diarrhoea, causes, symptoms,epidemiological factors

ppt on diarrhea

1. Diarrhoea BINEE MATHEW LECTURER BELIEVERS COLLEGE OF NURSING THIRUVALLA

2. Definition Diarrhoea is defined as the passage of loose, liquid, or watery stools. These liquid stools are usually passed more than three times a day. However it is the recent change in consistency and character of stools rather than the number of stools.

3. Magnitude of the problem Global Diarrhoeal diseases is a major Public health problem in all the developing countries like Asia, Africa, and Latin America. India In India, out of 120 crores of population, under fives constitute 15% of population. Infants hit hardest. It comes to about 5000 deaths per day, 200 per hour and 3 per minute.

4. Causes Infections and infestations Malnutrition Metabolic disorders( congenital enzyme deficiencies) Drugs ( Iatrogenic eg . Broad spectrum antibiotics ) AIDS Idiopathic Children with measles or who have had measles

5. Epidemiological factors Agent factos Viruses Rotaviruses Adenoviruses Astroviruses Calciviruses

6. Coronaviruses Norwalk viruses Enteroviruses Cytomegaloviruses Bacterial Campylobacter jejuni

7. Shigella Salmonella Vibrio cholerae Bacillus cereus E. Coli Staphylococcus aureus

8. Others E. Hystolytica Giardia intestinalis Trichuriasis Cryptosporidium SPP Intestinal worms, cyclospora

9. Host factors Age incidence - Diarrhoeal diseases occurs in all the age group. However, it is common in children below 5 years and infants hit hardest. Sex incidence- it is equal in both sexes Malnutrition Prematurity

10. Reduced gastric acidity Immunodeficiency Lack of personal and domestic hygiene Incorrect feeding practices Poverty

11. Environmental factors In temperature climates, bacterial diarrhoea occur more frequently during the warm season, whereas viral diarrhoea peak during the winter season. In tropical areas diarrhoea occurs throughout the year, increasing in frequency during the drier, cool months, whereas the bacterial diarrhoea peak during the warmer, rainy season

12. Predisposing factors Poverty Illiteracy Lack of sanitation Lack of protected water supply Poor standard of living

13. Reservoir In most cases, human being is the principal reservoir often animals also act as resevoir . Mode of transmission The diarrhoeal diseases are exclusively transmitted through feco oral route.

14. Types Acute watery diarrhoea Which lasts several hours to days, the main danger is dehydration, weight loss also occurs if feeding is not continued. Acute bloody diarrhoea Which is also called dysentery the main dangers are damage of the intestinal mucosa, sepsis and malnutrition, it is marked by blood in stools.

15. Persistent diarrhoea Which lasts 14 days or longer. The main danger is malnutrition and serious non- intestinal infection, dehydration may occur. Diarrhoea with severe malnutrition The main dangers are severe systemic dysfunction, dehydration, heart failure and vitamins and mineral deficiency.

16. Effects Loss of water results in hypovolemia. Loss of sodium and chlorides results in electrolyte Imbalance. Loss of bicarbonate salts favour the development of acidosis and renal failure. Loss of potassium salts results in muscular weakness, cardiac arrhythmia and paralytic ileus.

17. Incubation period Varies from few hours to few days. Clinical features Mainly due to dehydration In early stages –irritation, thirsty and drinks water eagerly When dehydration worsens- irritation, pinched look due to dry and sunken dry. Anterior fontanelle is depressed in an infant

18. Tongue becomes dried Abdomen becomes scaphoid Passes urine at longer interval Skin losses elasticity Shock, characterized by hypothermia, rapid and thready pulse, drowsiness, unconsciousness, hypotension,

19. Acidosis Renal failure Coma Death

20. Assessment

21. Prevention and control The diarrheal disease control programme ( DCC)- 1980 Components Short term – appropriate clinical management Long term- better MCH care practices Preventive strategies Preventing diarrheal diseases

22. Appropriate cLinical management Oral rehydration therapy can be safely and successfully used in treating acute diarrhoea due to all aetiologies, in all age groups, and in all countries. Aim- prevent dehydration and reduce mortality At first the composition of oral rehydration salt ( ORS)recommended by WHO was sodium bicarbonate. Inclusion of trisodium citrate in place of sodium bicarbonate made the product more stable and it resultedin less stool output.

23. Recommended formulation Reduced osmolarity ORS Sodium chloride -2.6 g/l Glucose, anhydrous -13.5g/l Potassium chloride -1.5g/dl Trisodium citrate, dihydrate-2.9 g/ dl Total weight-20.5 g/l

24. Guidelines

25. Treatment plan a Increase fluid intake –to prevent dehydration Continue feeds to prevent malnutrition Watch for signs of dehydration – to prevent acidosis, renal faliure and death. Increase fluids- Risk of dehydration starts with onset of diarrhoea. Oral fluids must be started from the time of onset of diarrhoea with home available fluids such as rice ganji , barely water, butter milk, lassi juice,

26. Fruit juices, carrot soup, and weak tea. Potassium is required in advance stage. Salt sugar solution 1 closed fistful of sugar + 3 finger pinch of salt+ 1 big class of water. Dose 50-100 ml after every loose stool for child below 2 years of age.

27. 2.100-200 ml after every loose stool for a child between 2 years and 10 years of age. Treatment plan b Correction of some hydration Maintenance of hydration After correction of dehydration with ORS, hydration has to be

28. Maintained till the patient is cured by giving ORS. After every loose stool 50-100 ml of ORS for a child below 2 years of age and 100-200 ml for a child between 2 years and 10 years of age and as much as for adults. Merits About 90-95% of cases of acute watery diarrhoea can be managed with ORS alone at home It is of modern scientific technology

29. It is free from side effects It has minimized use of Antibiotics Demerits ORT cannot be given to those who have persistent vomiting or unconscious. It cannot be given to those who have paralytic ileus and marked abdominal distension .

30. Treatment plan C This consists of hospitalization and replacement of fluids and electrolytes by intravenous infusion .The best IV fluids is Ringer’s lactacte . After starting IV infusion reassessment is done every alternate hours and the infusion is continued till the general condition improves .Diarrhoea treatment solution (DTS), recommended by WHO as an ideal polyelectrolyte solution for intravenous infusion

31. Age First give 30 ml/kg in Then give 70 ml/ kg in Infants ( under 12 months) 1 hour 5 hours Older 30 minutes 21/2 hours

32. 2.Intravenous rehydration 3.maintenance therapy Amount of diarrhoea Amount of oral fluid Mild diarrhoea 100 ml per kilogram body weight per day until diarrhoea stops Severe diarrhoea Replace stool losses volume for volume if,not measureable give 10 to 15 ml per kilogram body weight per hour

33. 4. Appropriate feeding During episodes of diarrhoea normal food intake should be promoted as soon as the child whatever it is age is able to eat. Newborn infants with diarrhoea who show little or no signs of dehydration can be treated by breastfeeding.

34. 5. Chemotherapy In bacterial diarrhoeas, specific antibiotic has been to be given as per the stool culture report. for diarrhoea due to cholera the drug of choice is doxycycline , tetracycline, TMP- SMX and erythromycin. for diarrhoea due to shigella the drug of choice is ciprofloxacin.

35. For Amoebiasis and giardiasis the drug of choice is Metronidazole. binding agents like pectin,kaolin , and Bismuth salts are not scientifically useful . antimotility drugs reduce peristalsis and give temporary relief Eg . Diphenoxylate hydrochloride

36. 6. Zinc supplementation when is zinc supplementation is given during an episode of acute diarrhoea it reduces the episodes duration and severity. Zinc supplements given for 10 to 14 days to lower the incidence of diarrhoea in the following 2 to 3 months.

37. Better mch care practices Maternal nutrition Improving prenatal nutrition will reduce the low birth weight problem. Prenatal and postnatal nutrition will improve the quality of breastmilk . child nutrition promotion of breastfeeding. appropriate weaning practices

38. Supplementary feeding vitamin A supplementation preventive strategies sanitation improved water supply

39. Improved the excreta disposal Improved domestic and food hygiene Hand washing with soap before preparing food ,before eating ,before feeding a child, after defecation,after cleaning a child who has defecated and after disposing off a child’s stool. clean and functioning latrine

40. Health education Important part is to prevent diarrhoea by convincing and helping community members to adopt and maintain certain preventive practices such as breast feeding, improved weaning, clean drinking water, use of plenty of water for hygiene, use of latrine, proper disposal of stools of young children etc.

41. Immunization Immunization against measles Rotavirus Vaccinep Rotashield The monovalent human rotavirus vaccine( rotarix )

42. The pentavalent bovine human reassortant vaccine ( Ratateq ) Rotarix Two doses schedule orally 6 weeks, 12 weeks Rotateq Orally at 2 months, 4 months, 6 months.

43. Control and prevention of diarrhoeal epidemics This requires strengthening of epidemiological surveillance systems. The integrated global action plan for the prevention and control of pneumonia and diarrhoea(GAPPD) Specific goals for 2025

44. Reduce mortality from Pneumonia in children less than 5 years of age to fewer than 3 per 1000 live births Reduce mortality from diarrhoea in children less than 5 years of age to fewer than 1 per 1000 live births. reduce the incidence of severe diarrhoea by 75% in children less than 5 years of age compared to 2010 levels. reduced by 40% The Global number of children less than 5 years of age

45. who are stunted compared to 2010 levels. by the end of 2025: 90% full dose coverage of each relevant vaccine ( With 80% in every district). 90% access to appropriate pneumonia and diarrhoea case management ( with 80% is coverage in every district )

46. At least 50% is coverage of exclusive breastfeeding during the first 6 months of life. virtual elimination of pediatric HIV. by the end of 2030 Universal access to basic drinking water in Healthcare facilities and homes

47. Universal accept to adequate sanitation in Healthcare facilities by 2030 and in homes by 2040. Universal access to hand washing facilities (water and soap) in healthcare facilities and homes. Universal access to clean and safe energy technologies in healthcare facilities and home .

48. Diarrheal diseases Control Programme in India Was launched in the year 1978 objective- reduce the mortality and morbidity due to diarrheal diseases. since 1985 to 86 with the inception of the national oral rehydration therapy programme, the focus of activities has been on strengthening case management of diarrhoea for children under the age of 5 years and improving maternal knowledge related to use of home available fluids ,use of ORS and continued feeding .