epidemiology and control of acute diarrheal diseases dr. anish khanna associate professor department...
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EPIDEMIOLOGY AND CONTROL OF ACUTE
DIARRHEAL DISEASES
Dr. Anish KhannaAssociate Professor
Department of Community Medicine and Public
Health K.G.M.U, Lucknow.
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WHAT IS DIARRHOEA? Diarrhoea is the passage of loose, liquid or
watery stool. In many regions Diarrhoea is defined as
passage of three or more loose or watery stools in 24 hour period.
However it is the recent change in consistency and character of stool than the number of stools that is more important.
In most cases the mother knows what is abnormal stool for her child.
It is a killer disease in children.One in four deaths in children under the
age of 5yrs. is due to diarrhoea.
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WHAT CAUSES DIARRHOEA? Infectious Disease Agents Causing Diarrhoea. BACTERIA
1. Escherichia coliIt produces heat labile (LT) and heat stable (ST) entertoxins.E.COLI - COULD BE
Enteropathogenic- Causes infantile diarrhoea. Entero toxigenic – Causes travellers diarrhoea. Enteroinvasive- Dysentery type of diarrhoea. Enteroadherent Enterohaemorrhagic
VIBRIO CHOLERAE- produces enterotoxins Vibrio para haemolyticus- Invasive. Non-Cholerae vibrios
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WHAT CAUSES DIARRHOEA? Infectious Disease AgentsSHIGELLAE–Invasive, produce bloody diarrhoea or Dysentery.
CAMPYLOBACTER JEJUNI – invasive. SALMONELLAE OTHER THAN S.TYPHI-
invasive.
STAPHYLOCOCCUS AUREUS- entrotoxins
CLOSTRIDIUM PERFRINGENS- enterotoxins.
3.VIRUSES
Rotavirus – invasive.
4.PARASITES
E. histolytica- invasive.
Giardia Lamblia- non invasive.
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WHAT IS THE MAGNITUDE OF THE PROBLEM?
WORLD WIDE?
IN INDIA?NFHS- 2 data highlights morbidity profile of under 3 yrs.
Fever- (27%)
A.R.I. - (17%)
Diarrhoea – (13%)
Under Wt. (43%)Often due to a combination of these conditions. Diarrhoeal diseases are a major public health
problem among children under 5yrs. of age.Around 8-11 million cases are being reported annually in India.
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WHAT IS THE EPIDEMIOLOGY
OF DAIRRHOEAL DISEASES?
RISK FACTORS OR DETERMINANTS
AGENT FACTORS
HOST FACTORS
ENVIRONMENTAL FACTORS
RESERVOIR OF INFECTION.
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HOW MANY TYPES OF
DIARRHOEA ARE THERE?
ACUTE WATERY DIARRHOEA.
DYSENTRY (BLOOD IN STOOLS).
PERSISTENT DIARRHOEA.
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HOW SHOULD ACUTE WATERY
DIARRHOEA IN CHILDREN BE
MANAGED?
ASSESSMENT OF DEHYDRATION
DOES THE CHILD HAVE SIGNS OF
DEHYDRATION?
IS DEHYDRATION MILD OR SEVERE?
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ASSESSMENT OF THE CHILD WITH DIARRHEA FOR THE DEGREE OF
DEHYDRATION AND MANAGEMENTDegree of dehydration signs Mild Severe
a. Look for
General conditionEyesTears on cryMouth and tongueThirst
Restless, irritableSunkenAbsentDryThirsty (drinks eagerly)
Lethargic, floppy, unconscious, Deeply sunken and dryAbsentVery dryVery thirsty but (drinks poorly or unable to drink)
b. Feel for
Skin pinch Goes back slowly, takes 1 to 2 seconds
Goes back very slowly, takes more than 2 seconds
c. Decide there is some dehydration. There is severe dehydration.
d. Treatment Plan B With WHO recommended ORS solution to correct some dehydration.
Plan CWith IV infusion urgently to correct severe dehydration and to prevent death
Fluid deficit is 5-10% of body weight > 10% of body weight
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AFTER CLINICAL ASSESSMENT
WHAT SHOULD BE DONE?LABORATORY INVESTIGATIONS
FEEDING DURING DIARRHOEA
RATIONAL USE OF DRUGS
# What is the role of anti Diarrhoeals?
FLUID THERAPY
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FLUID THERAPY IN DIARRHOEA WHAT IS THE PURPOSE OF FLUID
THERAPY.
APPROPRIATE FLUID THERAPY
- ORS
Basis of ORS
What is the mechanism of action of ORS?
OTHER FLUIDS
HAF
-SSS (Sugar salt solution)
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WHAT SHOULD BE THE
TREATMENT OF CASES OF
ACUTE WATERY DIARRHOEA THREE CATEGORIES OF CASES.
Cases with No Signs of dehydration- Plan-A.
Cases with some signs of dehydration- Plan-B
Cases with severe dehydration-Plan -C
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HOW CAN DIARRHOEA BE PREVENTED?
PREVENTIVE STRATEGIES.
Sanitation
- Hand washing
- Exclusive breast feeding
- Clean food
Environmental sanitation
Elimination of Reservoirs
Breaking the channel of transmissions
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PREVENTION OF DIARRHOEA?
ELIMINATION OF RESERVOIRS
Prevention of dehydration
Correction of dehydration
Maintenance of hydration
Chemotherapy
Restoration of Nutritional Status.
Diarrhoea- Leads to malnutrition
Increase in Breast feeding frequency
Increase in diet.
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OTHER PREVENTIVE STRATEGIES?
Vitamin –A prophylaxis Improved Nutrition Immunization
- Measles immunization ROTA VIRUS VACCINE
Two live oral attenuated rotavirus vaccines were licensed in 2006. Now there are three.Monovalent human rotavirus vaccine (Rotarix).The pentavalent bovine- Human reassortant vaccine (Rota Teq)They Provide 75-80% protection against rotavirus diarrhoea and 90-100% protection against rotavirus disease.
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WHAT ARE THE NATIONAL
PROGRAMS FOR DIARRHOEA IN
INDIA
National diarrhoeal disease control program
(NDDCP)
Diarrhoeal disease control program started in
1978.
1985 – 86 National Oral Rehydration Therapy
Program
Case management of diarrhoea by HAF & ORS.
Improvement of maternal knowledge and
practices with egard to HAF
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Since CSSM Program became a part of RCH program in 1997, Integrated Management of Child hood Illness (IMCI) has been adopted in India.
IMCI deals with all children not only sick children
-Diarrhoea
-Pneumonia
-Measles
-Malaria
-Health promotion
-Immunization
-Breast feeding
-Vit. A & Iron Supplementation
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WHAT ARE THE REVISED GUIDELINES FOR MANAGEMENT OF DIARRHOEA?
GOI & IAP (Indian Academy of Pediatrics)
Low osmolarity ORS Zinc (10mg Elemental Zinc for infants 2-6
month of age 20mg Zinc for children > 6 months for 14 days)
Feeding of energy dense foods in addition to Breast feeding
HAF Hygiene Antimicrobials for gross blood in stools or
shigella + culture.
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MCQ’s in Diarrhoea 1. WHO ORS contains: A) Sodium Chloride 2.5 gm B) Potassium Chloride 1.5 gm C) Glucose 20 gm D) Sucrose 10 gm E) Potassium Bicarbonate 2.5 gm Ans- B,C,E
2. For controlling an outbreak of Cholera all of the following measures are recommended except:
A) Mass chemoprophylaxis B) Proper disposal of excreta C) Chlorination of water D) Early detection and management of cases Ans- A
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3. In ORS the concentration of sodium chloride is: A) 3.5 gm B) 2.5 gm C) 2.9 gm D) 1.5 gm Ans- A
4. Drug of choice for carriers of typhoid is: A) Ampicillin B) Chloramphenicol C) Co-Trimoxazole D) Clindamycin Ans- A
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5. Typhoid oral vaccine is given: A) 1,3,5 days B) 1,2,3 days C) 1,2,4 days D) 1,7,14 days Ans- A
6. In WHO-ORS concentration of Sodium is: A) 60 mEq/l B) 50 mEq/l C) 40 mEq/l D) 90 mEq/l Ans- D
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7. True about citrate in ORS: A) Nutritious B) Cheaper C) Increases shelf life D) Tastier Ans- C
8. A convalescent case of Cholera remains infective for: A) less than 7 days B) 7 to 14 days C) 14 to 21 days D) 21 to 28 days Ans- C