5. INRODUCTION
Every year more than 10 million children
die in developing countries before they
reach their fifth birthday.
7 in 10 of these deaths are due to acute
respiratory infections (mostly pneumonia) ,
diarrhoea, measles, malaria, or malnutrition
and often to a combination of these illness.
7. DEFINITION
Diarrhoea is defined as the passage of loose
,liquid or watery stools .These liquid stools
are usually passed more than three times a
day . However , it is the recent change in
consistency and character of stools rather
than the number of stools that is more
important.
10. 1. ACUTE WATERY DIARRHOEA:
It lasts several hours to
days , the main danger is dehydration
, weight loss also occurs if feeding is
not continued. The pathogens that
cause acute diarrhoea that include
v.cholera or E.coli
11. 2.ACUTE BLOODY DIARRHOEA:
It is also called as dysentry ,
this damages the intestinal mucosa ,
sepsis and malnutrition other
coomplications including dehydration
may also occur.
Marked as visible blood in stools
common cause of bloody diarrhoea is
shigella.
12. 3.PERSISTENT DIARRHOEA:
This lasts for 14 days or longer
the main danger is serious malnutrition
and serious non intestinal infection ,
dehydration may also occur.
15. EPIDEMIOLOGY
Acute diarrhoea is revealed in importance only
by respiratory infection , as a cause of
morbidity on a world wide scale.
When the WHO initiated the diarrhoeal
diseases control programme in 1980 ,
approximately 4.6 million children used to die in
each year of the dehydration caused by
diarrhoea.
During the year 2011 about 10.6 million
cases with 1223 deaths were reported
in India.
21. RESERVOIR OF INFECTION
Man is the reservoir for some enteric pathogens and thus most
transmission occurs from human factors.eg: E.coli, shigella.
Animals are important reservoir and transmission originates from
both human and animal faeces.
e.g.: campylobacter, salmonella.
22.
23. HOST FACTORS
Diarrhoea is the most common in children especially in
those between 6months and 2 years.
Incidence is highest in the age group 6-11 months, when
weaning occurs.
It is also common in babies under 6 months of age fed
on cow’s milk.
24. ENVIRONMENTAL FACTORS
In temperature climate, bacterial diarrhoea occur more
frequently during the warm season where as viral diarrhoea caused by
rotavirus peak during the winter.
25.
26. MODE OF TRANSMISSION
Diarrhoea in many countries are transmitted
primarily or exclusively by the faeco-oral route. Its transmission may
be water borne, food borne or direct transmission.
29. CONTROL OF DIARRHOEAL DISEASE
The diarrhoeal diseases control programme of WHO has since its
inception in 1980.
Components of a diarrhoeal disease control programme:
1. Short term:
a. Appropriate clinical management
2. Long term:
a. Better MCH care practices
b. Preventive strategies
c. Preventing diarrhoeal diseases
30. APPROPRIATE CLINICAL
MANAGEMENT
Oral rehydration therapy:
The aim of oral fluid therapy is to prevent dehydration
and reduce mortality. It has been proved that 90to 95 percent of all
cases of cholera and acute diarrhoea can be treated by oral fluids
alone.
31. Oral Rehydration therapy
To prevent dehydration and reduce mortality.
REDUCED OSMOLALITY ORS gms/liter
Sodium chloride
Glucose, anhydrous
Potassium chloride
Trisodium citrate, dehydrate
TOTAL WEIGHT IS
2.6
13.5
1.5
2.9
20.5
33. A simple mixture consisting of
Table salt 5gm
Sugar 20gm
dissolved in 1 litre of boiled drinking of water
which is safely used until the mixture is obtained.
PREPARATION OF ORS
34.
35. INTRAVENOUS REHYDRATION
The solutions recommended by WHO for intravenous infusions are :
Ringer’s lactate solution(Hartman's solution)
It can correct dehydration due to acute diarrhoea of all cases.
36. a. BETTER MCH CARE
PRACTCES
Maternal nutrition
Child nutrition
o Promotion of breast feeding
o Appropriate weaning practices
o Supplementary feeding
o Vitamin A supplementation.
37. b. PREVENTIVE STRATEGIES
• Immunization:
Immunization against measles is a
potential intervention for diarrhoeal
control.
when administered at the recommended
age, the measles vaccine can prevent up to
25 percent of diarrhoeal deaths in children
under 5 years of age.
Rotavirus vaccine.
38.
39. DIARRHOEAL DISEASE CONTROL
PROGRAMME IN INDIA
It was started in the year 1978
with the objective of reducing the
mortality and morbidity due to
diarrhoeal diseases. Since 1985-
1986 , with the inception of the
national oral rehydration therapy
programme.
40.
41. INTRODUCTION
cholera is an acute diarrhoeal disease
caused by v.cholera 01 and 0139 . Typical
cases are characterised by the sudden onset
of profuse , effortless , watery diarrhoea
followed by vomiting , rapid dehydration ,
muscular cramps and suppression of urine.
unless there is rapid replacement of fluid and
electrolytes , the case fatality may be as high
as 30 to 40 percent.
42.
43. DEFINITION
An infectious sometimes
fatal disease of the small
intestine caused by the
bacterium vibrio.cholera. It
is spread from contaminated
water and food and causes
severe diarrhoea , vomiting
and dehydration.
44. INCIDENCE
The number of cholera
cases reported to WHO continues to
risk for 2011 alone , a total cases of
589,854 cases were notified.
Cholera remains a global threat to
public health and a key indicator of
lack of social development.
45.
46. EPIDEMIOLOGICAL FEATURES
Cholera is both an epidemic and endemic
disease.
AGENT-vibrio cholera
HOST-
ENVIRONMENTAL
All ages and both gender FACTORS-poor
47. MODE OF TRANSMISSION
Transmission occurs from man to man
via
Faecally contaminated
Contaminated food and drinks
Direct contact.
51. CLINICAL FEATURES
The severity of cholera is dependant on
the rapidly and the duration of fluid loss.
it shows three stages:
1.stage of evacuation:
the onset is abrupt with profuse ,
painless, watery diarrhoea followed by
vomitting.The patient may pass as many as 40
stools in a day.
52. 2.Stage of collapse:
The patient soon passes into a stage
of collapse because of dehydration.
signs are:
sunken eyes
hollow cheeks
Scaphoid abdomen
Sub normal temperature
Washerman’s hand and feet
Absent pulse
2.
53. 3.Stage of recovery:
if death does not occur the patient
shows signs of clinical improvement.
B.p begins to raise, temperature returns to
normal ,and urine secretion is re-
established.
if anuria persists the patient may die of
renal failure. severe cholera occurs in 5 to
10 percent of cases.
54. LABORATORY DIAGNOSIS
Collection of stool
Collection of vomitus
Water
food samples
Transportation
Direct examination
Culture method
55. CONTROL OF CHOLERA
1.verification of the diagnosis:
confirmation of the diagnosis as early
as possible.
2.Notification:
Educate the vulnerable group regarding
the disease.
3.Early case finding:
an aggressive search for the cases
should be made in the community.
56. 4.Establishment of treatment centers:
The mild dehydrated patients
should be treated at home with ORS
.Severely dehydrated patients requiring
intravenous fluids.
5.Rehydration therapy:
mortality rate have been brought
down to less than by effective rehydration
therapy.
57. 6.Adjuncts to therapy:
antibiotics should be given as
soon as vomitting has stopped which is
usually after 3 to 4 hours of oral
rehydration.ex- fluoroquinolones ,
tetracycline , ampicilline.
7.sanitation measures:
o Water control
o Excreta disposal
o Food sanitation
o disinfection
58.
59. HEALTH EDUCATION
The effectiveness and
simplicity of oral rehydration
therapy.
Isolation and early notification.
Food hygiene practices.
Hand washing after defecation and
before eating.
60. DIARRHOEAL DISEASE CONTROL
PROGRAMME
The incidence of cholera cases and
deaths has decreased in recent years.
During the year 1980- 1981 strategy of
national cholera control programme termed
as diarrhoeal disease control programme.
main aim: To prevent death due to
dehydration.
