acute diarrheal disease and its prevention

Diarrhea
Prevention of Diarrhea
Dr Athar Khan

1. Acute Diarrheal Disease
and Its Prevention
DR ATHAR KHAN
PROFESSOR
DEPARTMENT OF COMMUNITY MEDICINE
LIAQUAT COLLEGE OF MEDICINE & DENTISTRY
KARACHI
[email protected]

2. OBJECTIVES
•Describetheetiology,epidemiology,controland
preventionofAcuteDiarrhealdiseases
•Describetheclinicalfeatures,assessmentand
diagnosticcriteriaofAcuteDiarrhealdiseases
•Discusstheprocessofcontrolandpreventionof
AcuteDiarrhealdiseases
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3. Key facts
•Diarrhoealdiseaseisthesecondleadingcauseofdeathin
childrenunderfiveyearsold.Itisbothpreventableand
treatable.
•Asignificantproportionofdiarrhoealdiseasecanbe
preventedthroughsafedrinking-waterandadequate
sanitationandhygiene.
•Diarrhoeaisaleadingcauseofmalnutritioninchildren
underfiveyearsold.
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7. DIARRHEA
•Thepassageofthreeormorelooseorliquidstoolsper
day(ormorefrequentpassagethanisnormalforthe
individual).
•Frequentpassingofformedstoolsisnotdiarrhoea,noris
thepassingofloose,"pasty"stoolsbybreastfedbabies.
•Pastyorloosefoul-smellingstoolsindicatefat
malabsorption
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8. DIARRHEA
•Therearefourclinicaltypesofdiarrhoea:
•Acutewaterydiarrhoea–lastsseveralhoursordays,
andincludescholera;Thepathogensthatusuallycause
acutediarrhoeaincludeV.choleraeorE.colibacteria,
aswellasrotavirus.
•Acutebloodydiarrhoea–alsocalleddysentery;
shigella,
•Persistentdiarrhoea–lasts14daysorlonger.AIDS
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9. DIARRHEA
•Diarrhoeawithseveremalnutrition(marasmusand
Kwashiorkor)
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10. CAUSES
•Infection:RotavirusandEscherichiacoli,arethetwomostcommon
etiologicalagentsofmoderate-to-severediarrhoeainlow-income
countries.Otherpathogenssuchascryptosporidiumandshigella
speciesmayalsobeimportant.
•Malnutrition:Childrenwhodiefromdiarrhoeaoftensufferfrom
underlyingmalnutrition,whichmakesthemmorevulnerableto
diarrhoea.
•Source:Watercontaminatedwithhumanfaeces,animalfaeces
•Othercauses:Poorpersonalhygiene,unhygienicfood,unsafe
domesticwaterstorage,fishandseafoodfrompollutedwatermay
alsocontributetothedisease.
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11. •Reservoirofinfection:Man
•Hostfactors:mostcommon inchildren
between6monthsand2years.
•Environmentalfactors:bacterialdiarrhoea-
warmseason,viraldiarrhoea–winter
•Modeoftransmission:faecal-oralroute.
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12. CONTROL OF DIARRHOEAL DISEASES
1.OralRehydrationTherapy–ORS
2.IntravenousRehydration-Ringer'slactatesolution
(alsocalledHartmann'ssolutionforinjection)
3.MaintenanceTherapy-severedehydrationorshock-
Aftertheintravenoustherapyoralfluidshouldbeused
formaintenancetherapy.
4.AppropriateFeeding-includingbreastmilk–a
nutritiousdiet
5.Chemotherapy-Antibioticsshigella,typhoidorcholera.
6.ZincSupplementation-10to14days
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13. Integrated Management of Childhood Illness
IMCI
Integrated Management of Neonatal and
Childhood Illness
IMNCI
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14. Principles of Integrated Care
Acombinationofindividualsignsleadstoachild'sclassification(s)
ratherthandiagnosis.
-needs urgent hospital referral or admission
( classifies as and colour coded pink)
-needs specific medical Rx or advice
(classified as and colour coded yellow)
-can be managed at home
(classified as and colour coded green)
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15. AGE 2 MONTHS UPTO 5YEARS
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16. General Danger Signs
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17. DEHYDRATION
•Thedegreeofdehydrationisratedonascaleofthree.
•Severedehydration(atleasttwoofthefollowingsigns):
Lethargy/unconsciousness
Sunkeneyes
Unabletodrinkordrinkpoorly
Skinpinchgoesbackveryslowly(≥2seconds)
•Somedehydration(twoormoreofthefollowingsigns):
Restlessness,irritability
Sunkeneyes
Drinkseagerly,thirsty
•Nodehydration(notenoughsignstoclassifyassomeorsevere
dehydration).
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18. >2 seconds
< 2 seconds
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19. PINCH THE SKIN OF THE ABDOMEN
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21. 10
Up to 2 years 50 to 100 ml after each loose stool
2 years or more 100 to 200 ml after each loose stool1/7/2020 DR ATHAR KHAN -LCMD 21

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23. 1
level teaspoon
holds 4g of sugar
One level teaspoon contains 7 grams of salt
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26. Vaccination should not be initiated for infants aged > 12 weeks.
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27. CONTROL
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28. PREVENTION
•Keymeasurestopreventdiarrhoeainclude:
Accesstosafedrinking-water;
Useofimprovedsanitation;
Handwashingwithsoap;
Exclusivebreastfeedingforthefirstsixmonthsoflife;
Goodpersonalandfoodhygiene;
Fliescontrol
Healtheducationabouthowinfectionsspread;and
Rotavirusvaccination.
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30. WASH
•WASHisthecollectivetermforWater,Sanitation
andHygiene.
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