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Respiratory Infections, Diarrhea and Influenza

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Presentation on theme: "Respiratory Infections, Diarrhea and Influenza"— Presentation transcript:

1 Respiratory Infections, Diarrhea and Influenza
DIARRHEAL DISEASES Dr. Detels - Epi Feb 2014

2 Respiratory Infections, Diarrhea and Influenza
Top Ten Causes of Deaths in Low-Income Countries Dr. Detels - Epi Feb 2014

3 Respiratory Infections, Diarrhea and Influenza
Top Ten Causes of Deaths World-Wide Dr. Detels - Epi Feb 2014

4 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Importance of Diarrhea According to the World Health Organization, the incidence of diarrheal diseases (2,533 million cases) topped all other diseases in the Southeast Asian (SEARO) and Western Pacific (WPRO) regions in 2004, accounting for million disability-adjusted life years (DALYS) - 4.8% of all DALYS worldwide due to both infectious and non-infectious diseases Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 4

5 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Importance of Diarrheal Diseases According to the World Health Organization in 2005, 1.8 million people died of diarrheal diseases, nearly 70% of whom were young children Worldwide, diarrheal diseases are the third leading cause of mortality and morbidity (exceeded only by lower respiratory infections and cardiovascular diseases) Globally there were 1.7 billion cases of diarrhea in 2013 Diarrhea is a leading cause of malnutrition in children younger than 5 years Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 5

6 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza WATER TRUMPS OIL Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 6

7 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza "Next to oxygen, water is indisputably the most precious resource we have, and the shortage of freshwater is the biggest long-term problem facing the planet Earth. Even energy is a distant second--with energy, we have alternatives. With water there are none." Gil Grosvenor, chairman of the National Geographic Society World Water Day event focuses on growing thirst. National Geographic 2010 Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 7

8 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza The burden of thirst. National Geographic 2010 Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 8

9 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza The burden of thirst. National Geographic 2010 Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 9

10 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Water Sources and Usage Nearly 97% of the planet's water is salt water in seas and oceans Close to 2% of Earth's water is frozen in polar ice sheets and glaciers Only a fraction of 1% is available for drinking, irrigation, and industrial use Agriculture accounts for 70% of all water use Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 10

11 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Lack of Clean Water and Safe Waste Disposal The average American uses a hundred gallons of water at home every day In developing countries, nearly one billion people worldwide have no access to clean water 2.5 billion people (40% of world’s population) have no safe way to dispose of human waste Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 11

12 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Dirty Water and Lack of Hygiene Dirty water and lack of a toilet and proper hygiene kill 3.3 million people around the world annually, most of them children under age five Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 12

13 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Reasons for Lack of Clean Water Climate (drought, deforestation, climate changes) and dropping water tables worldwide (unsustainable rate of water use) Poverty (inability to build wells or to afford piped water or water purification tablets if available) Rural dwellers- remote, sparsely populated, drought-stricken villages of the world are least likely to be reached for water provision, education, etc. Pollution Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 13

14 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Steps to Reduce Waterborne Diseases Safe disposal of human waste (latrines) Hand washing Education about sanitation Piped, treated water Food safety Clasen T, Sugden S. Water and sanitation. Oxford Textbook of Public Health, 5th ed. Oxford Press, England. Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 14

15 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Politics of Water The United Nation's General Assembly voted to make water a basic human right. But 41 countries, including the United States, opted out, saying they were waiting for more data! Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 15

16 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Dr. Detels - Epi Feb 2014 Detels - Intervention - 5 December 2012 16

17 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Dr. Detels - Epi Feb 2014 Detels - Intervention - 5 December 2012 17

18 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Dr. Detels - Epi Feb 2014 Detels - Intervention - 5 December 2012 18

19 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Dr. Detels - Epi Feb 2014 Detels - Intervention - 5 December 2012 19

20 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Dr. Detels - Epi Feb 2014 Detels - Intervention - 5 December 2012 20

21 Respiratory Infections, Diarrhea and Influenza
International Health/Intervention Strategies Respiratory Infections, Diarrhea and Influenza Characteristics of Diarrheal Diseases Oral-fecal route of infection (contaminated water and food) Leads to rapid dehydration and inability to absorb nutrients from food; survivors may have impaired growth and development, malnutrition, long-term GI disorders, reduced immunity Detels - Intervention - 5 December 2012 Dr. Detels - Epi Feb 2014 21

22 Respiratory Infections, Diarrhea and Influenza
Diarrhea Incidence Dr. Detels - Epi Feb 2014

23 COMMON CAUSES OF DIARRHEA (1)
Respiratory Infections, Diarrhea and Influenza COMMON CAUSES OF DIARRHEA (1) Bacteria Escherichia coli Salmonella (S. typhii, etc.) Shigella (S. flexinari , dysenteria, sonnei, etc.) Campylobacter Vibrio cholerae Dr. Detels - Epi Feb 2014

24 COMMON CAUSES OF DIARRHEA (2)
Respiratory Infections, Diarrhea and Influenza COMMON CAUSES OF DIARRHEA (2) Viruses Rotavirus Protozoa Giardia lamblia Cryptosporidium parvum Entamoeba histolytica Cyclospora cayetanensis Dr. Detels - Epi Feb 2014

25 Respiratory Infections, Diarrhea and Influenza
IMPACT OF DIARRHEAL AGENTS ON GUT Directly pathogenic organism Production of toxin by specific organisms Disruption of gut mucosa and gut function Overcome commensal (good) gut organisms Inflammation of gut mucosa Dr. Detels - Epi Feb 2014

26 Respiratory Infections, Diarrhea and Influenza
TRANSMISSION ROUTES Direct: fecal-oral Indirect: Water (e.g. V. cholerae, Norwalk virus) Food (e.g., salmonella, campylobacter, E. coli, O157:H7) Eating utensils (e.g., baby bottles, nipples, cups, spoons) Animals (e.g., C. jejuni, C. perfringens, E. coli, O157:H7) Flies (carrier, ingested – Shigella) Poor hygiene (inadequate/infrequent hand washing and non-hygienic feces disposal Promiscuous drug use – overtreatment of humans and antibiotics in animal feed promotes drug resistance Dr. Detels - Epi Feb 2014

27 Respiratory Infections, Diarrhea and Influenza
Dr. Detels - Epi Feb 2014

28 Respiratory Infections, Diarrhea and Influenza
Dr. Detels - Epi Feb 2014

29 HOST RISK FACTORS FOR DIARRHEA
Respiratory Infections, Diarrhea and Influenza HOST RISK FACTORS FOR DIARRHEA Malnutrition (up to 70% increased risk) Micronutrient deficiency (e.g. vitamin A and zinc) Low gastric acid/hypochlorhydria (H. pylori) Reduced gastric acid acidity (e.g. associated with some medications) Compromised cell-mediated immune capacity/response Genetic profile (e.g., blood group O increases susceptibility to V. cholerae) Dr. Detels - Epi Feb 2014

30 COMMUNITY STRATEGIES TO REDUCE DIARRHEA
Respiratory Infections, Diarrhea and Influenza COMMUNITY STRATEGIES TO REDUCE DIARRHEA Promotion of breast feeding and better weaning practices Safe water provision and waste disposal Promotion of hand washing Measles vaccination Cholera vaccination in high risk areas Zinc and vitamin A supplementation Rotavirus vaccination: Rota Teq, Rotarix Dr. Detels - Epi Feb 2014

31 Prevention of Diarrheal Diseases
Respiratory Infections, Diarrhea and Influenza Prevention of Diarrheal Diseases Provision of accessible clean water Safe disposal of waste (sanitation) Education of mothers Making home treatment and storage of water inexpensive and feasible Provision of latrines Promotion of hand-washing and personal hygiene Reduce fly population Promotion of breastfeeding and proper weaning POLITICAL WILL MONEY Dr. Detels - Epi Feb 2014

32 TREATMENT OF ACUTE DIARRHEA
Respiratory Infections, Diarrhea and Influenza TREATMENT OF ACUTE DIARRHEA Oral rehydration Appropriate energy (food) intake Zinc supplementation for days Referral to health facility if not improving on above regimen Antibiotics (dysentery, typhoid fever, cholera only) Intravenous saline (severe cases only) Dr. Detels - Epi Feb 2014

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