Add control program

1. ACUTE DIARRHOEAL DISEASE CONTROL
PROGRAMME
Ameena C
Roll no 14

2. Introduction
• When the WHO initiated the Diarrhoeal Diseases Control Programme in 1980,
approximately 4.6 million children used to die each year of the dehydration
caused by diarrhoea.
• Although its toll has dropped by a third over the past decade, it killed more than
1,300 children under 5 years of age every day in 2016. It accounts for 8 per cent
of all under-five deaths

3. Components of a Diarrhoeal Disease Control
Programme
• Short term
- Appropriate clinical management
• Long term
- Better MCH care practices
- Preventive strategies
- Preventing diarrheal epidemics

4. Appropriate clinical management
1. ORS
• The main aim of oral fluid therapy is to prevent dehydration and
reduce mortality.
• Based on the observation that glucose given orally enhances the
intestinal absorption of salt and water and is capable of
correcting the electrolyte and water deficit
SHORT TERM INTERVENTIONS

5. • At first composition of ORS recommended by WHO was sodium bicarbonate
based
• TRISODIUM CITRATE in place of SODIUM BICARBONATE
• Made product more stable
• Reduces stool output
• Increase intestinal absorption of sodium&water

6. • More recently an improved ORS formulation has been developed
• Osmolarity is reduced to avoid adverse effects of hypertonicity
• Reduction of sodium concentration of ORS to 75 mOsmol/L - improved the
efficacy of ORS regimen for children with acute non-cholera diarrhea
• INDIA was the first country in world to launch ORS formulation since JUNE
2004

7. Assessment of dehydration

10. Plan A; Treat Diarrhoea at home
Counsel the mother on the 4 rules of home treatment;
1. Give extra fluid (as much as the child will take)
2. Give zinc supplements (age 2 months up to 5 years)
3. Continue feeding (exclusive breastfeeding if age <6months)
4. When to return

11. Guidelines for oral rehydration therapy (for all ages)
during the first four hours
Plan B

12. 2. Intravenous rehydration
• IV infusion is usually required only for initial rehydration of severely
dehydrated patient who is in shock or unable to drink
• Such patients are best transferred to nearest hospital or treatment centre
• Solutions recommended by WHO for IV infusion are ;
1. Ringer lactate solution;used to correct dehydration due to acute
diarrhoeas of all causes.
2. DTS

13. Diarrheal treatment solution (DTS) ; Recommended by WHO as ideal
poyelectrolyte solution for IV infusion. It contains in one litre,
▪️Sodium acetate – 6.5g
▪️Sodium chloride – 4g
▪️Potassium chloride – 1g
▪️Glucose – 10g
If nothing else is available normal saline can also be given but it is poorest
fluid because it will not correct the acidosis and will not replace the
potassium losses

14. Plan C; Treat severe dehydration quickly
• The recommended dose of the IV fluid to be given is 100 ml/kg,
divided as

15. 3. Maintenance therapy
• After the sign of dehydration has been corrected, oral fluid should be used
for maintenance therapy

16. 4. Appropriate feeding
• Especially relevant for the exclusively breast fed infants. If the child is
breast fed, nursing should be pursued during treatment with ORS
solution.
5. Chemotherapy

17. 6. Zinc supplementation
• It reduces episodes, duration & severity.
• Recommended by WHO & UNICEF.
• 10 mg Zn for infants under 6 months of age, 20 mg for children older
than 6 months for 10-14 days

18. LONG TERM INTERVENTION
1. Better MCH care practices
Maternal nutrition;
• Improving prenatal nutrition will reduce the low birth weight problem
• Prenatal and postnatal nutrition will improve the quality of breast milk

19. Child nutrition;
▪️ Promotion of breast feeding
▪️ Appropriate weaning practices
▪️ Supplementary feeding
▪️ Vit A supplementation
2) Preventive strategies
1.Sanitation
2.Health education

20. 3. Immunization
Measles vaccine can prevent 25% of diarrhoeal deaths in children
under 5 yrs of age
Rotavirus vaccine
There are two vaccines
ROTARIX – TM (monovalent human rotavirus vaccine)
• 2 dose schedule
• First dose : 6-12 weeks
• Second dose : 16-24 weeks
ROTA Teq – TM (pentavalent bovine – human vaccine)
• 3 oral doses at ages 2,4,6 months

21. 4. Fly control
Flies breeding in association with human or animal faeces should be
controlled.
3. Control and/or prevention of diarrhoeal epidemics
This requires strengthening of epidemiological surveillance systems

22. The Integrated Global Action Plan for the Prevention and
Control of Pneumonia and Diarrhoea (GAPPD)

23. Diarrhoeal Disease Control Programme in India
• The Diarrhoeal Disease Control Programme was started in 1978 with the
objective of reducing the mortality and morbidity due to diarrhoeal
disease
• Since 1985-86, with the inception of the National Oral Rehydration
Therapy Programme, the focus of activities has been on
1. strengthening case management of diarrhoea for children under the age
of 5 years &
2. Improving maternal knowledge related to use of home available fluids,
use of ORS and continued feeding.

24. • The changes in treatment recommendations and preventive measures have
subsequently led to monitorable treatment and diarrhoea prevention
indicators.
A)Diarrhoea prevention indicators ;
(1) Percentage of population using:
(a)improved drinking water sources
(b)Improved sanitation facilities
(2) Percentage of one year old immunized against measles
(3) Percentage of children who are :
- under-weight
- stunted
- exclusively breast-fed
- breast-fed with complementary food
- still breast-feeding (20-23 months of age)
(4) Vitamin A supplementation coverage rate

25. (B) Diarrhoea treatment Indicators;
Percentage of children under-five years with diarrhoea receiving:
(1) ORT with continuous feeding
(2) ORS packet
(3) Recommended home made fluids
(4) Increased fluids
(5) Continued feeding