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Control of diarrheal diseases
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Control of diarrheal diseases

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Diarrhea is a most important

Diarrhea is a most important

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  • 1. Dr. Dinusha Sirisena, MBBS (Col)Resident House OfficerPediatrics, SJGHWebsite : www.doctordinusha.info
  • 2. Objectives Objectives, targets and strategies of CDD Importance of the National CDD Program Types of Diarrhea Symptoms & Signs of Diarrhea Assessment of Degree of Dehydration Diarrhea treatment plan given in WHO charts
  • 3. Disease Burden of Diarrhea 2nd leading cause of death in under 5 year olds Each year diarrhea kills 760, 000 children under 5 Globally there are 1.7 billion cases of diarrhea eachyear Diarrhea is the leading cause of malnutrition inchildren under 5 year of agewww.doctordinusha.info
  • 4. www.doctordinusha.info
  • 5. Objectives of the National Program forControl of Diarrheal DiseasesReduction of,I. Mortality due to diarrheal diseasesII. Morbidity due to diarrheal diseasesIII. Report of Hospital admissions due to diarrheaIV. Number of outbreaks reported in an yearwww.doctordinusha.info
  • 6. StrategiesI. Implementation of standard case management at allhospitalsII. Train Hospital and PHC staff for prevention and controlof diarrheaIII. Develop & print IEC material for social mobilizationIV. Strengthen surveillance of diarrhoeal diseases andoutbreak investigationV. Strengthen laboratory surveillance(monitoring oforganism)VI. Improve environmental sanitation (safe drinking waterand sanitary latrines)www.doctordinusha.info
  • 7. www.doctordinusha.info
  • 8.  Strategies in using ORS & RehydrationI. Field coordination Operational “Rehydration Centers” in healthcarestationsII. Production and Distribution ORS “Oral Rehydration Salts” have to be produced andsent to health stations To be made available as OTCIII. Mass Media Create awareness and demand for ORS/ rehydrationsolutionwww.doctordinusha.info
  • 9. IV. Training Producing materials, programs to educate and traindoctors, nurses and related healthcare professionalsV. Research and Evaluation Providing grants and allowances for those involved inresearch and also evaluating the effects of ORS in themanagement of diarrheawww.doctordinusha.info
  • 10. Importance of the National Program forControl of Diarrheal Diseaseswww.doctordinusha.info
  • 11. Due to diarrhea….. In Somalia, which is number 1 in diarrhea relateddeaths, the count is usually about 179 per 100,000. In Sri Lanka, ranking at number 90, the death rate isaround 5.69 per 100,000 population. It is the 20th leading cause of death in Sri Lanka (1069deaths per year).www.doctordinusha.info
  • 12. Mortality rate of under 5 children (per 1000 live births)www.doctordinusha.infoReasons for reduced mortality• Breast feeding• Maternal education• Vaccination• Safe drinking water• ORS
  • 13.  Managing and preventing diarrhea is most importantwww.doctordinusha.info
  • 14. What is diarrhea?Passage of unusually loose or watery stools usually atleast three times in a 24 hour period. However it isthe consistency of the stools rather than the numberthat is most important.www.doctordinusha.info
  • 15. Types of diarrhea1. Acute watery diarrhea (including cholera)2. Acute bloody diarrhea (dysentery)3. Persistent diarrhea (lasting 14 days or more)4. Diarrhea with severe malnutritionwww.doctordinusha.info
  • 16. Osmotic diarrheawww.doctordinusha.info
  • 17. Malabsorptive diarrheawww.doctordinusha.info
  • 18. Secretory Diarrheawww.doctordinusha.info
  • 19. Exudative Diarrhea Bacillary dysenterywww.doctordinusha.info
  • 20. Causes1. Infection Feco-oral transmission Contaminated food or water Viral, bacterial and parasitic Viruses : RotavirusEnterovirusBacteria : E. coliShigellaCamylobacter jejuniV. CholeraeSalmonella (non typhoidal)Protozoal : Giardia duodenalisEntamoeba HistolyticaCryptosporidiumwww.doctordinusha.info
  • 21. 2. Malnutrition Diarrhea makes the small intestinal villi damaged andunable to absorb nutrients and thus making them proneto more infections (Vicious Cycle)www.doctordinusha.info
  • 22. Symptoms Fever Loose stools (frequency and consistency) Water/mucoid/blood stained Vomiting and nausea Generalized body ache Reduced UOP (<5 times per day/<5ml/kg/hr) Dizziness/feeling unwellwww.doctordinusha.info
  • 23. Signs Feberile (>98.4 F) Dehydrated (eyes, tongue and skin tugor) CRFT<2 seconds Pulse rate (tachycardia) BP (diastolic rise, and then systolic fall) Pulse pressure narrowing (<20mmhg) Altered level of consciousness Fitswww.doctordinusha.info
  • 24. www.doctordinusha.info
  • 25. Assessment of Dehydrationwww.doctordinusha.info
  • 26. Evolution of CVS clinical signs withdehydrationNo Dehydration Some Dehydration Severe DehydrationNormal Pulse Tachycardia Absent pulseNormal Pressure Diastolic pressure rises Systolic drops ->unrecordable pressureFluid Deficit <5% ofBW or 50 ml/kg5-10% of BW or 50-100ml/kg>10% of BW or100ml/kgwww.doctordinusha.info
  • 27. Oral Rehydration Salts (Jeevani) Water absorption happens in the small intestine via anosmotic gradient created by Na and Cl ionswww.doctordinusha.info
  • 28.  Sodium absorption happens by, Glucose mediated sodium absorption (coupled path) Sodium ion coupled as double exchange Diarrhea does not impair these path wayswww.doctordinusha.info
  • 29.  ORS contains constituents which increase theabsorption of water, replace potassium lost in stoolsand correct acidosis NaCl KCl Na Citrate (counter acidosis) Glucosewww.doctordinusha.infoNa 75mmol/lCl 65mmol/lGlucose 75mmol/lK 20mmol/lCitrate 10mmol
  • 30. Preparation and storage of ORS Add all contents to 1 l of boiled water (some packetscan be dissolved in less amount of water) Avoid adding extra sugar or salt Once prepared keep only for 24 hourswww.doctordinusha.info
  • 31. Principles of Diarrhea Management Correct dehydration Maintenance of hydration Provide electrolytes Correct acidosis Antibiotic therapy when needed Re colonization with normal florawww.doctordinusha.info
  • 32. Special Precautions Assess every 4 hours Stop it if the child is having swollen eyelids (continuewith breast milk and plain water) Don’t if vomiting Don’t if lethargic or drowsy (take the child to thehospital)www.doctordinusha.info
  • 33. Managing a child/adult withdiarrhea without dehydration Main aim is to replace the ongoing fluid andelectrolyte losses and to supply the daily maintenance Ongoing loss : Per each loose motion give 100-200 ml of ORS (<2yrold=100ml, >2yr old=200, teen = as much as they want)www.doctordinusha.info
  • 34.  Daily maintenance of fluids : Using the Holliday & Segar formula,www.doctordinusha.info
  • 35. Managing a child/adult withdiarrhea with some dehydration Better to be managed at the hospital setting The fluid loss has to be replenished by ORS, calculated as,Wt(Kg) * 75ml/kgIn initial 4 hours Reassessment is needed to decide on further Mx. The maintenance is calculated with the Holliday and Segarequationwww.doctordinusha.info
  • 36. Managing a child/adult withdiarrhea with severe dehydration Will need iv fluids ASAP.(Give 100ml/kg)www.doctordinusha.infoAge First 30 ml/kg Second 70ml/kg<1 year 1 hr 5 hrs>1 year 30 min 2 hrs 30 mins
  • 37. Further points in management1. Oral fluids ORS Rice Kanjee Rice water (salted) King coconut water Soup (vegetable/chicken soup-salted)2. Continue breast feeding3. Probiotic/Prebiotic mixtures (Bifilac/Prezolac)4. Multivitamins with Zinc saltswww.doctordinusha.info
  • 38. 5. Antibiotics if suspecting bacterial or dysentery(furazolidone/cephalosporin)6. Continue with normal feeds Yoghurt Protein rich foodwww.doctordinusha.info
  • 39. Preventive measures1. Hand hygiene2. Care in food preparation3. Safe drinking water4. Sanitary latrines5. Preventing malnutritionwww.doctordinusha.info
  • 40. Summary Diarrhea is a real problem, especially for children (<5yr olds) Oral Rehydration Salts (ORS) are a major find incombating diarrheal diseases Proper diagnosis and assessment of dehydration isrequired Proper rehydration method is needed Proper supportive therapy is needed EIC methodologies are needed (Not limited to papers,radio or TV now)www.doctordinusha.info
  • 41. www.doctordinusha.info
  • 42. If any queries regarding the lectureor the sub topics discussed here, Contact me at :www.doctordinusha.info(the lecture and the sources are also available at thesite) www.twitter.com/drdinusha/www.doctordinusha.info
  • 43. Thank you!www.doctordinusha.info