Acute diarrhoeal diseases are very common in all age groups. Especially in children below 5 years it is very common and if neglected it can be life threating. It is the second most leading cause of death in children below five years. According to WHO report, diarrhoea kills about more than five lakh children each year in below 5 years age group. Diarrhoea leads to malnutrition and malnutrition aggravates diarrhoea. This vicious cycle propagates in low socioeconomic status and in under privileged countries.
Diarrhea in children below 5 years
Rota viral disease is most prevalent among all causes of diarrhea in children. Among other causes are norwalk virus, astrovirus, adeno virus also very common. The bacterial causes are salmonella, shigella dysenteriae, campylobacter.
Diarrhea in adults
Diarrhoea in adults can be also bacterial, viral and parasitic. Bacteria causes can be E. Coli, shigella dysenteriae, salmonella, yersinia, vibrio cholerae, campylobacter. The viral causes can be HIV, isospora, cryptosporidium.
Dehydration types
Dehydration can be 3 types. No dehydration, some dehydration and severe dehydration. Only few episodes of diarrhoea with no change in composition of body fluids, feeding habits is no dehydration. In some dehydration, episode s of diarrhoea makes the child thirsty, urination decreased, child is irritable.
In severe dehydration, child is lethargic, unable to drink, no urination. Here only intravenous fluids are given.
Intensified Diarrhoea Control Fortnight(IDCF) in India
Intensified Diarrhoea Control Fortnight (IDCF) To increase awareness about the use of ORS and Zinc in diarrhoea, IDCF is observed during pre monsoon/monsoon with aim of zero child deaths due to childhood diarrhoea since 2014 in India. During the fortnight, the health workers visit the households of under five children creating community level awareness generation activities and distribute ORS packets to the families of under 5 children.
Diarrhoeal Disease Control Programme in India
The diarrhoeal disease control programme was started in 1978 with objective of reducing the morbidity and mortality. Now it has been part of National Health Mission.
Treatment of Diarrhoeal diseases
Oral rehydration therapy(ORT)
The standard WHO ORS is used for controlling the electrolyte imbalance.
The osmolality of the new WHO ORS is 245 mOsm/l. It contains the requisite electrolytes to be mixed with one litre of water. Glucose helps in absorption of sodium and water reducing their deficit. The new WHO ORS with sodium osmolarity of 75 is adopted worldwide since 2004. India was the first country to launch this ORS formulation since June 2004.
Zinc Supplementation
It reduces the episodes of severity and mortality in diarrhoea and it is recommended by WHO and UNICEF. The recommended dose of zinc for infants below 6 months is 10 mg and above 6 months is 20mg for a period of 10 to 14 days.
Intravenous fluids
The intravenous fluids of choice is ringer lactate.
Preventive Strategies to control Diarrhoeal diseases
1. Health Education
People should be aware of good sanitation practices. Hand washing practices should be practised to control infection. Surrounding areas should be kept neat and clean. Damp areas creating fly population should be filled and drainage system should be closed.
2. Breastfeeding practices
Exclusive breast feeding practices can significant ly reduce the morbidity and mortality. It protect s the newborn baby from outward infections. The factors present in breast milk prevent recurring diarrhoea and acute respiratory infections.
3. Vitamin A prophylaxis
Vitamin A maintain s epithelial integrity. It plays a great role in combating diarrhoea associated with measles.
4. Vaccination
Rotaviral diarrhoea is very common in children. It leads to significant morbidity and mortality in children. Rota viral vaccines given below 8 months. Usually three doses are given at one one month interval. It is given as two drops per orally. Measles vaccination can also prevent diarrhoea l mortality by around 25%.
5. Safe drinking water
Safe drinking water is a major way to prevent acute diarrhoeal diseases. Chlorination of public drinking water is one of the way of sanitising for safe drinking water. Especially in rural areas these measures should be undertaken to ensure prevention of diarrhoeal diseases.
