Details on Diarrhea including its types , epidemiology & factors + Assessment and its cure

1. Diarrhea
MR. RAHUL RAJPUT

2. What is diarrhea ?
 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. Types of Diarrhea :
 Acute diarrhea is 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.
 Chronic diarrhea is termed when the loose motion is occurring for 3 weeks or more. It is usually related
to underlying organic diseases with or without malabsorption.
 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.

4. Causes of Diarrhea
 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.

5. Epidemiology
 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.

6. Agent Factors
 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.
- Bacteria: Campylobacter jejuni,E.coli,Shigella,Salmonella,cholera vibrio,vibrio
parahemolyticus etc.
- Parasites: E.histolytica, G.lambia, Cryptosporidium,H.nana , malaria etc.
- Fungi: Candida albicans

7. Host Factors:
 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.
 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 diarrhea include prematurity, immunodeficiency
conditions, lack of personal hygiene, inadequate food hygiene, infant feeding practices,
illiteracy, poor socio-economic status etc.

8. Environmental factors:
 Bacterial diarrhea is more frequently occur in summer and rainy season,whereas
viral diarrhea ( specially rotavirus ) found in winter.

9. Mode of Transmission:
 It is mainly feco-oral route. It is water- borne, food-borne disease or may transmit
via fingers, fomites, flies or dirt.

10. Diarrohea : Prevention and Treatment
 In the year 2007 regarding diarrhea treatment a new policy introduced where for treatment there are two very
important components added
a. New ORS ( Which has the less amount of glucose & salt)
b. Zinc ( Tablet or syrup)
With these above two additions following are the benefits
a. More chances of reduction in Frequency & severity of diarrhea
b. Death rates due to diarrhea will decrease
New ORS & ZINC will improve the absorption power of minerals & prohibit the wastage of important minerals
from the body. During the treatment Breastfeeding & food intake is must in case of severe emergency antibiotics
can be used.

11. Assessment of diarrhea

12. ORS
 Reduction in vomiting
 Reduction in loose stools
 Gain of important electrolytes which
were lost during diarrhea

13. ORS Reccipe

14. ZINC
 What is zinc ?
- An important component for our body which is mandatory.
- Important component for overall growth
- Strengthen immune system& reduce the death rate of under 5 year childerens
 Why lack of zinc usually happens in children's ?
- Our country is vegetarian which directly leads to zinc deficiency
- During the diarrhea human body majorly face loss of water as well as zinc
 Loss due to lack of zinc ?
- Lack of zinc damage to immune system.
- Depletion in overall growth result to weakness & open invitation to harmful diseases.

15. ZINC : Beneficial or Harmful
 Benefits of zinc are :-
• Speedy recovery & reduction of water in stools during diarrhea
• Works like a tonic after diarrhea episode & reduce the chances of death due to
diarrhea
• Full course i.e. 14 days leads to defend the body from various disease like
pneumonia ,diarrhea etc.
 When is the right time to give zinc ?
• From very first day of episode till 14 days regularly

16. Zinc recipe

17. Dietary Management
 Diet to be planned to prevent malnutrition and allow normal nutritional requirement.
 Food items may include energy rich food with rice, potatoes, wheat, pulses, vegetables
oil, curd, fish, high fiber content foods and soft drinks should be avoided.
 Breast feeding to be continued during diarrheal episodes even along with ORS.
 Cereal mixture like rice- milk, dalia- sagu, or khichri can be given to the infants more
than 6 months of age.
 If the infant is non breast fed, cow’s or buffalo’s milk should not be diluted with water.
 Feeding to be given in small quantity frequently every 2 to 3 hours.

18. Preventive measures
 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.