provided with prevention and control strategies with few slides on IMNCI and on F-IMNCI

1. DIARRHOEA: PREVENTION AND CONTROL DR AJAY TYAGI DEPTT. OF COMMUNITY MEDICINE PGIMS, ROHTAK

3. PROBLEM - WORLD - INDIA

4. CLASSIFICATION

5. CAUSES

6. DEHYDRATION

7. CLASSIFICATION OF DEHYDRATION

9. ROLE OF PROBIOTICS

10. DDCP

11. IMNCI

13. However it is the consistency of the stools rather than the number that is more important.

14. Passage of even one large watery stool in young child is diarrhoea.

16. Dehydration occurs when water & salts are not replaced adequately -may lead to shock & death.

17. Diarrhoea also produces under nutrition and growth failure.

18. Diarrhoeal disease constitute one of the important “nutritional leak” in young children.

20. Globally, there are about 2 Bn cases of diarrhoeal disease every yr.

21. Diarrhoeal disease kills 1.5 Mn children every yr.

22. African and South-East Asian regions together account for nearly 78% of them.

23. India alone contributes about 20% of all global under-5 diarrhoealdeaths.

25. Each episode deprives the child of the nutrition necessary for growth

27. CAUSES OF DEATH IN CHILDREN IN DEVELOPING COUNTRIES, 2002*(in thousands) Rank Cause Numbersdeaths % 1. Perinatal conditions 2375 23.1 2. Lower resp. inf. 1856 18.13. Diarrhoeal Diseases 1566 15.2 4. malaria 1098 10.7 5. Measles 511 5.4 6. Congenital anomalies 386 3.8 7. HIV/AIDS 370 3.6 8. Pertussis 301 2.9 9 Tetanus 185 1.8 10. PEM 13 1.3 11. TOTAL 10263 100 * Source: World Health Report 2003

29. Fever - 27%

30. Acute respiratory infections -17%

31. Diarrhoea -13%

33. Acute watery diarrhoea

34. Dysentery

36. Most episodes recover or self limiting within 3-7 days. These may last up to 14 days

40. E. Coli

41. V. Cholera

42. V. Parahaemolyticus

43. Shigella- bloody diarrhoea or dysentery

44. S. Typhi

45. Staph. Aureus

46. Clostridium perfringensE. coli

48. Rotavirus

49. Astroviruses

50. Calciviruses

51. Coronaviruses

52. Norwalk group viruses

53. Enteroviruses

54. Rotavirus causes 15-25% diarrhoea cases in developing countriesRotavirus

56. E. histolytica- Dysentery

57. Giardia intestinalis

58. Trichuriasis

59. Cryptosporidium parvum

61. Flies can also bring germs to uncovered food

62. Drinking contaminated water

65. Early dehydration – no signs or symptoms.

66. Moderate dehydration:

67. thirst

68. restless or irritable behaviour

69. decreased skin elasticity

71. shock, with diminished consciousness,

72. lack of urine output,

73. cool, moist extremities,

74. a rapid and feeble pulse,

75. low or undetectable blood pressure, and

77. Lethargic or unconscious , difficult to wake

78. Floppy

80. Lethargic or unconscious , difficult to wake

81. Floppy

85. ORS is the drug of choice for all cases of diarrhoea

86. It is life saving when used timely, in adequate quantities

91. Give HAF or ORS

92. Plan A involves counselling the child's mother about the 3 Rules of Home treatment.

93. GIVE EXTRA FLUID (as much as the child will take)

94. CONTINUE FEEDING

97. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child’s weight (in kg) × 75

98. For infants who are not breastfed, also give 100-200 ml of clean water during this period. The breastmilk and water will help prevent hypernatraemia in infants.

99. Show the mother how to give ORS solution

100. After 4 hours

101. Reassess and classify the child for dehydration

102. Select the appropriate plan to continue treatment

104. Children with severe dehydration must be admitted.

106. N/S when R/L is not available

107. 1/2 N/S with 5% dextrose is acceptable

110. Thereafter, reassess the infant by skin pinch and level of consciousness at least every 1-hour

111. Also give ORS (about 5 ml/kg/hour) as soon as the infant can drink: usually after 3-4 hours

115. Low intake of “flesh” food

116. High prevalence of stunting

117. High rate of diarrhoea

121. These probiotics are effective for both treatment and prevention of acute diarrhoea caused mainly by rotavirus in children

124. -Helicobacter pylori infection

125. -Inflammatory bowel disease

126. -Cancers

127. -To increase Immunity

128. -Allergy

129. -Heart disease

131. Milk should not be diluted with water during any phase of acute diarrhoea.

132. Milk can also be given as milk cereal mixture e.g. dalia, milk-rice mixture.

134. However if there is only mucus, child should be treated as for acute diarrhoea without antibiotics

136. Tetracyline - 50 mg/kg/day 4 doses x 3 days or

137. Erythromycin -30 mg/kg/day 3 doses x 3 days.

138. Acute Amoebiasis:

139. Metronidazole -30 mg./kg/ day 3 doses x 5-10 days.

140. Acute Giardiasis:

142. The mother of a child with persistent diarrhoea will be advised on feeding her child

144. Bottle feeding should be avoided

145. Wash Hand

146. Eat clean Food

147. Drink clean water

148. Immunization e.g. Measles, Rota virus

149. Vit. A - Prophylactic doses

151. Withdrawn because of its association with intussuscption

152. Two new oral, live attenuated rotavirus vaccines were licensed in 2006 with very good safety and efficacy

153. The first dose administered between ages 6-10 weeks .

154. subsequent doses at intervals 4-10 weeks.

155. Vaccination should not be initiated before 6weeks and after 12 weeks of age.

159. Adherence to ORT is poor because caregivers want to reduce illness duration

160. This leads to use of antibiotics or other treatment of no proven value

163. Reducing CFR to less than 1%.

165. From 1992-93 the programme has become a part of CSSM Programme.

166. CSSM programme become a part of RCH programme in 1997

167. In RCH Programme, policy of IMCI was adopted

168. Strategy of IMCI was to address all children and not only sick children

170. Indian version of IMCI guidelines renamed as IMNCI.

171. Since 2003 - DDCP included in IMNCI which includes - Neonates of 0-7 days - Incorporating national guidelines on diarrhoea, ARI ,Malaria, Anaemia, Vit. A supplementation & Immunizations.

173. Promote standard case management practices among private practitioners through IMA and IAP.

175. Increase accessibility by marketing ORS through the PDS and commercial outlets.

176. Monitor hospital based data on ORS use rate, CFR & other parameters.

178. Community activities not given adequate focus

180. Asphyxia Management and

182. Immunization against measles

183. Using sanitary latrines

184. Keeping food and water clean

186. ORS is best drink.

187. A child with diarrhoea needs more food and frequent breast feeding.

188. A child who is recovering from diarrhoea needs an extra meal every day for at least 2 weeks.

190. K.PARK , TEXTBOOK OF COMMUNITY MEDICINE

191. SUNDER LAL, TEXTBOOK OF COMMUNITY MADICINE.

192. HARRISONS PRINCIPLES OF INTERNAL MEDICINE 17th edition

193. IAP GUIDELINES FOR MANAGEMENT OF DIARRHEA