EPIDEMIOLOGY AND CONTROL OF ACUTE DIARRHEAL DISEASES Dr. Anish Khanna Associate Professor Department of Community Medicine and Public Health K.G.M.U, Lucknow.

EPIDEMIOLOGY AND CONTROL OF ACUTE

DIARRHEAL DISEASES

Dr. Anish KhannaAssociate Professor

Department of Community Medicine and Public

Health K.G.M.U, Lucknow.

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.

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

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.

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.

WHAT IS THE EPIDEMIOLOGY

OF DAIRRHOEAL DISEASES?

RISK FACTORS OR DETERMINANTS

AGENT FACTORS

HOST FACTORS

ENVIRONMENTAL FACTORS

RESERVOIR OF INFECTION.

HOW MANY TYPES OF

DIARRHOEA ARE THERE?

ACUTE WATERY DIARRHOEA.

DYSENTRY (BLOOD IN STOOLS).

PERSISTENT DIARRHOEA.

HOW SHOULD ACUTE WATERY

DIARRHOEA IN CHILDREN BE

MANAGED?

ASSESSMENT OF DEHYDRATION

DOES THE CHILD HAVE SIGNS OF

DEHYDRATION?

IS DEHYDRATION MILD OR SEVERE?

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

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

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)

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

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

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.

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.

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

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

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.

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

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

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

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