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Control of diarrhoeal disease and acute respiratory infections
1. Control of Diarrheal Disease And Acute
Respiratory Infection
Presented To: Presented By:
School of Health and Allied Bikram Singh Dhami
Sciences (SHAS) Pooja Gautam
POKHARA UNIVERSITY
July 19, 2019CDD/ARI_BPH_IV 1
2. Outlines of Presentation
⢠Introduction and types of diarrhoea
⢠Scenario (Global/National)
⢠Control initiatives
⢠Prevention and control measures
⢠Acute respiratory infections
⢠Common respiratory tract infections
⢠Prevalence (Global/National)
⢠ARI Programs
⢠Causes of ARI
⢠Control Measures
July 19, 2019 2CDD/ARI_BPH_IV
3. Diarrhoeal Disease
Introduction
⢠Diarrhoea is defined as the passage of three or more loose
or liquid stools per day (or more frequent passage than is
normal for the individual).
⢠Frequent passing of formed stools is not diarrhoea, nor is
the passing of loose, "pasty" stools by breastfed babies.
(WHO)
⢠Diarrhoea that lasts longer than four weeks is classified as
chronic diarrhoea.
(American college of gastroenterology)
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4. Types of Chronic Diarrhoea
1. Acute Watery Diarrhoea
if <14 Days, severe dehydration,
E.coli/Cholera/Rotavirus, severe dehydration,
Malnutrition
2. Persistent Diarrhoea
If>14 days, 20-30% deaths, Under nourished and HIV exposed,
malnutrition, Dehydration and serious non-intestinal infections
3. Dysentery
With blood, with or without mucus, 10-15% of deaths, damage to
intestinal mucosa and sepsis
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5. Symptoms of Diarrhoea
⢠Cramping
⢠Abdominal pain
⢠Nausea or vomiting
⢠Fever
⢠Chills
⢠Bloody stool
⢠Change in appetite
⢠Weight loss or poor weight gain
July 19, 2019 5CDD/ARI_BPH_IV
7. Scenario
Global
⢠Second leading cause of death in children under five
years old.
⢠Each year diarrhoea kills around 525 000 children
under five.
⢠There are nearly 1.7 billion cases of childhood
diarrhoeal disease every year.
⢠Diarrhoea is a leading cause of malnutrition in children
under five years old.
https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
WHO, 2 may 2017
July 19, 2019 7CDD/ARI_BPH_IV
8. National
⢠One of the most common illnesses among children and continues
to be a major cause of childhood morbidity and mortality (MOHP, 2011).
⢠Prevalence of diarrhoea among children under age 5 is 8%.
⢠Children who reside in the Terai zone are more likely to suffer
from diarrhea (9%) than those in the Hill (6%) and Mountain
(5%).
(NDHS, 2016)
Treatment status
ORS- 37%, while 61% received either ORS or recommended home
fluids
Zinc supplementation- 18%
Both- 10%
https://www.publichealthupdate.com/nepal-demographic-and-health-survey-2016-key-indicators-report-short-
notes/
July 19, 2019
Scenario
Contd..
8CDD/ARI_BPH_IV
9. Prevalence of Diarrhoea cases by
province
51792
94447
43143
22088
67989
42918
54183
0
20000
40000
60000
80000
100000
Province 1Province 2Province 3Province 4Province 5province 6province 7
Total cases (HF+ORC diarrhoeal cases)
Total cases (HF+ORS diarrhoeal cases)
DoHS, Annual report 2074/75
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11. FY 2074/75
⢠Total Diarrhoeal cases (HF+ORC+FCHV)- 1148238
⢠No dehydration- 82.9%
⢠Some dehydration- 16.7%
⢠Severe dehydration- 0.46%
Annual report 2074/75;
https://dohs.gov.np/annual-report-2074-75/
July 19, 2019 11CDD/ARI_BPH_IV
12. Control initiatives
⢠A community-based national program to control diarrheal
diseases was launched in 1982.
⢠A working group oversaw planning, budgeting,
management and logistics.
⢠Strategies included promoting home-based oral
rehydration therapy and case management in health
facilities.
July 19, 2019 12CDD/ARI_BPH_IV
13. July 19, 2019
⢠In 1991, district-level planning and community
mobilization were included, and strategies were expanded
to include oral rehydration therapy, together with oral
rehydration corners in health centers and hospitals, and
case management by peripheral health workers.
⢠In addition, district health managers were involved in
social mobilization, program planning and training.
⢠Diarrhea case management was also assisted by
traditional local practitioners and drug sellers
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Control
initiatives
14. Prevention and Control Measures
Components of a diarrheal diseases control program
1. Short-term
2. Long-term
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15. Prevention and Control Measures
1. Short term
⢠Appropriate clinical management
a. Oral rehydration solution (ORS)
b. Intravenous rehydration
c. Maintenance therapy
d. Appropriate feeding
e. Chemotherapy
f. Zinc supplementation
July 19, 2019 15CDD/ARI_BPH_IV
16. 2. Long term
⢠Better MCH practices
a. Promotion of breastfeeding
b. Appropriate weaning practices
c. Supplementary feeding
d. Vitamin A supplementation
July 19, 2019 16CDD/ARI_BPH_IV
Prevention &
control measures
17. ⢠Preventive strategies
a. Sanitation
b. Health Education
c. Vaccination
d. Fly control
⢠Strengthening of the Epidemiological Surveillance
Systems
⢠Primary Health Care
July 19, 2019 17CDD/ARI_BPH_IV
Long term
18. Acute Respiratory Infections
⢠Acute diarrheal diseases and acute respiratory infections,
especially pneumonia remain the leading causes of child
mortality globally.
⢠ARI responsible for 20% of childhood(< 5 years) death
⢠90% from pneumonia
19. ARI mortality is highest in
children
⢠HIV- infected
⢠Under 2 year of age
⢠Malnourished
⢠Weaned early
⢠Poorly educated parents
⢠Difficult access to health care
July 19, 2019CDD/ARI_BPH_IV 19
20. Common upper respiratory
tract infections in children
⢠Tonsillitis
⢠Otitis media
⢠Influenza
⢠Bronchiolitis
⢠Asthma
⢠Pneumonia
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21. Prevalence on World
⢠Globally pneumonia is the leading communicable
disease which is the reason of fatality in children.
During 2013, it was reported that approximately
935000 children less than 5 years old died due to
pneumonia, which was 15% of all the deaths in
children. The scenario is more or less same in Sub-
Saharan Africa and South Asia.
⢠Pneumonia accounts for 16% of all deaths of chidren
under 5 years old, killing 920136 children in 2015.
Source: who fact sheet
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23. ⢠The total ARI related deaths at health facilities were
reported to be 127 which is slightly lower compared to
previous FY 2073/74 which was 176. The ARI case
fatality rate per 1000 at health facility also decreased
to 0.05 per 1000 in FY 2074/75 compared to last FY
2073/74 (0.28). ARI case fatality rate shows a wide
variation in between the provinces ranging from the
lowest 0.01 per 1000 in province 2 to the highesr 0.09
per 1000 in province 1.
Prevalence in
NEPAL
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24. ARI Program
⢠WHO supported programs for the control of diarrheal
diseases and respiratory infections started during the
1980s and reduced child mortality.
⢠MOHP recognizes ARI as one of the major public
health problems in Nepal among under 5 children.
⢠The program recognize the important role of mothers
and other care takers in the difference between the
need for home care and for referral to health facilities.
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25. Strategies
⢠Improving knowledge and case management skills of
health care staff.
⢠Improving overall health system.
⢠Improving family and community practices.
⢠Implementation modality
* CB-IMCI
*Trainings of CB- IMCI program to health
Workers.
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26. ⢠Raise public awareness
⢠Promote specific preventive measures through
communication and information activities.
⢠Involve Community health workers including the
volunteers from DDC, VDC, local NGOs and local
decision makers.
⢠Apply an integrated child health package including the
CDD , EPI, Nutrition, ARI and Malaria programes.
⢠Emphasize program management at all health facilities.
⢠Promote supervision and monitoring at all levels.
Strategies
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27. Activities
⢠Purchase of ARI sound timer
⢠Purchase of cotrimoxazole paedriatic tablet
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28. Causes of ARI
⢠Immediate causes
⢠underlying causes
⢠Basic causes
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29. Immediate causes
⢠Low birth weight
⢠Lack of immunization
⢠Malnutrition
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30. Underlying causes
⢠Indoor air pollution
⢠Outdoor air pollution
⢠Poor ventilation
⢠Environmental tobacco smoke
⢠Lack of breast feeding
⢠Overcrowding and poor housing and sanitation
July 19, 2019CDD/ARI_BPH_IV 30
31. Basic causes
⢠Poverty- quality and quantity of actual resources.
⢠Potential resources
July 19, 2019CDD/ARI_BPH_IV 31
