Presentation on theme: "EPIDEMIOLOGY AND CONTROL OF ACUTE DIARRHEAL DISEASES"— Presentation transcript:
1 EPIDEMIOLOGY AND CONTROL OF ACUTE DIARRHEAL DISEASES Dr. Anish KhannaAssociate ProfessorDepartment of Community Medicine and Public Health K.G.M.U, Lucknow.
2 Diarrhoea is the passage of loose, liquid or watery stool. WHAT IS DIARRHOEA?Diarrhoea is the passage of loose, liquid or watery stool.In many regions Diarrhoea is defined as passage of three or more loose or watery stools in 24 hour period.However it is the recent change in consistency and character of stool than the number of stools that is more important.In most cases the mother knows what is abnormal stool for her child.It is a killer disease in children.One in four deaths in children under the age of 5yrs. is due to diarrhoea.
3 WHAT CAUSES DIARRHOEA? Infectious Disease Agents Causing Diarrhoea. BACTERIAEscherichia coliIt produces heat labile (LT) and heat stable (ST) entertoxins.E.COLI - COULD BEEnteropathogenic- Causes infantile diarrhoea.Entero toxigenic – Causes travellers diarrhoea.Enteroinvasive- Dysentery type of diarrhoea.EnteroadherentEnterohaemorrhagicVIBRIO CHOLERAE- produces enterotoxinsVibrio para haemolyticus- Invasive.Non-Cholerae vibrios
4 WHAT CAUSES DIARRHOEA? Infectious Disease Agents SHIGELLAE–Invasive, produce bloody diarrhoea or Dysentery.CAMPYLOBACTER JEJUNI – invasive.SALMONELLAE OTHER THAN S.TYPHI- invasive.STAPHYLOCOCCUS AUREUS- entrotoxinsCLOSTRIDIUM PERFRINGENS- enterotoxins.3. VIRUSESRotavirus – invasive.4. PARASITESE. histolytica- invasive.Giardia Lamblia- non invasive.
5 WHAT IS THE MAGNITUDE OF THE PROBLEM? WORLD WIDE?IN INDIA?NFHS- 2 data highlights morbidity profile of under 3 yrs.Fever- (27%)A.R.I. - (17%)Diarrhoea – (13%)Under Wt. (43%)Often due to a combination of these conditions.Diarrhoeal diseases are a major public health problem among children under 5yrs. of age.Around 8-11 million cases are being reported annually in India.
6 WHAT IS THE EPIDEMIOLOGY OF DAIRRHOEAL DISEASES? RISK FACTORS OR DETERMINANTSAGENT FACTORSHOST FACTORSENVIRONMENTAL FACTORSRESERVOIR OF INFECTION.
7 HOW MANY TYPES OF DIARRHOEA ARE THERE? ACUTE WATERY DIARRHOEA.DYSENTRY (BLOOD IN STOOLS).PERSISTENT DIARRHOEA.
8 HOW SHOULD ACUTE WATERY DIARRHOEA IN CHILDREN BE MANAGED? ASSESSMENT OF DEHYDRATIONDOES THE CHILD HAVE SIGNS OF DEHYDRATION?IS DEHYDRATION MILD OR SEVERE?
9 Degree of dehydration signs ASSESSMENT OF THE CHILD WITH DIARRHEA FOR THE DEGREE OF DEHYDRATION AND MANAGEMENTDegree of dehydration signsMildSeverea. Look forGeneral conditionEyesTears on cryMouth and tongueThirstRestless, irritableSunkenAbsentDryThirsty (drinks eagerly)Lethargic, floppy, unconscious,Deeply sunken and dryVery dryVery thirsty but (drinks poorly or unable to drink)b. Feel forSkin pinchGoes back slowly, takes 1 to 2 secondsGoes back very slowly, takes more than 2 secondsc. Decidethere is some dehydration.There is severe dehydration.d. TreatmentPlan BWith WHO recommended ORS solution to correct some dehydration.Plan CWith IV infusion urgently to correct severe dehydration and to prevent deathFluid deficit is5-10% of body weight> 10% of body weight
10 AFTER CLINICAL ASSESSMENT WHAT SHOULD BE DONE? LABORATORY INVESTIGATIONSFEEDING DURING DIARRHOEARATIONAL USE OF DRUGS# What is the role of anti Diarrhoeals?FLUID THERAPY
11 FLUID THERAPY IN DIARRHOEA WHAT IS THE PURPOSE OF FLUID THERAPY.APPROPRIATE FLUID THERAPY- ORSBasis of ORSWhat is the mechanism of action of ORS?OTHER FLUIDSHAF-SSS (Sugar salt solution)
12 WHAT SHOULD BE THE TREATMENT OF CASES OF ACUTE WATERY DIARRHOEA THREE CATEGORIES OF CASES.Cases with No Signs of dehydration- Plan-A.Cases with some signs of dehydration- Plan-BCases with severe dehydration-Plan -C
13 HOW CAN DIARRHOEA BE PREVENTED? PREVENTIVE STRATEGIES. Sanitation- Hand washing- Exclusive breast feeding- Clean foodEnvironmental sanitationElimination of ReservoirsBreaking the channel of transmissions
14 PREVENTION OF DIARRHOEA? ELIMINATION OF RESERVOIRSPrevention of dehydrationCorrection of dehydrationMaintenance of hydrationChemotherapyRestoration of Nutritional Status.Diarrhoea- Leads to malnutritionIncrease in Breast feeding frequencyIncrease in diet.
15 OTHER PREVENTIVE STRATEGIES? Vitamin –A prophylaxisImproved NutritionImmunizationMeasles immunizationROTA VIRUS VACCINETwo live oral attenuated rotavirus vaccines were licensedin Now there are three.Monovalent human rotavirus vaccine (Rotarix).The pentavalent bovine- Human reassortant vaccine(Rota Teq)They Provide 75-80% protection against rotavirus diarrhoeaand % protection against rotavirus disease.
16 WHAT ARE THE NATIONAL PROGRAMS FOR DIARRHOEA IN INDIA National diarrhoeal disease control program (NDDCP)Diarrhoeal disease control program started in 1978.1985 – 86 National Oral Rehydration Therapy ProgramCase management of diarrhoea by HAF & ORS.Improvement of maternal knowledge and practices with egard to HAF
17 Since CSSM Program became a part of RCH program in 1997, Integrated Management of Child hood Illness (IMCI) has been adopted in India.IMCI deals with all children not only sick childrenDiarrhoeaPneumoniaMeaslesMalariaHealth promotionImmunizationBreast feedingVit. A & Iron Supplementation
18 WHAT ARE THE REVISED GUIDELINES FOR MANAGEMENT OF DIARRHOEA? GOI & IAP (Indian Academy of Pediatrics)Low osmolarity ORSZinc (10mg Elemental Zinc for infants 2-6 month of age 20mg Zinc for children > 6 months for 14 days)Feeding of energy dense foods in addition to Breast feedingHAFHygieneAntimicrobials for gross blood in stools or shigella + culture.
19 MCQ’s in Diarrhoea 1. WHO ORS contains: A) Sodium Chloride 2.5 gm B) Potassium Chloride 1.5 gmC) Glucose 20 gmD) Sucrose 10 gmE) Potassium Bicarbonate 2.5 gmAns- B,C,E2. For controlling an outbreak of Cholera all of the following measures are recommended except:A) Mass chemoprophylaxisB) Proper disposal of excretaC) Chlorination of waterD) Early detection and management of casesAns- A
20 3. In ORS the concentration of sodium chloride is: A) 3.5 gmB) 2.5 gmC) 2.9 gmD) 1.5 gmAns- A4. Drug of choice for carriers of typhoid is:A) AmpicillinB) ChloramphenicolC) Co-TrimoxazoleD) Clindamycin
21 5. Typhoid oral vaccine is given: A) 1,3,5 daysB) 1,2,3 daysC) 1,2,4 daysD) 1,7,14 daysAns- A6. In WHO-ORS concentration of Sodium is:A) 60 mEq/lB) 50 mEq/lC) 40 mEq/lD) 90 mEq/lAns- D
22 7. True about citrate in ORS: A) NutritiousB) CheaperC) Increases shelf lifeD) TastierAns- C8. A convalescent case of Cholera remains infective for:A) less than 7 daysB) 7 to 14 daysC) 14 to 21 daysD) 21 to 28 days