2. INTRODUCTION
Its now obvious that some known and unknown
organism probably causes diarrhoea .
Regardless of the causative agents or age of patient; the
sheet anchor of treatment is oral rehydration therapy
such as the one advocated by WHO/ UNICEF.
3. DIARRHOEAL DISEASE CONTROL
PROGRAMME
The diarrhoel disease control programme was started in 1978
with the objective of reducing the mortality & morbidity
due to diarrohoeal diseases.
from 1992-1993 , the programme has become a part of
child survival & safe motherhood programme.
At present, it is a part of NRHM
4. COMPONENT OF A DIARRHOEAL
DISEASES CONTROL PROGRAMME
Short Term
Appropriate clinical management
Long Term
. Better MCH care practices
.preventive strategies
.preventing diarrhoeal epidemics
5. Appropriate clinical
management
1. ORAL REHYDRATION THERAPY
The main aim of oral fluid therapy is to prevent
dehydration and reduce mortality.
Oral fluid therapy is based on the observation that glucose
given orally enhances the intestinal absorption of salt and
water and is capable of correcting the electrolyte and water
deficit.
6. At 1st the composition of ORS ( oral rehydration salt )
recommended by WHO was sodium bicarbonate based
INCLUSION OF TRISODIUM CITRATE IN PLACE OF
SODIUM BICARBONATE
made product more stable
reduces stool output
increase intestinal absorption of sodium & water .
7. This ORS formulation focuses on reducing osmolarity of
ORS solution;
. to avoid adverse effects of hypertonicity on net fluid
absorption by reducing concentration of glucose and
sodium chloride in solution.
8. Reduce the sodium concentration of ORS solution to
75 mOsmol/ L ,improved the efficacy of ORS regimen
for children with acute non-cholera diarhoea.
Since January 2004 new ORS formulation is the only 1
procured by UNICEF .
INDIA was 1st country in world to launch ORS
formulation since JUNE 2004
10. How to access the dehydration
MILD SEVERE
PATIENT APPEARANCE THIRSTY, ALERT ,
RESTLESS
DROWSY, LIMP, COLD
,SWEATY, MAY BE
COMATOSE .
RADIAL PULSE NORMAL RATE &
VOLUME
RAPID , FEEBLE
,SOMETIMES
IMPALPABLE
BLOOD PRESSURE NORMAL <80mm Hg
SKIN ELASTICITY PINCH RETRACTS
IMMEDIATELY
PINCH RETRACTS VERY
SLOWLY
TONGUE MOIST VERY DRY
URINE FLOW NORMAL LITTLE/ NONE
ANTERIOR FONTANELLE NORMAL VERY SHRUKEN
% BODY WEIGHT LOSS 4-5% 10% Or MORE
11. GUIDELINES FOR ORAL REHYDRATION THERAPY
(FOR ALL AGES /DURING FIRST FOUR HOURS )
AGE Under
4
months
4-11
months
1-2 yrs. 2-4 yrs. 5-14 yrs. 15 yrs. or
over
WEIGHT
(KG)
UNDER
5
5-7.9 2-10.9 11-15.9 16-29.9 30 OR
OVER
ORS
SOLUTIO
N ( IN ml)
200-
400
400-
600
600-
800
800-
1200
1200-
2200
2200-
4000
Amt. of ORS sol.= wt. of child X 75 ml / kg
12. 2. INTRAVENOUS REHYDRATION
Intravenous infusion is usually required only for initial
rehydration of severely dehydration pt. who is in
shock or unable to drink . Such patients are best
transferred to nearest hospital or treatment Centre .
Solution recommended by WHO for intravenous
infusion are…….
1.RINGER LACTATION SOLUTION
Its also known as Hartmamm’s solution for injection. It is the
best commercially available solution . It supplies adequate
concentration of sodium and potassium arid the lactate
yields bicarbonate for correction of the acidosis.
13. 2.DIARRHOEAL TREATMENT SOLUTION ( DTS )
Recommended by WHO as ideal polyelectrolyte solution for
intravenous infusion . It contains in one litre
Sodium Acetate- 6.5g,
Sodium Chloride- 4g,
Potassium Chloride- 1g
Glucose- 10g.
Normal saline can also be given but its poorest fluid because it
will not correct the acidosis and will not replace the potassium
losses.
.
14. Plain glucose and dextrose solution should not be used as
they provide only water & glucose.
The initial rehydration should be fast until an easily palpable
pulse is present . Reasses the patient every 1-2 hours.
After infusing 1-2 litres of fluid , rehydration should be
carried out at a somewhat slower rate until pulse and blood
pressure return to normal.
It is most helpful to examine skin elasticity and pulse
strength ,both of which should be normal.
15. 3.MAINTENANCE THERAPY
After the sign of dehydration has been corrected
oral fluid should be used for maintenance therapy .
AMOUNT OF
DIARRHOEA
AMOUNT OF ORAL
FLUID
Mild diarrhoea
(not more than one stool every
2hrs or longer, or less than 5ml
stool per kg)
100 ml /kg body weight per day
until diarrhoea stops
Severe diarrhoea
(more than one stool every 2
hours, or more than 5 ml of
stool per kg per hour)
Replace stool losses volume for
volume , if not measurable give
10-15 ml/kg body weight per
hour
16. 4 . APPROPRIATE FEEDING
• Especially relevant for the exclusively breast-fed infants. If
the child is breast-fed , nursing should be pursued during
treatment with ORS solution.
• Non-breast-fed infants under age 6 months should be given
an additional 100-200 ml of clean water during the first four
hour ,when old ORS containing 90 mmol/L is given.
• But additional water is not given along with 75 mmol/L.
17. • Commercially carbonated beverages , commercial fruits
& sweetened tea should not be given as it causes osmotic
diarrhoea and hypernatraemia.
• Rice water ,unsalted soup ,yoghurt drinks , green
coconut water should be given.
18. 5 . Chemotherapy
• Drug of choice for cholera
DOXICYCLINE
TETRACYCLINE,
TMP-SMX
Drug of choice For diarrhoea due to shigella
ciprofloxacin.
As shigella resistant to ampicillin & TMP-SMX.
19. 6 . ZINC SUPPLEMENT
It reduces episodes duration and severity so recommended
by WHO & UNICEF
10 mg of Zn for infants under 6 months of age 20 mg
for children older than 6 months for 10-14 days
20. B. BETTER MCH CARE
PRACTICES .
a . Maturation nutrition
Improving prenatal nutrition will reduce the low birth weight
problem
Prenatal & postnatal nutrition will improve the quality of
beast milk .
21. b. child nutrition
. Promotion of Breast feeding
. Appropriate weaning practices
.Supplementary Feeding
.vitamin A supplementation
23. Sanitation
It emphasis on personal & domestics hygiene like hand washing
with soap before preparing food
before eating ,
before feeding a child,
after defecation ,
after cleaning a child who has defecated and
after disposing off a child’s stool .
24. Health Education
An important job of health worker is to prevent diarrhoea
by convincing and helping community members to adopt
and maintain preventive measures like breast feeding,
improved weaning ,
clean drinking,
use of plenty of water for hygiene,
use of latrine,
proper disposal of stools of young children etc.
25. IMMUNISATION
Immunization against measles is a potential intervention
for diarrhoea control.
Measles vaccine can prevent 25% of diarrhoeal deaths in
children under 5 yrs. of age
26. ROTAVIRUS VACCINE
There are two vaccines
ROTARIX –TM ( monovalent human rotavirus vaccine)
ROTA Teq-TM ( pentavelent bovine-human vaccine)
Rotarix-TM …… 2 -dose schedule to 2 -4 months aged
child
1 . DOSE - 6 weeks - 12 weeks
2 . DOSE - upto 16 weeks & no later than 24
weeks.
Rota Teq-TM……3 oral dose at ages 2,4,6 months.
27. FLY CONTROL
Flies breeding in association with human or
animal faeces should be controlled.
28. Control and prevention of
diarrhoeal epidemics
An intersectoral approach centered upon PHC involving
activities
in fields of water supply & excreta disposal ,communicable
disease control,
mother & child health ,
nutrition & health education is regarded as essential for
ultimate for ultimate control of diarrhoeal diseases.
