Use of ORS & Zinc for diarrhoea management and biannual deworming to control STH.

1. ASSESSMENT,
CLASSIFICATION &
MANAGEMENT OF DIARRHEA
Dr. Priyakshi
Borkotoky
Guwahati, Assam

2. Why It Is Important To Know About Diarrhea
in children
 Proportion of water is more in children ,so dehydration occur early.
 Child can loose 5ml-200 ml liquid in 24 hrs
 Metabolic rate is high and use more water as compared to adults
 Kidney can conserve less water ,so loss is more
 Sodium loss can be 70-110 m mol/kg

3. Diarrhea is a condition in which characterized by-
1. Unusual frequency of bowel movements (more
than 3 times a day).
2. Changes in the amount
3. Change in consistency( liquid stool)
( when the bowl takes the shape of a container )

4. 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.
 Persistent Diarrhea means diarrhea for more than 14 days.
 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.

5. High risk groups
 Young age groups
 Immune deficient children/ individuals
 Measles experienced children
 Child suffering from malnutrition
 Travel to endemic areas
 Lack of breast feeding
 Exposure to unsanitary conditions
 Poor maternal education

6. What is not diarrhea?
 Frequent passing of normal stools, that is not diarrhea
 Exclusively breastfed babies often pass soft stools,
that is not diarrhea
 Young infants may pass stool after each feed which is
due to gastro colic reflex, that is not diarrhea.

7. Does the child have diarrhea?
If yes, ask:
 For how long?
 How many?
 Has the child been vomiting?
 Is there blood in stool?
ASK

8. Look And Feel:
Look at the child’s general condition. Is
the child:
 Lethargic or unconscious?
 Restless and irritable?
Look for sunken eyes.
Offer the child fluid. Is the child:
 Not able to drink or drinking poorly?
 Drinking eagerly, thirsty?

11. Children with signs of severe dehydration should
Children with severe persistent diarrhea should
Children with dysentery should be treated with
Children with some dehydration should be
be referred to hospital.
be referred to hospital.
medicine at home
rehydrated with ORS.
Action

13. Other useful drinks
 Breast Milk
 Yoghurt drink
 Lemon drink Coffee
 Rice, Water
 ‘Dal’ (lentil/ Mung)
 Vegetable soup
 Fresh Fruit Juice (unsweetened)
 Plain clean water
Prepared ORS
may be kept for 24
hours for use,
after that please
discard the
solution.
ORS has life saving action in Diarrhea

14. Dose of zinc
 ½ tablet per day (10 mg) for children 2 Months up to 6 months: to be
dissolved in breast milk 1 tablet per day (20 mg) for children
 6 months: to be dissolved in breast milk or plain water.
 Older child can chew it directly
Duration of use
Start as soon as the diarrhea begins i.e. from the first day and give for 14 days
irrespective of when the child recovers.
Why should zinc be given for 14 days
 It will replenish the zinc lost through stools
 Improves appetite and weight gain
 Prevents diarrhea and pneumonia over the next 2 months
 Acts as a tonic after recovery from diarrhea

15. Can I give Zinc and ORS at the same time?

16. Can Zinc be added directly to the
ORS?

17. Should I give less ORS since I am
giving Zinc?

18. Why are Zinc tablets recommended after the diarrhea episode
has stopped?

19. If my child vomits the Zinc should I give
another one?

20. What are the side effects of Zinc
supplementation?

21. Should I get an antibiotic for the diarrhoea?
The only specific clinical indications for use of
antimicrobial agents are:
Cholera
Bloody diarrhea
Associated non-gastrointestinal infections e.g.
pneumonia, septicemia, meningitis, urinary tract
infection, etc.
But this to be done by doctor

22. Should I feed my child as
usual?

23. Does breast milk cause
diarrhoea?

24. Can I still give my child
milk?

26. Combating Worm Infestation

27. About STH:
Helminths (worms) which are transmitted through soil contaminated with faecal matter are called
soil-transmitted helminths (Intestinal parasitic worms). Roundworm (Ascaris lumbricoides),
whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale)
are worms that infect people.
STH transmission:
•Adult worms live in human intestines for food and survival and produce thousands of eggs each day.
•Eggs are passed in the faeces of infected person.
•Infected people who defecate outdoors spread worm eggs in the soil.
•Eggs contaminate the soil and spread infection in several ways: ─
•Ingested through vegetables that are not carefully cooked, washed or peeled;
•ingested from contaminated water sources;
•ingested by children who play in soil and then put their hands in their mouths without washing them.

28. It can lead to anemia, malnutrition, impaired mental and physical &
cognitive development, and reduced school participation.

30. STH Infections can be prevented by:
● Regular Deworming
● Using sanitary toilets, not defecating outside
● Hand-washing, particularly before eating and after using toilets
● Wearing slippers and shoes
● Washing fruits and vegetables in safe and clean water
●Eating properly cooked food

31. Thank you