Prevention and Control of
Diarrhoea
Diarrhoea
• Passage of loose watery stool for more than 3
times a day
• Change in frequency and consistency of the stool
• Age group of 6 month -5 year
Countries with largest burden of Pneumonia and Diarrhoea
760000 Diarrhoea Deaths
Incidence is higher in lesser
developed region
India’s contribution to global burden
24%
26%
19%
18% 20%
17%
Total Child Maternal Newborn Pneumonia Diarrhea
Population Births Deaths Deaths Deaths Deaths
Source: Global burden of disease 2013
Causes of under five deaths
45%
Malnutrition
Diarrhea is common in
malnourished children.
Also repeated diarrheal
episodes result in weight
loss and malnutrition.
Estimation of Mortality : Diarrhea
Per year 1,40,451
Per Month 11,704
Per day 385
Per hour 16
31,587 97,828 25,445 78,806
9,926
Death per 1000 LB 5.4
43.959 36,202 9,297
12,416 10,225
9,554 34,382 22,344 6,160 27,696 18,401
Severe Episode 11,219 6.8 million annually
12,587
9,038
10,366
14,092 9,085
Total episode 321 million annually
8,683
6,596 14.5
13.3
12.6
Incidence Episodes 2.44 2,897 6,640 8.1
per child per year 5.9
4.9
Based on (i) Lancet 2010, Vol 376 (rate per 1000 live births) and (ii) SRS 2013
More in Socio-economically poor families
Silent tragedies
that can be
prevented
By simple intervention
significant death can be averted
Estimated U5 deaths that can be prevented with universal coverage of services
Serial No Preventive Interventions Proportion of all deaths (%)
1 Breastfeeding 13%
2 Oral re-hydration therapy 15%
3 Insecticide treated material 6%
4 Complementary feeding 7%
5 Zinc bundling along with ORS 5%
6 Hib Vaccine 4
7 Antibiotics for sepsis 6
8 Antibiotics for Pneumonia 6
9 Use of anti malarial drug 5
10 New born resuscitation along with 4
temperature management
11 Measles Vaccine 1
12 Water/Sanitation / Hygiene 3
Integrated Approach for Diarrhea Control as per GAPPD
PROTECT PREVENT TREAT
Classification
Type Particular Causative agent
Acute Watery • Lasts for several hours to day • V. Cholerae
diarrhoea •Dehydration , weight loss •E coli bacteria
•Rota virus
Acute Bloody • Also called dysentery •Shigella bacteria
diarrhoea •Damage of intestinal mucosa,
sepsis and malnutrition
•Visible blood in the stool
Persistent • Lasts for more than 14 days • Any systemic infection for
diarrhoea • Malnutrition , non intestinal which diarrhoea is associated
infection, dehydration (20%)
Diarrhoea with • Systemic infection • Systemic infection
severe •Malnutrition
Malnutrition •Dehydration
•Heart failure
Assessment of Diarrhoea cases
• Based on duration of episode of diarrhoea
• Consistency and content of the stool
• Condition of the child
• General condition like consciousness / lethargic
• Sunken eye
• Refusal to take water or milk
• Elasticity of the skin (pinch of the skin goes back slowly/very
slowly )
• Assessment of dehydration
• Indication for Hospitalisation
• Severe dehydration
• Severe Malnutrition
• Associated disease or co morbidity
Plan of Treatment of
dehydration
• No Dehydration: PLAN-A
• Some Dehydration: PLAN-B
• Severe Dehydration: PLAN-C
PLAN – A for NO Dehydration
Extra Fluid
PLAN – B for SOME Dehydration
• In OPD
• Treat ‘some’ dehydration with ORS
PLAN – C for SEVERE Dehydration
• Start I.V. Fluid immediately at the facility
• Give 100 ml/kg of Ringer’s Lactate
Age First give Then give
30ml/kg in 70 ml/kg in
Under 12 months 1 hour 5 hours
12 months and ½ hour 2½ hour
older
Which IV Fluids
• Ringer Lactate – preferred
• Normal saline may be used if RL is not
available
• Plain Dextrose Solutions should NOT be used
as it does not correct dehydration
ORS Composition
Content Low Osmolar ORS Old ORS
Glucose 13.5 gm 20 gm
Sodium Chloride 2.6 gm 3.5 gm
Potassium 1.5 gm 1.5 gm
Tri Sodium Citrate 2.9 gm 2.9 gm
Osmolarity 245 Osmol/l 311 Osmol/l
Give extra fluid
• AMOUNT OF FLUID TO GIVE IN ADDITION TO
THE USUAL FLUID INTAKE:
Up to 2 years: 50 to 100 ml after each loose stool.
>2 years :100 to 200 ml after each loose stool.
• Continue to give extra fluid until diarrhea stops
Zn supplementation
Age Dose Mode
2 month -6 month 10 mg/day/14 days Half tablet in breast milk
/water
6 month -60 month 20 mg/day/14 days Full tablet in Breast milk
or water
• Available with combo pack along with ORS
• Strip of 14 tablets which is dispersible and of 20 mg
• Combination of ORS and Zn is called DTK
(Diarrhoea treatment kit )
Thank you