice is up to her.
However, their miscarriage is documented in the Community Health Volunteer’s notebook. The
community agents are responsible for the creation of a notebook that includes the number of
participants, woman’s status and the result of each pregnancy.
2.8 Monitoring and Evaluation
Participants
When women have given birth, they exit the FARN/G program and new participants are
identified. However, in reality, there are always women coming to and leaving from the groups
(not everyone gives birth at the same time, or gets pregnant at the same time!), so there are no
fixed “start” or “stop” dates for a FARN/G site. Once everyone is trained and a site has been
created, FARN/G meetings are held once every month throughout the year. A woman who has
given birth can continue to come to these sessions for social support.
** In some cases women choose to continue participating in monthly FARN/G meetings, even
after they have given birth. This is a great opportunity to reinforce breastfeeding messages,
improve infant and young child feeding practices, and promote care-seeking behavior for sick
children.
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Home Visits
You should conduct home visits after delivery. Women who have given birth are followed for 3
months after delivery during which time they benefit from nutritional advice and Iron/Folic Acid
supplementation. (See Appendix C: Prenatal Package). It gives health workers the
opportunity to chart the growth and monitor the health of children who have participated in
FARN/G sessions. Additionally, it is a chance to monitor the mother’s health. The mother’s
weight should be taken three months after delivery in order to ensure that her health is
progressing normally.
III. FUNDING
It is not necessary to have many materials to conduct FARN/G sessions in the village. Many
Peace Corps Volunteers who have conducted Hearth for children or FARN/G programs have
done so without any financial investment. In theory, all of the necessary tools to have a
successful FARN/G already exist within the community. Some volunteers have asked
participants to provide all essential materials for meal preparation such as pots and pans, soap,
measuring utensils, containers, etc; while other volunteers have searched for funding for such
materials. In regards to the monitoring tools and equipment (such as scales, height measuring
equipment), they should already be available at your health centers and notebooks for
monitoring can easily be purchased locally.
HKI/Guinea purchased Hemocue® machines to measure blood hemoglobin levels of
participating women during the pilot phase of the program (to measure the impact of the
program on anemia). However, during scale up of the program to Sierra Leone, visual
symptomatic measures were used to identify anemic participants. Although slightly less
accurate, this can be done simply by looking at women’s inner, lower eyelids and the palms of
their hands. If they are not red, but pale, it means the woman is anemic.
Many of the medical costs associated with the program (iron folic acid supplements, vitamin A
supplements, tetanus vaccinations, malaria prophylaxis and deworming medications) are
normally included in prenatal packages covered by the Ministry of Health, often with support
from UNICEF or WHO. If, for any reason, one of the medical costs is not covered, volunteers
can search for outside funding for these items. The overall prenatal care package
recommended by the Ministry of Health varies depending on local health statistics and health
care practices. For example, in areas where malaria is not endemic, or intestinal worm
infections are less common, these components are not included in prenatal care packages.
Supervisions and trainings can be combined with existing health outreach programs (also know
as “Stratégie avancée” in Guinea), for additional cost savings. Thus, the FARN/G program can
be conducted with minimal funds or no funds at all. Remember to be creative. For example, if
deworming medication is not available you may ask the pharmacy to provide it as an in-kind
donation or perhaps the village will pay for it. Other ideas are to approach local NGOs, or other
groups, or to do a fund-raising campaign if you are in an area frequently visited by tourists.
You may be able to approach NGO’s for education materials or perhaps you can get your local
school to do some drawings for you. In the case of one PCVs’ site, the health center staff
actually paid for all training costs. The Health Center was also stocked with vitamin A
supplements and deworming medication. Although the health center donation may be
surprising, it is a reminder that we should never underestimate the commitment of our
communities.
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Supply List
The following is a sample list of basic supplies needed for most Hearth sessions:
 Fuel: wood/charcoal/manure
 Matches (or a coal from an existing fire)
 Water
 Large cooking pot
 Large mixing bowl
 Bowls or containers for storing ingredients
 Knife (to cut food)
 Large spoon (to stir pots)
 Strainer or basket (tami; for winnowing rice)
 Soap
 Mat for women to rest
 Visual aids for animations
IV. TROUBLESHOOTING
Motivation
One problem that many volunteers may encounter is tardiness or absenteeism of the participant
mothers. Make sure you cover all the potential reasons why this may be occurring – is this due to
the time of year (i.e., rainy season)? The group picked a day that was too busy to meet or a time
when it is unrealistic for women to be able to come? You may also want to conduct a home visit
and talk to the woman and her husband to understand why she was not able to come and find a
solution.
Another way volunteers have garnered community support is by launching the first FARN/G on a
holiday such as International Women’s Day (March 8th), World Water Day (March 22nd), Malaria
Day (April 25th), World AIDS day (December 1st), etc. It helps get people excited about the
program. Certain holidays may also be good for encouraging the whole community to participate.
If the whole community is involved in the launch, it is more likely that the women will take
attendance seriously.
Make sure to continue to inform the village elders and religious leaders of what is going on with the
program. Do not only go to them when you are having problems or challenges, but make them
aware of the successes. Even if you think they are minor successes, share them with this group. If
they see the positive impact of the program they will be more likely to get behind you and the
village health committee when challenges arise.
Planning a FARN/G from a male Peace Corps Volunteer perspective
Ryan Derni (Public Health Volunteer, Guinea 2005-2007) shared the following information on
the planning of a FARN/G in his village.
If you want to undertake a FARN/G, first have established counterparts. The counterparts
know the community as well as the mothers; a lot better than I do. If the counterparts are the
ones doing the FARN/G, it matters less what your gender is. I heavily relied on the Agents
Communautaires (Community Health Agents) and the Peer Educators in my village for any
project that I did. If you can get support from the health center staff or village officials that also
helps. Our Sous-Prefet (local official) came to our formation (training) and made an “official”
announcement to all of the districts that this project was going to happen. Lastly, for males it
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helped that the one co-conducting the training and organizing was a female. The female intern
I worked with was in her mid-20s or so and was educated. She happened to know everyone in
the village, especially a lot of pregnant women. The Prenatal Consultant Agent is another
obvious counterpart choice for male PCVs.”
Male PCVs are also great role models for men in the village. The fact that a man is
implementing a nutritional program for women and children highlights how important nutrition is
to the health of their wives and children and in the prevention of disease.
V. RESULTS TO DATE AND CONCLUSION
It is often difficult to see and measure the effects of behavior change. However, the FARN/G program
allows us and members of our community to see how simple changes in behavior can have a significant
impact on our health. HKI conducted a pilot program in Guinea with 206 participants over a one-year
period.5 Preliminary results indicate that almost all participants attended at least 3 prenatal consultation
sessions. Furthermore, more than half attended prenatal consultations during the 9th month, which is
particularly important to identify potential maternal risk factors. From the time of joining the program to
that of delivery, participants’ weight gain averaged 7.4 (±1.3) kg, and the anemia rate decreased. Out of
the 71% of participants who delivered at home, 84% were assisted in delivery by trained village
midwives, compared to the national average of 35%. Average birth weight was 3.26 kg, and only one
low birth weight infant was recorded. These are visible results that will not go unrecognized by your
community. Thus, FARN/G is an effective way to reduce anemia during pregnancy and to reduce the
prevalence of low birth weight. Women who have participated have more energy and healthier babies.
A study done by Lynn Morin in 2005 shows that “85% of the women report a difference between their
pregnancy during the FARN/G program and their previous pregnancies.6 These women describe the
change as positive with 69% of the responses noting less illness and an easier delivery during the
program period.” Other women in the community will notice this and want to join the group or the
participants themselves will encourage their friends to join.
One major reason FARN/G has been such a success is because all activities are implemented by
community members and health center workers in the field, with minimal long term supervision
required. As one community health volunteer described it, “Nous sommes les bénéficiaires,
partenaires, et propriétaires de l’activité” (We are the beneficiaries, partners and owners of the
program).
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Appendix A
Pregnant Women’s Support Group Program
Formula 3*8
8 Key Stakeholders or Actors
1. District Level Health Officials
2. Health Center Staff
3.Traditional birth attendants
4. Village Health Volunteers
5. Village elders, traditional and religious leaders
6. Model mothers
7. Husbands
8. Pregnant women
8 Key Program Components
1. Outreach prenatal care and referral
2. Iron/Folic Acid supplementation
3. Treatment for malaria
4. Deworming
5. Tetanus Vaccination
6. Nutrition lessons and cooking demonstrations
7. Vitamin A post partum
8. Iron/Folic Acid post partum
8 Steps to Program implementation
1. Inform District Level Health Officials
2. Mobilize Communities
3. Train TBA’s, Health Center staff and village Health Committee
4. Village census of pregnant women
5. Identify and train Model Mothers
6. Prepare Monthly Women's Support Group sessions
7. Conduct monthly support group meetings
8. Monitor and Evaluate
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Appendix B
Training Materials
MICRONUTRIENTS
Nutrients:
Nutrients are chemical substances found in foods, which are released through the
process of digestion and enter the blood stream for various body functions.
VITAMIN A
Functions:
- Essential for optimal growth and vision
- Essential for proper immune function, makes the body resistant to diseases and infections
- Protection, maintenance, and reconstitution of certain tissues such as:

The conjunctiva and the cornea of the eye;

The rod-shaped cells of the retina;

The intestinal mucous membrane of the gastro-intestinal tract;

The lining of the bronchioles in the lungs.
Effects of Deficiency
- Reduced fetal stores and lower levels of vitamin A in breast milk.
- Increased risk of appetite loss, eye problems, lower resistance to infections, more frequent and
severe episodes of diarrhea and measles, iron deficiency anemia, and growth failure.
- Increased risk of illness leads to an increased risk of death.
- Night blindness
- Acute Vitamin A Deficiency (VAD) can lead to blindness
Sources:
- Animal sources (vitamin A): Liver, egg yolks, whole milk and fish.
Plant sources (provitamin A, or beta carotene): Orange-fleshed fruits and vegetables (carrots,
pumpkin, mangoes and papaya), orange-fleshed sweet potatoes, dark green leaves (cassava,
sweet potato, spinach, amaranth, sorrel etc.)
Supplements:
- For women during immediate Post-Partum: A high dose vitamin A capsule (200,000 IU) as
soon after delivery as possible up to six weeks post partum. (Many countries include this in
their national health program).
- Cautionary note for pregnant women: Because high doses of vitamin A during pregnancy
can cause birth defects, PREGNANT WOMEN SHOULD NOT be given a mega dose vitamin
A supplements.
- Cautionary note for children: Because the capsule form of Vitamin A is fat soluble, the body
has the ability to store large amounts, which is why you should always be careful when
administering supplements to children. Make sure the children have not received a Vitamin A
capsule within the past six months and no more than two capsules per year).
- Note for infants and children: Infants under 6 months should not receive vitamin A capsules.
A child less than one year old should receive half of the normal dose.
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IRON
Functions:
- Iron is a mineral commonly found in nature and which the human body needs to make red
blood cells.
- Iron is part of the haemoglobin, which serves to transport oxygen from the lungs to the body
tissues. If the body does not have enough iron, the quantity of haemoglobin diminishes and the
person becomes anaemic, which means that the body's tissues are not well oxygenated.
Effects of Deficiency:
- Anemia (tiredness, tachycardia (irregular heart beat), shortness of breath, dizziness, insomnia
(difficulty sleeping), visual disturbances, edema)
- Decreased resistance to infections
- Reduced productivity at work
- Low birth weight
- Maternal death
- Premature birth
- High infant mortality rate
Foods:
- Animal sources (Heme iron): Meet, liver, eggs, fresh/smoked/dried fish
- Plant sources (Non-heme iron): Green leaves (potato/manioc/baobab/amaranth/spinach
leaves), dried okra, Hibiscus leaves, dried neri seeds, sorghum, fonio, beans
Supplement:
- Pregnant women should be given 60 mg/day of Iron sulfate during the second and third
trimesters of pregnancy
- Lactating mothers should be given 60 mg/day of Iron sulfate for three months after delivery.
*Vitamin C aids in the absorption of nonheme Iron (iron found in plant foods, dairy products, eggs and
iron-fortified foods). Foods rich in Vitamin C are oranges, mangoes, lemons, guavas and hibiscus
leaves. For it to be effective, foods rich in Vitamin C should be eaten WITH the foods containing iron.
Example, if a child eats a meat soup, he should follow it up with an orange.
* Tannins in tea and coffee inhibit its absorption if they are consumed during a meal or just after.
Women should avoid these beverages or encouraged to drink them 2 hours before or after a meal
* One way of explaining iron to women in the village is that it makes the blood strong.
IODINE
Function:
- Necessary for baby’s growth, especially fetal brain development
- Synthesis of thyroid hormones, which serve to control the metabolic rate
Effects of Deficiency:
- Goiters (a swelling of the thyroid gland in the neck)
- Mild intellectual impairment (a decrease of 13.5 points in IQ score) to severe, irreversible
mental retardation or cretinism (a physical and mental development delay in children)
- Miscarriage in pregnant women
- Deafness
Sources:
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- Best source is salt that has been iodized
- Foods that come from salt water, such as shrimp, mussels and salt-water fish
ZINC
Functions:
- Maintaining healthy immune system
- Protein synthesis
- Healing of wounds
- Child development during pregnancy, childhood and adolescence
Effects of Deficiency:
- Growth delay
- Diarrhea
- Hair loss
- Loss of appetite
- Slowed sexual development
- Slow fetal development
Foods:
- Red meat
- Poultry
- Beans
- Nuts
- Whole grains
- Dairy products
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Appendix B
Essential Nutrition Actions (ENA) During Pregnancy
http://www.basics.org/documents/pdf/ENA.pdf
The Essential Nutrition Actions approach provides a framework for promoting important nutrition “actions”
that focus on pregnant women and children up two years of age. ENA focuses on optimal nutritional
practices spanning infant and young child feeding, micronutrients, and maternal nutrition. The
framework highlights priority interventions and specific contacts with the health system for incorporating
appropriate nutrition emphases. These ENA should be adapted to respond to the contextual realisties
of each country. Several countries, including Benin, India, Madagascar, Ethiopia, and Senegal have
been active in promoting ENA. The majority of these actions are appropriate for community-based
nutrition interventions and can be integrated into a range of nutrition activities that PCVs carry out,
including FARN/G.
The essential actions developed for the FARN/G in Guinea and Sierra Leone includes the following;
ACTION # 1
1. Provide nutritional support and counseling to pregnant and lactating women.
ACTION # 2
2. Improve infant weaning and complimentary feeding practices
ACTION # 3
3. Eliminate vitamin A deficiency (VAD)
ACTION # 4
4. Reduce anemia (iron/folic acid supplementation, de-worming, malaria treatment, dietary diversification)
ACTION # 5
5. Birth Spacing of 3 years or more
ACTION # 6
6. Promote HIV/AIDS awareness and accessing HIV/AIDS services
***************************************************************************************************************************
Essential actions
ACTION # 1
1. Provide nutritional support and counseling to pregnant and lactating women. The
critical components of “Action # 1” include:

Encourage increased food intake during pregnancy and lactation
During pregnancy: Pregnant women need to increase food intake by at least 200 calories per day and more
if their pre-pregnancy weight was low. For example, a serving of maize porridge and 12 groundnuts meets
this additional requirement.
During lactation: Most breastfeeding women in developing countries need approximately 650 additional
calories—nearly the equivalent of an extra meal per day—to meet the energy needs of lactation. Pregnant
women often object to increasing food intake because they are concerned that a bigger baby will make
delivery more difficult. Women may be more receptive to messages that focus on eating specific foods,
giving birth to healthy babies, and feeling better during pregnancy than to messages that focus solely on
eating more food.

Monitor weight gain in pregnancy
Women should gain about one kilogram per month and no more than 2 in the second and third trimesters of
pregnancy.
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
Counsel on reduced energy expenditure
African women engage in physically demanding activities requiring high levels of energy. They often
maintain these activities throughout pregnancy without taking additional rest or changing their diets.
Reducing workloads helps to improve women’s nutritional status and increase birth weight. This message
needs to be directed to male partners and other family members as well as to mothers.

Adequate Micronutrient Intake during Pregnancy and Lactation
Improving micronutrient status through diet diversification and micronutrient supplementation is an important
step to reducing maternal malnutrition. Many women display not one but several micronutrient deficiencies.
Minimal intake of micronutrient-rich foods and the body’s inability to absorb and use certain micronutrients
efficiently account for the prevalence of multiple deficiencies.

Counsel on diet diversification
During antenatal, immediate postpartum, postnatal, and family planning contacts, women should be asked
about their diet and affordable foods and counseled on ways to increase consumption of the following:
 Fruits and vegetables: Increased daily consumption of green leafy and yellow orange fruits and
vegetables will improve the uptake of many micronutrients.
 Animal products: Meat, fish, milk, and eggs are excellent sources of protein, fat, and micronutrients.
Many micronutrients in animal products are more easily absorbed and/or used by the body than
those found in fruits and vegetables.
 Iodized salt: Promotion of iodized salt for use by the entire family is a public health priority. Iodine
requirements increase during pregnancy.
 Fortified foods: Fortification of flour and other common foods with iron and other nutrients can
improve micronutrient intake.
ACTION # 3 Eliminate vitamin A deficiency (VAD)
 Distribute vitamin A to postpartum women
The health sector can help prevent vitamin A deficiency by providing lactating women with a high dose
vitamin A capsule (200,000 IU) as soon after delivery as possible. Because high doses of vitamin A during
pregnancy can cause birth defects, they should not be given to pregnant women. That means that highdose vitamin A must be administered in the first six weeks postpartum.
ACTION # 4 . Reduce anemia (iron/folic acid supplementation, de-worming, malaria treatment, dietary
diversification)
 Prescribe and make accessible iron/folic acid supplements
A healthy diet alone, usually cannot meet all of the iron requirements of pregnant women, especially those
who begin pregnancy with low stores. Large amounts of iron are lost during pregnancy— due to tissue
synthesis in the mother, placenta, and fetus— and during delivery. Iron supplements can prevent and treat
iron deficiency anemia in pregnant women. Health programs should assess whether a pregnant woman is
severely anemic (generally defined as a hemoglobin level less than 7 g/dl). Pallor (extreme paleness) at
either the conjunctiva or palms indicates severe anemia. The following tables provide iron supplementation
guidelines for pregnant women.
Malaria in Pregnancy
Pregnant women have a decreased level of immunity making them more susceptible to contracting malaria.
Pregnant women who contract malaria face serious maternal and fetal health risks. For example, malaria is the
cause of 15 percent of prenatal anemia and 35 percent of preventable low birth weight. In highly endemic
countries, many women have developed some immunity; consequently re-infection with malaria during
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pregnancy may be asymptomatic, therefore masking the need for treatment. Women in their first pregnancies
are at increased risk for malaria.

Promote use of insecticide-treated bed nets.
Use of insecticide-treated bed nets can significantly lower pregnant women’s risk of contracting malaria. The
consistent use of insecticide-treated nets (ITNs) for pregnant women has been documented to decrease both the
number of malaria cases and malaria death rates in pregnant women and their children.2

Promote intermittent presumptive treatment (IPT) for pregnant women
Health programs can reduce the impact of malaria infections among pregnant women by giving intermittent
presumptive treatment for malaria to all pregnant women, regardless of whether or not they show signs of
infection. Intermittent presumptive treatment (IPT) in pregnancy involves giving a curative treatment dose of
an effective antimalarial drug at predefined intervals during pregnancy even if the mother has not tested
positively for malaria. This approach has been shown to be safe, inexpensive and effective. The main treatment
regimens during pregnancy are two curative doses of sulfadoxine-pyrimethamine (often referred to as
Fansidar), one in the second trimester of pregnancy and the other in the third trimester.

Treat clinical infections
In addition to the anti-malarial drugs a woman with a clinical case of malaria should receive drugs to reduce
fever. During pregnancy women should never take several anti-malarial drugs—tetracycline, doxycycline,
primaquine, halofantrine, and artemisinin derivatives. Also, a woman should be given iron/folic acid
supplements to treat anemia.
Hookworm in Pregnancy

Reduction of Hookworm Infection in pregnant women
Hookworm causes chronic blood loss, resulting in iron deficiency anemia. Hookworms attach to and feed
upon the intestinal lining. The amount of blood lost with a heavy hookworm infection can be substantial. A
hookworm infection of moderate intensity may cause a woman to lose as much or more iron as the
additional amount needed during pregnancy.

Counsel on preventive measures
Preventive measures include appropriate disposal of human waste and use of footwear to protect feet from
contaminated soil. Hookworm infection occurs mainly through physical contact with soil contaminated by
human feces.

Prescribe and make accessible anthelminthics during pregnancy
Deworming compares favorably with other interventions to improve women’s iron status. During prenatal
contacts, health workers should give pregnant women a deworming treatment in the second and third
trimesters. Several safe and effective drugs are available to treat hookworm infection. The most commonly
used anthelminthic drugs are:
• Albendazole (single dose of 400 mg) or
• Mebendazole (single dose of 500 mg or 100 mg twice daily for three days)
2 A study in an area of high malaria transmission in Kenya has shown that women protected by ITNs every night during their
first four pregnancies produce 25% fewer underweight or premature babies. In addition, ITN use benefits the infant who sleeps
under the net with the mother by decreasing exposure to malaria infection. Health education programmes, social marketing
and lobbying to reduce the prices of ITNs and re-treatments are helping to encourage the use of ITNs by pregnant women.
(source: Roll Back Malaria, RBM Infosheet 4 of11 March 2002)
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ACTION #5- Birth Spacing of 3 years or more. The critical components of “Action # 5
include:

Birth Spacing for Three Years or Longer
Extending birth spacing and giving women longer non-pregnant, non-lactating intervals provides them the
time they need to replenish their energy and micronutrient stores. As well as improving maternal nutrition,
longer birth intervals improve child survival and health. An inter-pregnancy interval of 39 months allows for
six months of exclusive breastfeeding, followed by at least 18 months of breastfeeding and complementary
feeding, and at least six months of neither pregnancy nor lactation.

Promote optimal breastfeeding practices
The first step to birth spacing in Africa is to ensure that breastfeeding rates are maintained and that the
fertility-inhibiting impact of breastfeeding is maximized. In Africa— where contraceptive prevalence is low—
the contribution of breastfeeding to birth spacing is many times greater than that of all modern
contraceptives combined. Optimal breastfeeding practices include:
 Early initiation of breastfeeding (within the first hour after delivery)
 Exclusive breastfeeding for six months
 Continued breastfeeding along with complementary foods from about six months through two years
or more
These practices support child spacing as well as child survival and women’s health. Putting the baby to the
breast immediately after delivery may reduce a mother’s risk of postpartum hemorrhage since suckling
stimulates the release of oxytocin, which helps to trigger uterine contractions. Breastfeeding lengthens the
duration of postpartum amenorrhea (the absence of menstrual bleeding). Amenorrhea helps a woman
recover her iron stores lost in pregnancy.

Promote family planning as a health and nutrition intervention
To achieve longer birth intervals, women need to have access to family planning methods. Health workers
should discuss with women different family planning options and refer them to appropriate services. Women
and their partners should be provided with a full range of safe and effective contraceptive methods from
which to choose. Modern methods for birth spacing include: condoms, spermicides, sterilization, oral
contraceptives, vaginal barrier options, intrauterine devices, Natural Family Planning, the Lactational
Amenorrhea Method (LAM), as well as implants, injections, and other progestin-only contraceptives.

Consider breastfeeding status when prescribing contraception
Breastfeeding women have special reproductive health needs that need to be addressed when choosing a
family planning method. Service providers often fail to ask women about their breastfeeding status. Many
are unaware that initiation of some methods, in particular combined hormonal pills and injectibles, should be
delayed during breastfeeding.
ACTION #6 Promote HIV/AIDS awareness and accessing HIV/AIDS services
HIV/AIDS and STI Prevention To help reduce the risk of HIV infection in mothers and their infants, health
workers should be trained to promote dual protection and to make condoms available to clients at all times:
prior to the decision to become pregnant, during pregnancy, and postpartum. Dual protection refers to
protection against both pregnancy and HIV/STIs. Dual protection can be achieved through the use of
condoms (male or female) alone or along with another contraceptive method. Although breastfeeding
women will be protected from pregnancy and STIs with appropriate and consistent use of condoms, using
LAM along with condoms will provide additional benefits to the mother and her child.
HIV/AIDS All women should be encouraged to get tested for HIV/AIDS. If a pregnant woman is HIV
positive or is living with AIDS it is critical that she access Prevention of Mother to Child (PMTCT) services to
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minimize the possibility of HIV transmission to her fetus/baby. Furthermore, it is critical that she access
HIV/AIDS services for her own well being.
I
IMPORTANCE OF PRENATAL CARE
What to look for during Prenatal Exam
DANGER SIGNS
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Appendix C
Example of Guinea’s Prenatal Package
STRATEGY-PRENATAL CONSULTATION
Vaccination/Medication/
Supplement
Anti-tetnus 1 (VAT1)
Anti- tetnus 2 (VAT2)
Booster
Deworming medication
Anti-malarials
Iron (FAF)
Vitamin A
Iron (FAF)
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Month and Dose
Vaccination/Shot
1st prenatal consultation (if a woman has had all 3 doses for a previous birth, she only
needs to get the first as a booster
Vaccination/Shot
45 days after 1st dose
(if she has not already received for a previous birth)
Vaccination/Shot
45 days after second dose
(if she has not received it for a previous birth)
Mebendezole
Dose: 1 pill (500mg)
When: 1 dose after 1st trimester
and 1 dose after second trimester
Sulphadoxine Pyrimetamine
Dose:3 pills
When: 1 dose at 4 months and
1 dose at 7 months
FAF (Iron/Folic Acid)
Dose: 1 pill per day (pill is composed of Iron 60mg and Folic Acid 40mg)
When: Immediately after a meal or before bed. Not on empty stomach.
Dose: 1 capsule 200,000 UI capsule
When: up to 6-8 weeks AFTER birth
Women should continue taking 1 pill per day (60 mg of Iron 40mg of Folic Acid) for the 3
months after birth
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Appendix D
Prenatal Messages Shared During FARN/G sessions
1. Pregnancy is a shared responsibility. Husbands and wives should support one another during
pregnancy, to reduce pregnancy risks and protect the life of the baby, and the mother.
2. A successful pregnancy is directly linked to the habits practiced during pregnancy. Pregnant
women must eat well (from each different food group), eat often (more than usual), and rest.
Husbands should make sure their wives have healthy food to eat, and that they rest a little
each day.
3. Prenatal consultations are important. They can save your life, and the life of your baby.
Husbands should encourage their wives to have regular prenatal consultations.
4. Women should get at least three prenatal consultations during their pregnancy – once during
the first trimester, another during the second trimester, and the last one in their last month of
pregnancy. The last prenatal consultation is very important, and can considerably reduce the
risk of infant and maternal mortality. Husbands should accompany their wives to prenatal
consultations.
5. Prenatal consultations include vaccinations, malaria prophylaxis, iron and folic acid
supplementation, and deworming medication. These medicines will make the mother stronger,
so she can withstand labor, and will make the baby stronger.
6. Pregnant women should eat green leafy vegetables, to prevent night blindness. They should
eat yellow and orange fruits and vegetables, and palm oil. Pregnant women should eat meat,
fish, eggs and liver to strengthen their blood. After each meal, pregnant women should eat fruit
rich in vitamin C, such as oranges, lemons, mangoes or guavas.
7. It is very important to take iron and folic acid tables during pregnancy, and up to three months
after pregnancy. Pregnant women are often dizzy and weak. Iron tablets will make you strong
and reduce the risk of blood loss during delivery. Folic acid will protect your baby in the womb
and reduce the risk of birth defects. Iron tablets should be taken just before bedtime, or during
meals with fruit, to reduce negative side effects and promote absorption into the bloodstream.
8. Iodine is also very important for pregnant women. Iodine helps the baby grow and is especially
important to the development of the brain. A lack of iodine can cause abortions or lead to
irreversible mental retardation. Goiter is a visible sign of lack of iodine. Iodized salt is the best
source of iodine. Other sources of iodine include items which come from salt water, such as
shrimp, mussels and salt water fish.
9. Malaria is very dangerous to pregnant women. It can cause high fevers, abortions, and risks
the life of the mother and the unborn child. Pregnant women should take chemoprophylaxis
and sleep under impregnated mosquito nets to reduce their exposure to malaria. Pregnant
women with fevers should go to the health center immediately.
10. Pregnant women should gain weight during pregnancy (between 9 – 12 kgs). Women with
twins should gain even more weight. Pregnant women should weigh themselves every month,
and should gain approximately 1 kg per month.
11. Pregnant women should not carry heavy loads, and should rest for at least one hour each day.
Husbands should support their wives to make sure they do not overexert themselves.
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12. Pregnant women should not smoke, drink alcohol or consume caffeine. These products reduce
the absorption of iron and other vitamins into the blood stream. Pregnant women should eat
foods rich in iron, Vitamin A and protein, and always use iodized salt.
13. Hygiene is very important to health. Pregnant women are especially at risk of becoming sick.
Pregnant women should be especially careful to wash their food before preparing it, cook their
food well, and protect their food from flies and other sources of contamination. All family
members should wash their hands frequently with soap, especially before eating, and after
using the bathroom or working outside. Pregnant women should clean their clothes well and
change them regularly. Every household should have a latrine, to prevent contamination and
reduce disease.
14. Danger signs during pregnancy include swollen feet, genital blood, genital secretion, abdominal
pain, fever, dizziness, persistent head aches, and lack of movement of the child during two
days during the last trimester. If any of these signs occur, go to the health center or hospital
immediately.
15. Vitamin A is very important for pregnant and lactating women and infants. It helps the baby
grow faster, strengthens the eyes, and protects mother and child from disease. Pregnant and
lactating women should eat liver, meat, milk or yogurt, eggs, red palm oil, carrots, mangoes,
papaya, squash, and green leaves to increase the vitamin A in their body. Women should also
take vitamin A supplements just after delivery, and again no later than six weeks after delivery.
16. Immediate and exclusive breastfeeding can save your life, and your child’s life. Immediate
breastfeeding will signal your body to discharge the placenta, which is critical to recovery from
delivery. Immediate breastfeeding will also signal your body to stop bleeding. These are the
main causes of the death of mothers during or just after delivery.
17. The first milk, called colostrum, is rich in vitamins and minerals, and protects your baby from
disease. Newborn babies are very fragile, and rely on their mothers’ milk to protect them from
disease. Other food sources, including water, could contain diseases. They are not safe for
your baby. Only breast milk is safe for your baby for the first six months.
18. Women who are breastfeeding need to eat frequently, and eat extra food. They should drink
plenty of liquids, so that they can adequately feed their baby.
19. Women who are breastfeeding should continue to take iron and folic acid supplements for three
months after delivery. During delivery, women loose a lot of blood. Iron and folic acid tables
will help rebuild the blood, and facilitate the proper development of the baby.
20. Every family should have a household garden, to support the nutritional needs of pregnant
women and young children. Plant fruit trees and vegetables rich in iron and vitamin A, such as
orange and yellow vegetables.
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Galloway et al Anemia Prevention and Control: What Works Part II Tools and Resources. Produced by
The Population, Health and Nutrition Information (PHNI) Project June 2003 Page 63, 67
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Appendix E
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FARN/G Monitoring Forms
1. Notebook to register new mothers
District:
Chiefdom:
Village :
Name of the Health Volunteer :..............................Month:_____/Year: 200__
Name
Age
Number of
children
No of
months
preg.
Nut
surveil
(Y/N)
FARN/G
(Y/N)
PNC 1
(Y/N)
PNC 9
(Y/N)
Referred to
health center
(Y/N)
Note/ This notebook is maintained by the community health volunteer to record data from women who are monitored during
community pregnancy surveillance meetings, for the minimum recommended parameters.
2. Notebook to monitor pregnancy and post-partum
District:......................
Chiefdom : ....................................
Name
No of
months
pregnant
Village ..............................
Health Volunteer :................................................
Danger
signs
(Y/N)
Urinary
signs
(Y/N)
Assisted
delivery
(Y/N)
Referral
(Y/N)
Birth
weight
(grams)
Infant
died
within 28
days
(Y/N)
Mother
died within
28 days
(Y/N)
Note/ This notebook is used by the community health agent to monitor the effects of the program on infant and maternal
morbidity and mortality, and infant birth weight .
3. List of those present during FARN/G
District:.......................
Chiefdom ..................
Village ........................
Agent:..............................
Name of Model Mother
………………
Site Number :................
Number of Session :……………..Number of women in the group :………………
Name
No
month
preg
Hb
Weight
(initial)
Height
Community Surveillance
(5 sessions)
S1
S2
S3
S4
Hb
Weight
(final)
Height
(final)
S5
Note : This form is used by community health volunteers or health agent to monitor women’s participation in FARN/G
sessions, changes in their weight, hemoglobin and height.
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Appendix E
PRENATAL EXAM CHECKLIST
Pregnancy monitoring check-list (to be completed by TBA or community agent)
Name:
BSG site:
PHU:
Community agent’s name:
TBA’s name:
Pregnant woman’s screening
Parameters
Pregnant woman's screening parameters
Yes
No
Observations
Fatigue when walking
Paleness of eyelids or palms
Weight (women should gain at least 1 kg
and up to 2kg per month during 2nd and 3rd
trimester)
Difficulty breathing and/or cough lasting
more than a week
Dizziness
Swelling of joints or muscles
Lack of activity by the fetus
Vaginal bleeding
Headaches
Vaginal discharge (odorous or not)
History of stillbirths
EXISTENCE OF ONE OR MORE OF THESE SIGNS REQUIRES REFERRAL
TO NEAREST HEALTH CENTER
Note: The before mentioned situations cannot be handled by the community
agents or TBAs. They are responsible for identifying these danger signs and
organizing the pregnant woman's referral to a nearby health facility
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Appendix F
Exercises from PD/Hearth Program
FOCUS GROUP DISCUSSION (FGD)
Conduct a Focus Group Discussion
A Focus Group Discussion is an open-ended conversation with a targeted group of community
members intended to help you understand cultural beliefs and traditional practices. It may be helpful to
conduct such discussions with local women, men, grandmothers, older siblings or other community
groups whose ideas about nutrition, pregnancy and women’s health would be helpful to understand
before planning a FARN/G. If you choose to conduct FGDs, it is important to remember that it should
be an interactive discussion rather than an interrogatory interview. Writing down each person’s
comment may give the impression that you are looking for “right” answers that may make individuals
less likely to respond to your questions truthfully. Remember the questions are there to help you spark
discussion. You may see that the group cannot come to a consensus. Allow the group to talk it out and
pay close attention to all the different answers they may be giving for one question. There is a list of
suggested questions at the end of this manual. Do not hesitate to expand. Make sure to tailor your
questions to the group and the topic at hand.
Remember that these questions are only a guide to initiate discussion.
Nutrition Practices/Pratiques Alimentaires :
What should pregnant women eat?
Quels sont les aliments que une femme enceinte doit manger?
What should pregnant women not eat?
Quels sont les aliments que une femme enceinte ne doit pas manger ?
Where do women tend to give birth?
Normalement, les femmes font l’accouchement ou?
Who assists the woman when she is giving birth?
Qui est la pour assister la femme pendant l’accouchement?
If a woman is pregnant who does she seek advice from?
Si une femme est engrosses, elle cherche les conseilles ou?
Are there any medicines (traditional or non) that women take during pregnancy?
Are mosquito nets available in your community?
Est que les moustiquaires sont disponibles dans votre communauté?
In terms of nutrition, what is good for pregnant women to eat and why?
Pour les alimentées, qu’est-ce qui est bon pour les femmes enceintes de manger? Pour quoi?
The yellow liquid/colostrum that comes from the mother’s breast during the first hour after birth, should the
baby receive this?
Serait il bon ou mauvais de donner a vos bébé ce colostrum (la liquide jaune qui sort dans la
Première heures suivant la naissance)?
Until what age should you breast feed exclusively and why?
Jusqu'à quel age serait il bon de donner uniquement du lait maternel a l’enfant? Pour quoi?
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During weaning, what are good foods to give the infant?
Pendant le sevrage quel genre d’aliment les mères donnent a leurs enfants ?
Until what age do mothers breastfeed their infants (this includes breastfeeding along with other foods)?
Jusqu’à quel age la majorité des mères allaitent leurs enfants ?
At what age should the mother introduce foods other than breast milk and why?
A quel age introduit on de la nourriture autre que le lait maternel et pourquoi? Quels sont les aliments
donner aux enfants?
Do you encounter any challenges with breast feeding? If so, what are these challenges?
Quels sont les défis que les mère pourraient rencontrer en essayent de téter leurs enfants ?
What should a breastfeeding mom eat?
What should a breastfeeding mom not eat?
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Enquête Sur Le Marché (Market Survey)
Aliment (Food)
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Quantité
(Amount)
Prix (Price)
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Riche en quel nutrients (rich in
which nutrients)
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CREATING A RECIPE/DETERMINING PROTEIN and CALORIE CONTENT
You can use this guide to create a recipe. However, villages often have recipes that are rich in
nutrients, they just do not make them as often or the meal is divided up among so many people that
each person does not get the calorie and protein content to meet their individual needs. Often we just
need to reinforce the value of these recipes and importance of having the right portion for the person’s
dietary needs. You can use this guide to determine the calorie and protein content of recipes already
existing in your community.
Tips:
-
Keep it simple
Use local measurements
Build upon local recipes
Should contain an element from each food group (construction, protection, energy)
Keep affordability in mind
What you will need:
-
Scale (food)
Food composition table
Local utensils for measuring
Determining food content:
To determine the food content, all you have to do is calculate how many calories are in a given number
of grams of food. You do this by calculating the ratio of set grams to 100 grams. Here is an example:
100g of millet powder contains 351 calories. In order to get the number of calories in 90g, multiply 351
by 9 to get 316.
100g of tomatoes there are 1.1g of protein. In order to find the number of protein in 128g, multiply 1.1
by 1.28 to get 1.4.
Etc…
Once you have the breakdown for each ingredient, you can add them up to see if you have a nutrient
dense meal.
Other thoughts to keep in mind when determining recipes:
a. Oil can always be added to increase the number of calories, without increasing the portion size
b. If you are having trouble reaching enough calories or protein, try getting the children to have a
snack while the food is being prepared or after. I.e., oranges, mangoes, dried fish, peanuts,
etc.
NB: This is not an exercise that has to be done with mothers. It may be a good exercise to do with
your health committee. Or it may be good to do on your own and use as a gauge to determine if you
have enough calories and protein in your recipes.
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These recipes are drawn from Hearth (for malnourished child) recipes used in Guinea.
Farine de mil
Tomates
Poisson sec
Gombo sec
Oignon
Huile d'arachide
Total
Millet powder
Tomatoes
Poisson sec
Dried okra
Onion
Peanut Oil
Total
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Kcal (100g)
351
20
269
28
40
884
Kcal (100g)
351
20
269
28
40
884
Protides (100g)
8,6
1,1
47,3
10,8
1,4
0
Protein (100g)
8.6
1.1
47.3
10.8
1.4
0
Toh avec poissons et gombo
Fer (100g) Mesures traditional
0 2,5 verres de thé
0,6 2 petites tomates
4,9 2,5 cuillères a soupe
26,3 1,5 cuillères a soupe
0,5 1 cuillère a soupe
0 1.5 cuillère a soupe
Poids
90
128
20
27
14
0
Ration
0,9
1,28
0,2
0,27
0,14
0
Kcal
316
26
54
8
6
159
569
Protides (g)
7,7
1,4
9,5
2,9
0,2
0
21,7
Fer (mg)
Toh with fish and okra
Traditional
Iron (100g) Measurements
0 2,5 small tea glasses
0.6 2 small tomatoes
4.9 2,5 soup spoons
26.3 1,5 soup spoons
0.5 1 soup spoon
0 1.5 soup spoons
Volume
90
128
20
27
14
0
Ratio
0,9
1.28
0.2
0.27
0.14
0
Kcal
316
26
54
8
6
159
569
Protein (g)
7.7
1.4
9.5
2.9
0.2
0
21.7
Iron (mg)
0
0.8
1
7.1
0.1
0
9
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0
0,8
1,0
7,1
0,1
0
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Peace Corps Guide for Pregnant Women’s support group program__Final Draft August 2008
References
Robert E Black, Lindsay H Allen, Zulfi qar A Bhutta, Laura E Caulfi eld, Mercedes de Onis, Majid
Ezzati, Colin Mathers, Juan Rivera, for the Maternal and Child Undernutrition Study Group (2008).
Maternal and child undernutrition: global and regional exposures and health consequences. Lancet
371: 243-60 January 17.
1
2CORE
Dietary Guide, Maternal Nutrition During Pregnancy and Lactation www.linkagesproject.org
3CORE
Group (2003). POSITIVE DEVIANCE HEARTH A Resource Guide for Sustainably
Rehabilitating Malnourished Children Child Survival Collaborations and Resources Group February, Pg.
7
4HKI
Guinea/Ministry of Public Health, Republic of Guinea (2007). Rapport de
l’enquête d’évaluation de l’impact de l’approche FARN/G « Foyer d’Apprentissage et de Renforcement
Nutritionnel des Femmes en Grossesses » (FARN/G)
HKI Guinea (2003). Results from a community-based pregnancy surveillance program (FARN-G) in
Dinguiraye, Guinea
5
6Morin,
Lynn (2005). Participant Perceptions of a Prenatal Community Surveillance Program in
Upper Guinea June
Other sources used in the creation of this manual include:
Barriqualt, Aurélien (2005). Enquete de consummation alimentaire chez les femmes enceintes et
allaitantes participant au FARN/G en Haute Guinee (Guinee Conakry). October
Galloway et al Anemia Prevention and Control: What Works Part II Tools and Resources. Produced by
The Population, Health and Nutrition Information (PHNI) Project June 2003 Page 63, 67
HKI Sierra Leone, Training of Trainers Guideline August 2006
HKI Guinea, Technical Note on the Implementation of Pregnant Women’s Support Groups
HKI Guinea, Training Module for the Implementation of Community-Based Pregnancy
Support Groups (FARN/G)
AED, Dietary guide, maternal nutrition during pregnancy and lactation, August 2004.
Sandra L. Huffman et al (2001). Essential health sector actions to improve maternal nutrition in
Africa, Linkage project, May.
HKI Guinea, Modules de Formation en Nutrition Des Agents de Sante, June 2005.
CORE Dietary Guide, Maternal Nutrition During Pregnancy and Lactation www.linkagesproject.org
http://www.coregroup.org/working_groups/nutrition_nuggets.cfm
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http://www.coregroup.org/working_groups/pd_hearth.cfm
Micronutrient Fact Sheets Dr. Penelope Nestel Dr. Ritu Nalubola January 2003
http://www.ilsi.org/file/microfacts.pdf
National Institute of Health-Office of Dietary Supplements-facts about supplements-zinc
http://dietary-supplements.info.nih.gov/factsheets/cc/zinc.html#extra
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