DIARRHOEA

PRESENTED BY :-
Simran aneja (132)
simranjeet singh(133)
Simranjeet kaur (134)
Sobia sandhu (135)
Sorav bansal(136)
Staphy (137)
Sukhmanjit kaur (138)
 INTRODUCTION
 Diarrhoea is defined as passage of unusually loose or
watery stools usually at least three times in a 24 hour
period. (WHO)

 However it is the consistency of the stools rather than

the number that is more important.

 Passage of even one large watery stool in young child is

diarrhoea.

 Frequent passage of normal stool is no diarrhoea.

 6-12 months of age are affected severely & account for
high mortality.
 Dehydration occurs when water & salts are not replaced
adequately -may lead to shock & death.
 Diarrhoea also produces under nutrition and growth
failure.
 Diarrhoeal disease constitute one of the important
“nutritional leak” in young children.
 Even a brief episode of diarrhoea leads to the loss of 1-2
% of body weight in children.
 MAGNITUDE OF THE PROBLEM:
 In developing countries, children under three years of
age experience on an average three episodes of diarrhoea
every year

 Each episode deprives the child of the nutrition

necessary for growth

 As a result, diarrhoea is a major cause of malnutrition,

and malnourished children are more likely to fall ill
from diarrhoea.
CLINICAL TYPES OF DIARRHOEA
Four clinical types of diarrhoea can be recognised,
each reflecting the basic underlying pathology and
altered physiology.these are:
 Acute watery diarrhoea

 Dysentery(acute bloody diarrhoea)

 Persistent diarrhoea

 Diarrhoea with severe malnutrition

 Acute watery diarrhoea
 Start suddenly ;last for several hours to days;
 Main danger is dehydration weight loss also occurs if
feeding is discontinued.
 Pathogens-V.cholerae,E.coli,rotavirus.

Acute bloody diarrhoea(dysentery)

 Diarrhoea with visible blood & mucus in the faeces.
 Also abdominal cramps, fever, anorexia and rapid weight
loss.
 Main danger is intestinal mucosal damage,sepsis and
malnutrition.
 Pathogen-shigella.
 Persistent Diarrhoea
 Diarrhoea which lasts for > 14 days
 Main danger is malnutrition and serious non intestinal
infections.Persons with diseases such as AIDS are more
likely to develop persistant diarrhoea.
Diarrhoea with severe malnutrition
(marasmus and kwashiorkor)
Main dangers are systemic infection,dehydration,heart
failure and mineral and vitamin deficiency.
Epidemiological determinants
A unique feature of epidemiology is to test and
identify the underlying causes (risk factors)of disease.
In developing countries diarrhoea is almost infectious
in origin.
The chain of infection can be shown as :
Agent factors
A wide variety of organisms had been discovered recently tha cause
acute diarrhoea such as rotavirus and campylobacter.
The various infections causing diarrhoea are

1.Viruses
Many diarrhoeal diseases are caused by viruses.These are:
 Rotaviruses
 Rotavirus first discovered in 1973 has emerged as a leading cause o
severe ,dehydrating diarrhoea in children aged <5 years globally.
 Rotavirus reinfection is common but primary infection is more
significant clinically.
 Rotaviruses are shed in very high concentrations in stools and
vomits of infected individual for many days.transmission occurs
mainly by faeco ora route,directly from person to personor
indirectly by contaminated fomites.
The other viruses that cause diarrhoea are as follows:
astroviruses,adenoviruses,calciviruses,enterviruses,coronaviruses
etc.
2.Bacterial causes
the most common bacteria that cause diarrhoea: Vibrio
cholerae,Salmonella,Shigella,Campylo-
bacter jejuni,E.coli etc
these bacteria produce a potent enterotoxin .
Enterotoxigenic E.Coli is important cause of acute
 watery diarrhoea in adults and children in
developing countries.ETEC does not invade bowel
mucosa but diarrhoea it causes is mediated by toxins.

Salmonella cause inflammation of the bowel

epithelium

Diarrhoea caused by salmonella and e. Coli are

Endemic diseases in India.

Shigella accounts for high rate of mortality due to

diarrhoeal diseases . The estimates suggest that 1
million deaths occur every year in children less than 5
years of age.
3.Parasites
 E. histolytica- Dysentery

 Giardia intestinalis

 Trichuriasis

 Cryptosporidium

 Intestinal worms

 1/3r causes can’t be pin pointed

 HOST FACTORS
These include :
1.AGE-diarrhoea is more common in children especially
between 6 months and 2 years.Incidence is highest in
age groups 6-11 months when weaning occurs .
2.Nutrition: diarrhoea is common in person with
malnutrition.malnutrition leads to infection and
infection to diarrhoea.
3.Other factors :poverty,prematurity,reduced gastric
acidity,immunodeficiencyand lack of personal
hygiene increase the risks of infection.
 ENVIRONMENTAL FACTORS
SEASONAL PATTERNS ;in temperate climates
bacterial diarrhoea occur more frequently during
warm season whereas viral diarrhoea during winter
season. In tropical seasons rotavirus diarrhoea
occurs throughout the year whereas bacterial
diarrhoea occur during the warmer rainy season.
MODES OF TRANSMISSION
Most of the pathogenic organisms are transmitted
exclusively by faecal oral route. faeco oral route may
be water borne ;food borne or direct transmission.
 RESERVOIR OF INFECTION
For the enteric pathogens there are 2 major reservoirs of
infection.these are:
1.MAN: eg enterotoxigenic E.coli,V.cholerae,E.histolytica
etc.
2.ANIMALS:eg campylobacter jejuni,salmonella etc.
 RISK FACTORS OF DIARRHOEA
 Bottle fed babies have more chances to develop
diarrhoea because of unclean bottles

 Flies can also bring germs to uncovered food

 Drinking contaminated water

 Unclean food, milk, unclean hands & unclean utensils

-Open defecation

-poor sanitation

-Improper handling of food

-Living in Congested areas

SIGNS OF DEHYDRATION(major
danger of diarrhoea)
 What is ORS ?
It is oral rehydration salt which enhances the intestinal
absorption of salt and water and is capable of correcting the
electrolyte and water deficit.

COMPOSITION-:

SALT grams/l
Sodium chloride 2.6
Glucose,anhydrous 13.5
Trisodium citrate 2.9
Potassium chloride 1.5
 Cases with No Signs of Dehydration
Plan A
 In early stages, when fluid loss is <5% of the body
weight, children may not show any clinical signs of
dehydration
 Plan A involves counselling the child's mother about
the 3 Rules of Home treatment.

 GIVE ORS (HOME MADE)

 CONTINUE FEEDING
 GIVE EXTRA FLUID (as much as the child will take)
 Cases with signs of Some Dehydration
(PLAN B)

 Children who have dehydration should be kept under

observation in the hospital/ health center for a few
hours and given prepared ORS solution during the
period
 The approximate amount of ORS required (in ml) can
also be calculated by multiplying the child’s weight
(in kg) × 75

 For infants who are not breastfed, also give 100-200

ml of clean water during this period.
Cases with signs of severe dehydration
Plan-C
 1% diarrhoea may develop severe dehydration.
 Children with severe dehydration must be admitted.
 Child is rehydrated quickly by using I/V infusion.
I/V infusions recommended :
 RINGER’s LACTATE SOLUTION
 DIARRHOEA TREATMENT SOLUTION (DTS)
AGE 30ml/Kg in 70ml/Kg in
Infants under 12 1 hour 5 hour
months

older 30 minutes 2 and half hour

 FEEDING IN DIARRHOEA
 Children should continue to be fed during diarrhoea.

 To make foods-energy dense some of preparation

are:-
- Khichri with oil
- Rice with curd & sugar
- Mashed banana with milk or curd
- Mashed potatoes with oil.

Breast feeding should be continued uninterrupted even

during rehydration with ORS.
Role of Probiotics

 The strongest evidence of a beneficial effect has

been for - Lactobacillus rhamnosus
 These probiotics are effective for both treatment and
prevention of acute diarrhoea caused mainly by
rotavirus in children
 Antibiotic associated diarrhoea has also been found
to respond when probiotics have been used as
prophylaxis and also for therapy
-Can inhibit the growth and adhesion of a wide range of
entero-pathogens
The most highlighted beneficial effect of probiotics has been
on acute diarrhoea caused by rotavirus in children
Recommendations for use of zinc in clinical management of acute diarrhoea:

20 mg per day of Zn supplementation for 14 days

starting as early as possible after onset of diarrhoea.

WHO and UNICEF recommend daily 10 mg of zinc

for infants under 6 months of age and 20 mg for
children older than 6 months for 10-14 days
 CHEMOTHERAPY
Antibiotics are mainly used in case of SHIGELLA ,TYPHOID AND
CHOLERA related diarrhoea.

In case of cholera- 1- doxycycline

2- tetracycline
3- erythromycin

In case of shigella- 1- ciprofloxacin (adults)

2- ornidazole
Levels of prevention of diarrhoea:
Primary prevention:( aim to prevent the disease even before it
occurs )
Vaccines: rotavirus and measles
Hand washing with soap
Environmental sanitation
Providing adequate and safe drinking water.
Secondary prevention : ( aims to reduce the impact of the
disease or injury that has already occurred )
Promote breastfeeding
Vitamin A supplementation
Treatment with Zn
Tertiary prevention : (aims to soften the impact of
ongoing illness or injury that has lasting effects )
Eg:- use of IVF
 Rota virus vaccination
 Rotashield vaccine -1999
 Withdrawn because of its association with
intussuscption
 Two new oral, live attenuated rotavirus vaccines were
licensed in 2006 with very good safety and efficacy
 The first dose administered between ages 6-10 weeks .
 subsequent doses at intervals 4-10 weeks.
 Vaccination should not be initiated before 6weeks and
after 12 weeks of age.
 All doses should be administered before 32 weeks.
 DIARRHOEAL DISEASE CONTROL PROGRAMME
IN INDIA
 It was started in 1978.
 Main objective were reduction of mortality through
introduction of ORT.
Goals were:
Reduce diarrhoeal associated mortality in children <5
years by 30% by 1995 and by 70% by 2000 A.D.
Improvement in water and sanitation facilities was the
long term goal of NDDCP
National ORT Programme was incepted in 1985- 86
From 1992-93 the programme has become a part of
CSSM (child survival and safe motherhood )
programme.
 CSSM programme become a part of
RCH(reproductive and child health)
programme in 1997

 In RCH Programme, policy of

IMCI(integrated management of childhood
illness) was adopted

 Strategy of IMCI was to address all children

and not only sick children

 IMCI focused on life threatening illnesses-

diarrhoea, Pneumonia, Measles, Malaria
Th
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