The document discusses diarrhea, its causes, types, risk factors, symptoms, management and prevention. Diarrhea is defined as having 3 or more loose or liquid stools per day and can be acute (lasting less than 14 days) or chronic (lasting 3 weeks or more). It is a major cause of death in children, especially in developing countries. Proper management includes oral rehydration with WHO recommended amounts of ORS. Prevention focuses on improved hygiene, sanitation, breastfeeding and nutrition.

1. AKASH
4TH SEM, PSPH

2. Diarrhea is a condition in which there is :
- Unusual frequency of bowel movements (more
than 3 times a day).
- Changes in the amount ( more than 200g a
day).
- Change in consistency( liquid stool).
 It is a common cause of death in developing
countries and the second most common cause
of infant deaths worldwide.
WHO defines :
 Having 3 or more loose or liquid stools per
day, or as having 3 or more loose stool.

3. * Acute diarrhea
* Chronic diarrhea

4.  An attack of loose motion with sudden
onset which usually lasts 3 to 7days but
may last up to 10 – 14 days.
 It is caused by an infection of the large
intestine, but may be associated with
infection of gastric mucosa and small
intestine. The term “acute
gastroenteritis” is most frequently used
to describe acute diarrhea.

5.  It is termed when the loose motion is
occurring for 3 weeks or more. It is
usually related to underlying organic
diseases with or without mal-
absorption.
 Diarrhea with watery stools and visible
blood in the stools is called dysentery.
 Persistent diarrhea refers to the
episodes of acute diarrhea that last for
2 weeks or more and may be due to
infective origin.

6.  The main causes of this disease are lack of
knowledge of hygiene and sanitation, home
environment, feeding practices of the parents
and under five years of children.
 It can be caused by chronic ethanol ingestion.
 Chronic mild diarrhea in infants and toddlers
may occur with no obvious cause and with no
other ill effects ,this condition is called
toddler’s diarrhea.

7.  About 1/3 of total hospitalized children are
due to diarrheal diseases and 17% of all
deaths in indoor pediatric patients are
related to this condition. The morbidity rate
in terms of diarrhea episodes per year per
child under the age of 5 years is about 1.7.

8.  Diarrhea is mostly infectious. A large
numbers of organism are responsible for
acute diarrhea.
 The infectious agent causing diarrhea with
enteric infection include the followings:
 Viruses: Rota virus, adenovirus, enterovirus,
Norwalk group viruses, measles virus etc.

9.  Man is the main reservoir of enteric
pathogen, so most transmission originates
from human factors. For some enteric
pathogens and viral agents animals are
important reservoir.

10.  The disease is most common
specially between 6months to
2years. The incidence is higher
during weaning period, i.e. 6 to 11
months of age.
 It occurs due to combined effects of
reduced maternal antibodies, lack of
active immunity and introduction of
contaminated food or direct spread
through child’s hands.

11.  Diarrhoea is more common in artificial
feeding, specially with contaminated cow’s
milk or unhygienic preparation of tin milk.
 Malnutrition leads to infection leads to
infection and infection leads to Diarrhoea.
 The predisposing factors of Diarrhoea
include prematurity, Immunodeficiency
conditions, lack of personal hygiene,
inadequate food hygiene, infant feeding
practices, illiteracy, poor socio-economic
status etc.

12.  Bacterial diarrhea is more frequently occur in
summer and rainy season, whereas viral
diarrhea ( specially rotavirus ) found in winter.

13.  It is mainly feco-oral route. It is water-
borne, food-borne disease or may transmit
via fingers, fomites, flies or dirt.

14.  Stools are usually loose watery in consistency. It
may be greenish or yellowish-green in color with
offensive smell. It may contain mucus, pus or
blood and may expelled with force, preceded by
abdominal pain.
 Frequency of stools varies from 2 to 20 per day
or more.
 The child may have low grade fever, thirst,
anorexia.
 Behavioral changes like irritability, restlessness,
weakness, lethargy, sleepiness, delirium, stupor
and flaccidity are usually present.

15.  Physical changes like loss of weight, poor
skin turgor, dry mucus membranes, dry lips,
pallor, sunken eyes, depressed fontanels are
also found.
 Vital signs are changed as low blood
pressure, tachycardia, rapid respiration, cold
limbs and collapse.
 Decreased or absent urinary output.
 Convulsions and loss of consciousness may
also present in some children with diarrheal
diseases.

16.  History taking and physical assessment.
 Stool examination can be done for routine
and microscopic study and identification of
causative organisms.
 Blood examination can be performed to
detect electrolyte imbalance, acid- base
disturbances, hematocrit value, TC,DC,ESR
etc. The suspected associated cause should
be ruled out for adequate management.

17. Rehydration Therapy:
 The management of diarrhea is a vast
majority of children is best done with ORS
solution and continued feeding.
 ORS means drinking of solution of clean
water, sugar and mineral salt to replace the
water and salt lost from the body during
Diarrhoea, especially when accompanied by
vomiting, i.e. gastroenteritis.

18.  When the child is having diarrhea with some dehydration,
management should be done under supervision of health worker
with ORS.
 The appropriate amount of ORS solution to be given in the first 4
hours are as follows:
 Age less than 4 months or weight less than 5 kg- 200 to 400ml.
 Age 4 to 11months or weight 5 to 7.9 kg – 400 to 600 ml.
 Age 12 to 23 months or weight 8 to 10.9 kg – 600 to 800ml.
 Age 2 to 4 years or weight 11 to 15.9 kg – 800 to 1200ml.
 Age 5 to 14 years or weight 16 to 29.9 kg – 1200 to 2200 ml.
 Age 15years or older or weight 30kg or more to 2200 to 4000ml.

19. Improvement of food hygiene and environmental
hygiene. These includes:
 Safe water, adequate sewage disposal, hand washing
practices, clean utensils, avoidance of exposures of
food to dust and dirt, fly control, washing of fruits
and vegetables etc.
 Avoidance of bottle feeding is most significant
practice needed for prevention of diarrhea.
 Boiling or filtering to be practiced for safe drinking
water.
 Prevention of LBW and prematurity, exclusive breast
feeding, appropriate weaning practices, balanced
diet, immunization are significant aspects of child
care.

20.  Dehydration
 Hypovolemic shock
 Renal failure
 Paralytic ileus
 Thromboembolism
 Convulsions
 Over dehydration
 Hypoglycemia
 Consumptive coagulopathy
 Toxic mega colon
 Malnutrition
 Growth retardation
 Mental subnormalities

21.  Mortality is higher in neonate and infants
than the older children.
 Malnourished children are having poor
prognosis and greater mortality.
 Antibiotic resistant type E.Coli and shigella
cause very severe illness and poor prognosis.
 Presence of severe dehydration ,electrolyte
imbalance and pneumonia have poor
prognosis.