Diarrhoea is a major health problem for children in India, responsible for 13% of under-5 deaths annually. It is usually caused by viral, parasitic or bacterial infections spread through contaminated food, water or poor hygiene. Types include acute diarrhoea lasting less than 14 days, persistent diarrhoea over 14 days, and dysentery with blood in stool. Assessment involves checking for dehydration signs like lethargy, sunken eyes, and slow skin pinch response. Oral rehydration therapy with ORS and continued feeding is the primary treatment, along with zinc supplementation. National programs promote awareness and distribution of ORS and zinc. Rotavirus vaccination and improved sanitation, water and hygiene

1. DIARRHOEA
MAYURDEEP BORA
MPH 1ST YEAR
CMCVELLORE
A MAJOR HEALTH PROBLEM OF CHILDREN

2. • Diarrhoea is defined as the passage of three or more loose or liquid
stools per day (or more frequent passage than is normal for the
individual).
• Frequent passing of formed stools is not diarrhoea, nor is the passing
of loose, "pasty" stools by breastfed babies.
• It is usually the symptom of gastrointestinal infection, which can be
caused by a variety of viral, parasitic and bacteria organisms.
• Infection is spread through contaminated food or drinking-water or from
person to person as a result of poor hygiene.
DIARRHOEA DEFINITION

4. • Types of diarrhoea in young infants (0-2 months age)
• A young infant has diarrhoea if the stools have changed from the usual pattern, and are
many and watery. This means more water than fecal matter. The normally frequent or
semi - solid stools of a breastfed baby are not diarrhoea.
• Type of Diarrhoea in children
1.ACUTE DIARRHOEA - Is an episode of diarrhoea that lasts less than 14 days. Acute
watery diarrhoea causes dehydration and contributes to malnutrition. The death of a child
with acute diarrhoea is usually due to dehydration.
2.PERSISTENT DIARRHOEA - If an episode of diarrhoea that lasts for 14 days or more.
(Up to 20% of episodes of diarrhoea become persistent, and this often causes nutritional
problems and contributes to death in children)
3.DYSENTERY - Diarrhoea with blood in the stool, with or without mucus. The most
common cause of dysentery is Shigella bacteria. Amoebic dysentery is not common in
young children. A child may have both watery diarrhoea and dysentery.
TYPES OF DIARRHOEA

5. ASSESSING DIARRHOEA
LOOK : ATTHE CHILD’S GENERAL CONDITION
o If the child is lethargic or unconscious, s/ he has a general danger sign. A child is classified as restless
and irritable if s/he is restless and irritable all the time or every time s/he is touched and handled. If
an infant or child is calm when breastfeeding but again restless and irritable when he stops
breastfeeding, s/he has the sign restless and irritable. Many children are upset just because they are
in the health facility. Usually these children can be consoled and calmed, and do not have this sign.
• For the young infant : watch the infant’s movement. Does he move on his own? Does the infant only
move when stimulated, but then stops? Is the infant restless and irritable?
LOOK FOR SUNKEN EYES
o The eyes of a child who is dehydrated may look sunken.
LOOK:TO SEE HOWTHE CHILD DRINKS (only in children 2 months to 5 years age)
o A child is not able to drink if he is not able to suck or swallow when offered a drink. A child may not
be able to drink because he is lethargic or unconscious.
FEEL: BY PINCHING THE SKIN OFTHE ABDOMEN
o This skin pinch tests is an important tool for testing dehydration. When a child is dehydrated, the
skin loses elasticity. To assess dehydration using the skin pinch

6. DEHYDRATION ASSESMENT
1. SEVERE DEHYDRATION (RED) - If the child has two or more of the following signs: lethargic or unconscious, not
able to drink or drinking poorly (not in children less than two months), sunken eyes, or very slow skin pinch.
• ACTION - Any child with dehydration needs extra fluids. A child classified with SEVERE DEHYDRATION
needs fluids quickly. Treat with IV (intravenous) fluids.
2. SOME DEHYDRATION (YELLOW) - if the child has two or more of the following signs: restless and irritable, not
able to drink or drinking poorly (not in children less than two months), sunken eyes, or very slow skin pinch.
• ACTION - A child who has SOME DEHYDRATION needs ORS , foods and Zinc supplements. Treat the child
with ORS solution and Zinc supplementation. In addition to ORS, the child with SOME DEHYDRATION
needs food. Breastfed children should continue breastfeeding. Other children should receive their usual
milk or some nutritious food after 4 hours of treatment with ORS.
3. NO DEHYDRATION (GREEN) - A child who does not have enough signs to classify as dehydration is classified as
having NO DEHYDRATION. This child needs extra fluid and foods to prevent dehydration.

7. BURDEN
• Diarrhea is the third leading cause of childhood mortality in India,
and is responsible for 13% of all deaths/year in children under 5
years of age killing an estimated 300,000 children in India each
year.
• Globally, four billion episodes of diarrhea
were estimated to occur each year, with >
90% occurring in developing countries.
• Diarrheal disease is an important public
health problem among under-five children in
developing countries.

8. The number of diarrhea deaths and mortality rate (per 100,000 population)
Age Sex Number of Deaths Mortality Rate
All Ages Male 230,468.8 32.31
All Ages Female 401,876 59.31
All Ages Both 632,344.7 45.46
Under 5 Male 22,392.69 36.53
Under 5 Female 32,916.93 59.01
Under 5 Both 55,309.61 47.24
5–14 years Male 6742.824 4.97
5–14 years Female 9609.717 7.77
5–14 years Both 16,352.54 6.31

9. At the national level, the prevalence of diarrhoea has been reported of
9.2%. About 9.5% of male children and 8.9% of female children are
living with diarrhoea disease.
Eight states/UTs have shown more than the national average of diarrhoea
prevalence.
Highest Prevalent States Lowest Prevalent States
Uttarakhand (17.1%) Sikkim (1.8%)
Uttar Pradesh (15%) Assam (2.9%)
Puducherry (11.3%) Kerala (3.4%)
Meghalaya (10.6%)
Among male child the prevalence of diarrhoea varies from 1.8% (Sikkim) to
17.5% (Uttarakhand).
Contrastingly, among female the range is from 0.5% (Sikkim) to 16.5%
(Uttarakhand).
Reference - https://www.sciencedirect.com/science/article/pii/S2213398421001214
PREVALANCE

10. RISK FACTORS
• Environmental factors include unsafe water,
sanitation, and handwashing; and air
pollution (i.e., ambient particulate matter
pollution and household air pollution from
solid fuels).
• Behavioral factors include suboptimal
breastfeeding; malnutrition; vitamin A
deficiency.
• Major risk factors of diarrhea-related child
mortality are unsafe water sources followed
by child wasting and unsafe sanitation.
• It is shown that the under-5 diarrhea-
specific mortality rate is 43 (95% uncertainty
interval: 30–59) due to unsafe water,
sanitation, and handwashing factors.

11. PATHOGEN
• The most prevalent disease-causing pathogen
is found to be Campylobacter.
• In India Adenovirus is the major
contributor to childhood diarrheal deaths.
• Literature from all over the world suggests
Rotavirus being the major cause of
childhood diarrhea, the number of deaths
associated with it among the children under
5 years is highest.
• These deaths can be reduced by promoting
and implementing the rotavirus vaccine in
the country. Route :- Faeco-Oral

12. MANAGEMENT AND INTERVENTIONS
• Ministry of Health and Family Welfare, Government of India,
recommend low osmolarity oral rehydration salt solution (ORS),
zinc and continued feeding of energy dense feeds in addition to
breastfeeding.
• Oral rehydration therapy (ORT) with ORS remains the
cornerstone of appropriate case management of diarrheal
dehydration and is considered the single most effective strategy to
prevent diarrheal deaths in children.
• Knowledge of ORS/ORT among mothers of under-five children in
India is good (73%), but there is a big gap between knowledge and
practice as reflected in poor ORS usage rates (43%).

13. • Zinc supplementation (10 mg of elemental zinc for 14 days for
children aged 2-6 months and 20 mg/day for older children) has the
potential to reduce morbidity and mortality by reducing the duration
and severity of diarrheal episodes and lowering their incidence.
• It is distributed under the National Health Mission (NHM)

14. NATIONAL PROGRAM
• Health Ministry has launched Intensified Diarrhoea Control Fortnight (IDCF)
program under NHM.
• Aim of this program is to increase awareness about use of ORS and Zinc in
diarrhoea at state, district and village levels.
• Nearly 12 crore under 5 children are covered in this program.
• IDCF is being observed during pre-monsoon/ monsoon seasons, with the aim of
zero child deaths due to diarrhoea, since 2014.
• ASHA workers distribute ORS packs to household of U5 children in the village.
• ORS-Zinc corners set ups at health care facilities, schools and anganwadis under
this.
• There has been consistent decline in IMR and U5MR after implementation of the
programme.

15. Routine Immunization Strengthening
• 1. Mission Indradhanush - •To increase the rate of increase of full
immunization coverage, Government of India launched Mission
Indradhanush in December 2014 with an aim to increase the full
immunization coverage to at least 90% by 2020, which was preponed to
2018.
• 2. Intensified Mission Indradhanush • During the review of Mission
Indradhanush in Pro-Active Governance andTimely Implementation
(PRAGATI) meeting on 26th April, 2017, directions were received to achieve
the goal under the mission by December, 2018

16. Rotavirus vaccine (RVV)
• RVV has been introduced to reduce mortality and morbidity caused by
Rotavirus diarrhoea.
• Presently, the vaccine has been introduced in 11 States viz. Andhra Pradesh,
Assam, Haryana, Himachal Pradesh, Madhya Pradesh, Odisha, Tripura,
Rajasthan, Tamil Nadu , Jharkhand and Uttar Pradesh through domestic
funds.
• Till February, 2019, around 4.14 crore doses of Rotavirus vaccine have been
administered to children in above mentioned States since its introduction.
• Rotavirus vaccine is being expanded to the entire country by end of the year
2019.

17. TYPES AND DOSAGE OF RVV
• There are 3 types of Rota Virus Vaccine that are given-
1. Oral Rotavirus vaccine (Rotavac) was introduced in the universal
immunization program in India in 2016.
It is administered to infants in a three-dose course at the ages of 6, 10 and 14
weeks.
2. RotaTeq® (RV5) is given in 3 doses at ages 2 months, 4 months, and 6
months
3. Rotarix® (RV1) is given in 2 doses at ages 2 months and 4 months

19. Reference
• https://www.sciencedirect.com/science/article/pii/S2213398421001214
• 04 ChapterAN2018-19 NHM Annual Report on Child Health
• https://immunizeindia.org/content/rotavirus-
vaccination/#:~:text=The%20rotavirus%20vaccine%20is%20very,vaccine%20safel
y%20during%20routine%20use.

20. THANK YOU