Epidemiological Study on Diarrhea, ARI and Worm Infestations.

1. Epidemiological Study on Diarrhoeal Disease:
Introduction:
Diarrhea is a condition that involves the frequent passing of loose or watery stools - it is the
opposite of constipation and can have many causes, which may be infectious or non-infectious.
There are two types of diarrhoea. Acute diarrhea, meaning diarrhea that is not long-term, is a very
common cause death in developing nations, especially among young children and babies. It usually
appears rapidly and may last from between five to ten days. Chronic diarrhea, meaning long-term
diarrhea is the second cause of death among children in developing countries. The national control
of diarrhoeal disease programme is an integral part of primary health care and accorded high
priority by the MOHP. The programme focuses on children less than 5 years because the majority
of deaths in this age group are diarrhoea related. The MOHP followed the WHO guidelines for the
classification of diarrhoea cases. Therefore all cases of diarrhoea assessed by health workers
should be classified into the following categories:
 No dehydration
 Dehydration
 Severe dehydration
Problem Statement:
According to the World Health Organization (WHO) approximately 3.5 million deaths
each year are attributable to diarrhea. 80% of those deaths occur in children under the age of 5
years. Children are more susceptible to the complications of diarrhea because a smaller amount of
fluid loss leads to dehydration, compared to adults. Diarrhoes is a leading cause of morbidity and
mortality among children in developing countries. Diarrohea is a major cause of childhood
morbidity and mortality in Nepal. 12% of children under five years suffer from diarrhea and 5%
die due to the conditions. Children ages 6 – 23 months are most susceptible to diarrhea (i.e. 24%).
About 4 in 10 (40%) of children with diarrhea is taken to a health provider. Half of children with
diarrhea are treated with ORS. 30% received no treatment at all. (Lamichhane A andC.MR, Outbreak
of Diarrhoeal Diseasesin Nepal. Journal of Nepal PublicHealthAssociation,2009. 4: p. 61 - 65.)
The national incidence of diarrhoea per 1,000 under‐five year children has 500/1,000 in 2067/68,
which is slightly higher than in 2065/66. Likewise the reported incidence of diarrhoea has
decreased in all regions. The highest incidence was observed at FWDR (749/1,000 under five
children) and MWDR (734/1,000 under five children) compared to other regions. Out of the total
1,735,844 diarrheal cases, 27 percent were treated at HFs, 18 percent were treated by
VHW/MCHWs and 55 percent were treated by FCHVs. This implies that 73 percent of diarrheal
cases who seek care in the public sector were treated at community level, either by FCHVs or by
VHW/MCHW. (Annual Report 2067/68)

2. In Surkhet district, the incidence rate is 988.5/1000 live birth in 2068/69 whereas the prevalence
of diarrhoea among under 5 children is 44120 including all the cases of dysentery. There was
significantly decrease in diarrheal incidence in comparison to last year (48068) but still the case
of the diarrhoea is high. Among 41955 cases of diarrhea (substituting the 2165 cases of dysentery)
40470, 1431 and 58 were the cases of no dehydration, dehydration and severe dehydration
respectively. (Annual Report, Surkhet 2069)
Objectives:
General –
 To study the epidemiology of diarrhoea in Surkhet district.
Specific -
 To conduct the detail epidemiological study regarding time, place and person distribution
of diarrhoea.
 To recommend the responsible authority for planning, organizing and evaluating
preventive and curative services for the control of diarrhoeal diseases.
Rational of the study:
 Diarrhoea is a major public health problem.
 It occupies the eighth position among the top ten diseases in Surkhet district.
 It is the priority program of GoN.
Methodology:
Study design: Descriptive type of study in which past 3 years information were reviewed.
Study area: District Health Office, Surkhet
Study duration: 3 days
Study technique: Secondary data review
Study tools: Format for secondary data review (Annual Report, Monthly Monitoring Sheet, Annual
Performance Review Sheet)
Study analysis: Editing, Tabulation, Comparison and interpretation.
Study variables:
Time Variables: - Month/season/year
Place variable: - Locality/Area/Ilaka

3. Person variables: - Sex
Epidemiological characteristics of diarhoeal diseases:
Agent: There are different causing agents of diarrhoea i.e. virus, bacteria and parasites.
1. Virus – Rotavirus, Astrovirus, Calcivirus, Coronavirus, Norwalk group virus, Enterovirus.
2. Bacteria – Compylobacter jejuni, Shigella, Escherichia, Salmonella, Vibrio,
Parahaemolyticus, Bacillus cereus
3. Parasites – E. histolytica, Giardia intestinalis, Trichuriasis, Cryptospodium sps, Intestinal
worms
Host: Diarrhoea is most common in children especially those between 6 months and 2 years.
Incidence is highest in the age group 6-11 months, when weaning occurs. It reflects the combined
effects of declining levels of maternally acquired antibodies. The lack of active immunity in the
infants, the introduction of contaminated foods, the direct contact with human or animal feces
when the infants start to crawl are the main reason for diarrhoeal infection. Diarrhoea is more
common in person with malnutrition. Poverty, premature, reduced gastric acidity,
immunodeficiency, lack of personal and domestic hygiene and incorrect feeding practices are all
contributory factors.
Environment: In temperature climate bacterial diarrhoea occurs more frequently during the warm
season, whereas viral diarrhoea is peak during the winter. The incidence of persistent of diarrhoea
follows the winter seasonal pattern.
Mode of transmission: Most of the pathogenic organism that cause diarrhoea and all the pathogens
that are known to be major causes of diarrhoea are transmitted by the faeco-oral route. Faeco-oral
transmission may be water borne, food borne or direct transmission which implies an array of other
faeco-oral routes such as via fingers, fomites, dirts which may be ingested by young children.
Reservoir of infection: For some enteric pathogen, man is the principle reservoir and thus most
transmission originates from human factors. For other enteric pathogen, animals are important
reservoirs and transmission originates from both human and animal faeces. For viral agents of
diarrhoea, the role of the animal reservoir in human disease remains uncertain.
Control of diarrhoeal disease:
 Hand washing - regular hand-washing with soap and warm water helps reduce the risk of
catching or passing on germs. Especially after going to the toilet, playing with pets, and
before touching food.
 Keeping the kitchen and toilets as clean as possible - also reduces the risk. When handling
raw meats wash your hands before touching other things, such as other foods, work
surfaces etc.

4. The intervention measures recommended by WHO may be classified as below –
Short term
 Appropriate clinical management
 ORT (Oral Rehydration Therapy)
 Intravenous rehydration
 Maintenance thrapy
 Appropriate feeding
 Chemotherapy
 Zink supplementation
Long term
 Better maternal and child health care practices
 Maternal and child nutrition
 Promotion of breast feeding
 Appropriate weaning practices
 Supplementary feeding
Preventive strategies:
 Sanitation
 Health education
 Immunization
 Flies control
Prevention and control of diarrhoeal diseases:
This requires the strengthening of epidemiological surveillance systems. It should be the delivery
of a package of curative and preventive services at the community level. An intersectoral approach
centered upon primary health care involving activities in the fields of water supply and excreta
disposal, communicable disease control, mother and child health, nutrition and health education is
regarded as essential for the ultimate control of diarrhoeal diseases.
Findings:
Person variable –
Sex wise distribution –

5. Time variable:
Figure: Year wise
incidence of Diarrhoea
In Surkhet district, the
incidence of diarrhoea
among children under 5
years of age was in
decreasing trend since
F/Y 2066/67. The
highest incidence of
diarrhoea was recorded
in 2066/67 than after it
was decreasing. In F/Y
2068/69, the incidence
of diarrhoea was 988.5
per thousand live births.
In those 4 years time,
least incidence of
diarrhoea was recorded
in 2065/66.
Place variable:
Figure: Ilaka wise reported incidence of Diarrhoeal cases
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Ilaka wise Reported Incidence of Diarrhoeal
Cases
843.66
1224.2
1069.18
988.5
0
200
400
600
800
1000
1200
1400
2065/66 2066/67 2067/68 2068/69
Year wise incidence of Diarrhoea
Incidence
of
Diarrhoea

6. Amongtotal diarrhoeaincidencecases,the highincidencecases (9350) were found inSalkotIlaka(Salkot,
Babiyachaur, Vidayapur, Ghatgaun, Tatapani, Chhapre, Pokharikanda) whereas least incidence cases
(1890.46) were foundinLekhgaun (Lekhgaun,Gadi).Amongall VDCsof Surkhetdistrict,highestincidence
cases (1968.55) were found in Kaprichaur VDC and least incidence cases (74.91) were found in Katkuwa
VDC.

7. Epidemiological Study on ARI:
Epidemiological characteristics:
Agent factors:
There are various categories of the bacteria and virus are more associated with respiratory
tract infection. They are the primary cause of the great majority of respiratory illness. The
bacteria and virus which may cause ARI are as follow:
1. Bacteria:
- Bordetella perrtusis
- Streptococcus pneumonia
- Haemophilus influenza
- Klebseilla pneumonia
2. Virus:
- Adeno viruses-endemic type (1, 2, 5)
-epidemic types(3, 4, 7)
- Entero viruses
- Influenza (A, B, C)
- Parainfluenza (1, 2, 3)
- Rhinoviruses
- Corona viruses
Host factors: Generally rates tend to be high in infants and young children, and in the elderly.
Although the age group with the highest rate can differ.
Upper respiratory tract infections e.g., common cold and pharyngitis are several time higher in
children than in adults.
Illness rate are highest in young children and decrease with the increasing age. Adult women
experience more illness then men. Under 3 years of boys are affected more often and more
severely.
Environmental factors:
Include climatic condition, housing, level of industrialization, and socio-economic
development. Overcrowded dwellings, poor nutrition, and low birth weight, intense indoor
smoke pollution underlines the high risk.
In infants maternal cigarette smoking has been linked with for increased occurrence.
Objectives:
General objective: To study the epidemiology of ARI in Surkhet district.

8. Specific objective:
 To identify the time variation (seasonal) of the ARI cases,
 To analyze the Ilaka wise (place) distribution of the ARI cases,
 To describe the person distribution of the ARI in terms of sex.
Methodology:
Study area: Surkhet district
Study population: Under five year children of Surkhet district
Study type: Descriptive type of study in which past 3 years data were reviewed.
Study technique: Secondary data review.
Study tools: Format for secondary data review.
Study variables:
Time variables: months/season/year
Place variables: locality/Ilaka
Person variables: Sex
Findings:
Figure 1: Month wise distribution of the ARI cases
4846
5252
3707
4886
4865
4924
4677
4369
3832
3896
4008
3729
0
1000
2000
3000
4000
5000
6000
ARI Cases
ARI
Cases

9. The above table reflects that, month wise distribution of ARI cases in the fiscal year 2068/2069.
The high cases were seen in between Shrawan and Bhadra i.e. 5252 and low cases were observed
in between Aahwin and Kartik i.e. 3707.
Place variable:
Figure 2: Ilaka wise distribution of ARI cases.
The above table reflects that, according to Ilaka wise distribution of ARI cases in F/Y 2068/2069,
the high cases were seen in Bajedichaur i.e. 10354.2 and the low cases were seen in Latikoili i.e.
2480.1.
5309.4
7752.2 7956.3
5060.3
2790.6
6059.8
2480.1
3989.8
2694.6
3673.7
6034.8
10354.2
0
2000
4000
6000
8000
10000
12000
Illaka wise distribution of ARI Cases
ARI Cases

10. Figure:
The above table reflects that, the maximum service in pneumonia was given by FCHV in the F/Y
2066/2067-2068/2069 and the minimum service was given by VHW/MCH.
Figure 3: Proportion of severe pneumonia
0
10
20
30
40
50
60
2066/67 2067/68 2068/69
Treatment of ARI cases
HF
VHW/MCH
FCHV
0
0.5
1
1.5
2
2.5
3
5.12
2063/64
2064/65
2065/66
2066/67
2067/68
2068/69

11. The above table reflectsthat,the highcasesof severe pneumoniawere seeninF/Y2063/2064 and the
lowcaseswere observedinthe F/Y2067/2068.
EpidemiologicalStudy of Worm Infestation
Worm Infestation:
Infestation of the intestines or other parts of the body with worms or wormlike
parasites; helminthiasis. Worm infestation is common in children all over the world.
Worms may be of many shapes and sizes, from microscopic “pinworms” to tape-worms”
that are several feet long. Most of these worms live in the intestinal tract. Any of several
types of worms may live in the human body as parasites (infestation), sometimes
causing mild to severe illness. These worms, which infest the blood, intestines or organs
(e.g., liver, lungs), include flukes, hookworms, pinworms, tapeworms and whipworms.
The sizes of the worms range from microscopic to about 1 meter.
Problem Statement:
Worm infestation is one of thecommon health problems worldwide especially in children.
WHO estimated that about 1400 million people worldwide are infested with at least one
type of intestinal worm. The common helminthes found in India are round worm,
hookworm, pinworm and tapeworm, commonly acquired orally or percutaneously or
both routes. Worm infestation is the most common problem in children due to its close
association with health practices and sanitary conditions2
. Worm infestations have a close
relationship with the socio demographic and ecological factors like poverty, illiteracy,
poor personal and environmental hygiene. Children are at special risk due to their
activities like play and lack of importance to personal hygiene. From the children, the
entire family may eventually get worms and suffer. Worm infestations are generally not
noticed but can sometimes lead to significant problems, which affect many organ
systems. Most of these are a result of unsanitary living conditions and poor food
preparation. These constitute an important public health problem, as anemia is caused
by hookworm infestation in a significant number of children.
A wide variety of worms

12. infest humans, these range from half inch pinworms to tape worms as long as 30 feet.
The most important among them are Pinworms, the Round worms, and the Hookworms.
Rational of the study:
 Major public health problem
 National priority program
 The disease problem was found to be in top ten disease of the district.
 The problem was prioritized on the consultation with the health staffs.
Goal and objectives:
Goal
To find out epidemiological situation of worm infestation in the surkhet district.
Objectives:
 To find out the distribution of worm infestation in terms of time, place, and
person.
 To provide background data for the planning, organizing and evaluating
preventive and curative services for the control of worm infestation.
Methodology:
Study design: the study design was descriptive study.
Study area: Surkhet district
Tools and techniques:
Tools: Records, interview guideline
Techniques:
 Records/reports overview
 Key informant interview
Variables:

13. Dependent variable – Worm infestation
Independent variable – Age group, sex, place, care and preventive services of worm
infestation.
Findings and discussion:
The above table shows that the high cases of worm infestation were seen in Shrawan and
Bhadra 2068. In this year 2069 high cases were seen in the Jestha month.
879
655
438
395
447 413 420
364
522
462
584 586
1163
867
616 592 622
575 610
469
687 651
849
707
Shrawan Bhadra Ashwin Kartik Manshir Poush Magh Falgun Chaitra Baishak Jestha Ashad
Monthly trend of worm infestation 2068/069
Male Female