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DIARRHOEAL DISEASES Final
DIARRHOEAL DISEASES Final
DISEASES
Prepared by:
Norina Pandey
Om Prakash Tandon
Pooja K. C.
Madan Kumar Yadav
OBJECTIVES:
• Define diarrhoea and list it’s clinical types.
• Outline global and national scenario of diarrhoea
• Diarrhoeal epidemiology
• Dehydration in diarrhoea and its treatment
• Control of diarrhoeal diseases
Diarrhoea:
IMPORTANT
• Recent change in consistency and the character of
stool
Clinical types
760,000 diarrhoea
deaths
• 64% of global
diarrhoeal deaths
Diarrhoeal deaths 18 43 6 7 15 89
80
60
40
20
6.4 5.4 4.7
3.7 3.1
0.2 0.3 0.2 0.2 0.1
0
EDR CDR WDR MWDR FWDR
no dehydration some dehydration severe dehydration
National Data- FY 2072/2073
Programme indicators 2070/71 2071/72 2072/2073
(2013/2014) (2014/2015) (2015/2016)
80
75
EASTERN CENTRAL WESTERN FAR WESTERN MID WESTERN NATIONAL
2070/71 2071/72 2072/73
Indicators:
A. Diarrhoea prevention indicators
B. Diarrhoea treatment indicators
Agent
Disease
Host Environment
Agent factors
1.Viruses
Rotaviruses
Adenoviruses
Astroviruses
Calciviruses
Coronaviruses
Enteroviruses
Norwalk group of viruses
Cytomegaloviruses
Rota virus
• Leading cause of severe, dehydrating
diarrhea in children < 5years
• First episode of Rota viral diarrhoea:
- in developing countries - <12months
-in developed countries - delayed until 2-5
years
• Rotavirus gastroenteritis is largely limited to
children aged 6-24 months
Agent contd….
2.Bacterias
Campylobacter jejuni
Enterotoxigenic Escherichia coli
Shigella
Salmonella
Vibrio cholerae
Vibrio parahaemolyticus
Bacillus cereus
Staphylococcus aureus
Clostridium perfringens
Clostridium difficle
3.Others
E.histolytica
Giardia intestinalis
Trichuriasis
Cryptosporidium species
Intestinal worms
Cyclospora
Reservoir of infection :
• Malnutrition
• Poverty
• Prematurity
• Reduced gastric acidity
• Immunodeficiency
• Lack of personal and domestic hygiene
• Incorrect feeding practices
Environmental factors :
• Seasonal pattern in many geographical areas.
• Temperature climate : warm season - bacterial diarrhoea
winter season - viral diarrhoea
Water-borne
1.Short term
a. Appropriate clinical management.
2. Long term
b. Better MCH care practices.
c. Preventive strategies.
d. Preventing diarrhoeal epidemics.
A) Appropriate clinical management
I. Oral rehydration therapy
II. Intravenous rehydration
III. Maintenance therapy
IV. Appropriate feeding
V. Chemotherapy
VI. Zinc supplementation
Oral Rehydration Solution
ORAL REHYDRATION THERAPY
Na 90mM
K 20mM
Cl 80mM
Citrate 10mM
Glucose 110mM
Total osmolarity 310mOsm/L
New formula WHO-ORS(2002)
Nacl 2.6g
KCl 1.5g
Trisodium citrate 2.9g
Glucose 13.5g
Water 1L
Na 75mM
K 20mM
Cl 65mM
Citrate 10mM
Glucose 75mM
Total osmolarity 245mOsm/L
ORS- New vs Old
• Trisodium citrate added in place of sodium
bicarbonate as it increases shelf life (Na
bicarbonate powder cakes and becomes brown)
• Low Na, Low Glucose
• Rationale:
Maximum water absorption occurs from a slightly
hypotonic solution and when glucose concentration
is between 60-110mM
At higher concentration glucose appears in
stool(osmotic action)
• Reduced osmolarity of ORS solution to avoid
possible adverse effects of hypertonicity on net
fluid absorption by reducing the concentration of
glucose and sodium chloride .
• Reduced osmolarity solution also appears to be
safe and effective as standard ORS for use in
children with cholera .
• Packets of “oral
rehydration mixture
“are freely available at
all primary health
centres and hospital.
• Contents dissolved in
1L of drinking water .
• Solution should be
made fresh daily and
used within 24 hours.
• It should not be boiled
or otherwise sterilized.
HOME MADE ORS:
If WHO fluid not available :
• Usually recommended are home fluid : at least one
fluid that contains salt.
• Should add about 3g/lit to an unsalted drink or
soup.
Eg: Green coconut water, rice water,
Yoghurt drinks, etc don’t contain salt.
• Few fluids are potentially dangerous and should be
avoided during diarrhea:
o carbonated drinks
o commercial fruit juices
o sweetened tea,
cause osmotic diarrhea and hypernatremia.
Guidelines for oral rehydration
therapy(for all ages) during the first
four hours
Age Under 4 4-11 1-2 years 2-4 years 5-14 years 15 years or
months months over
• Sanitation
• Health education
• Immunization
Rota virus vaccine
• Two live ,oral
,attenuated Rota viral
vaccine
• Monovalent human
Rota virus vaccine
(Rotarix)
• Pentavalent bovine
human reassortant
vaccine (Rota Teq)
• Rotatrix
Route: Oral
No of doses: 2
Age of administration: 6 wks (no later than 12 wks)
10 wks (no later than 24 wks)
• Rota Teq :
Route: Oral
No of doses :3
Age of administration 2,4 & 6 months
Vaccination should not be initiated for infants>
12wk - chance of intussuception
D)Control and/or prevention of
diarrhoeal epidemics
Governmen
of Nepal
Ministry of Health
ACUTE WATERY DIARRHOEA (rice watery stool
with/ without vomiting)
ACUTE BLOODY DIARRHOEA (with fever)
OTHER DIARRHOEA
CBIMNCI
• CB-IMNCI is an integration of CB-IMCI and CB-NCP
Program that is being implemented across the
country after the decision of MoH on 2071/6/28
(October 14,2015)
• Among the age group of 2 months to 59 months
children, it addresses major childhood illnesses like
pneumonia, diarrhoea, malaria, measles and
malnutrition in a holistic way.
• % of under 5 children with diarrhoea treated with
ORS and Zinc is one of the six CB-IMNCI Program
Monitoring Key Indicators
Interventions towards diarrhoea
Newborn Specific Interventions
• Management of sepsis among young infants (0‐59 days)
including diarrhoea
Child Specific Interventions
• Case management of children aged between 2‐59 months
for 5 major childhood killer diseases (Pneumonia, Diarrhoea,
Malnutrition, Measles and Malaria)
Cross Cutting Interventions
• Behaviour change communications for healthy pregnancy,
safe delivery and promote personal hygiene and sanitation
• Improved knowledge related to Immunization and Nutrition
and care of sick children
Vision 90 by 20
CB-IMNCI program has a vision to provide targeted
services to 90 percent of the estimated population
by 2020 as shown in the diagram below.
Institutional
Delivery
Under 5
children with To provide Service
pneumonia Newborn who
to 90% of target had CHX gel
treated with group by 2020
antibiotic applied
Under 5 children
with diarrhea
treated with ORS
and zinc
Water, Sanitation, and Hygiene
(WASH) Program
• Improves sanitation,
promotes hygiene
behavior, and increases
access to safe drinking
water
• project operates in
Nepal’s Far-Western
Region
School Led Total Sanitation (SLTS)
• Initiated by Government of Nepal and UNICEF in
2006
• Aim : To create demand of sanitation services with
focus of empowering people and change in hygienic
behavior.
• Target : Having 100% toilet coverage leading to
open defecation free (ODF) school catchment area.