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'Talking Books' Teach Health

When families in the West Darfur villages of Lagissa and Refida Kosa, Sudan, first received their talking books, they reacted with great curiosity and interest. Parents and children alike took turns pushing the buttons to activate recorded messages in simple Arabic about health and nutrition. Each electronic talking book is 10 pages long, with short messages consisting of text, recorded voices and pictures—all linked together to bring important health and nutrition messages to life.

Talking Books help spread health messages in Darfur.

Talking Books help spread health messages in Darfur. Photo by CRS staff

The two villages are located in what was known during the conflict years as the "zone of insecurity." Access to education is a rarity, and a large percentage of the population is illiterate. At the peak of the conflict, basic services collapsed, insecurity escalated and local families bore the brunt.

"Here we do not have any basic services at all," says Fatima, a mother of six. "Fathers marry off their daughters as early as possible. We have a new baby every year. Many women and children die during labor because of complications."

Malnutrition rates in children under age 5 hover around 16%, according to the most recent surveys conducted, and severe acute malnutrition rates are around 5.3%. Both are well above World Health Organization-defined emergency thresholds, making malnutrition a leading cause of death for children under 5.

Catholic Relief Services introduced the books as a new and interactive way to bring key messages to the community. The talking books deliver critical health messages to the community and sustain that information for as long as possible. The messages are simple and clear, and are recorded in the local Arabic dialect so that all members of the community can understand them, regardless of education.

The books contain a total of 16 health and nutrition messages about breastfeeding, growth monitoring, nutrition, water sanitation and hygiene, antenatal care, care of lactating women, and care of sick children. Illustrations of hand-washing and locally available foods help reinforce the importance of proper hygiene and adding more nutritious foods to family diets.

One page shows an entire family—a girl, a boy, a wife with a baby and a husband—sitting and eating together, contrary to some traditions that dictate that women and girls should eat last. It is a subtle but important way to help create greater equality and improve the health of families. The next page shows a mother at a health clinic weighing her baby, which helps remind mothers about the importance of well-child visits.

The books have been received extremely well. Nutrition staff has reported that during home visits, many women can recite the contents of a book without looking at it. They are proud to know the messages inside and are eager to share them. Children like to imitate the recorded voices, and family members take turns exploring the books' pages.

In an area with no bookstores, libraries—let alone schools—talking books are powerful tools in the fight against malnutrition and easily preventable childhood diseases. But the books alone are not enough: they need to be reinforced by respected village leaders. In order to strengthen the fledgling health system, CRS has trained 40 locally selected leaders to become community health promoters.

Community health promoters receive intensive training and make monthly visits to households with expectant mothers and young children. They also help raise community awareness on a range of health issues. To date, health promoters have distributed more than 500 talking books, which are shared by 2,500 people.

"In the absence of doctors and midwives, we are now dealing with health problems positively," says Fatima, "We now know that pregnant women should follow up with the trained midwife, receive the tetanus vaccine during pregnancy and eat foods rich with balanced nutrients. From the date of the speaking book distribution, men, women and children all sit in groups listening to the talking book."

Catholic Relief Services has been working in Sudan since 1978. CRS currently serves more than 600,000 Sudanese.

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