DIARRHOEA

DIARRHOEA IN CHILDREN:

DIARRHOEA IN CHILDREN Dr Mohammad Saleem Khan Dr Riaz Tanoli

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PART 1

“An ounce of prevention is worth a pound of cure.” :

“An ounce of prevention is worth a pound of cure.” ~Henry de Bracton

Diarrhoea a Public Health Concern:

Diarrhoea a Public Health Concern Diarrhoea is the second leading cause of mortality and morbidity in the world after pneumonia among children under five globally. Globally, there are about two billion cases of diarrhoeal disease every year. Nearly one in five child deaths, about 1.5 million each year, is due to diarrhoea. Today only 39 per cent of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000.

What is Diarrhoea:

What is Diarrhoea Diarrhea is defined by the World Health Organization as having 3 or more loose or liquid stools per day, or as having more stools than is normal for that person. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. People of all ages can get diarrhoea, but it is more common in children below five years of age.

Types of Diarrhoea:

Types of Diarrhoea There are three clinical types of diarrhoea: Acute watery diarrhoea It lasts several hours or days; the stool is loose and watery without blood and includes cholera. Acute bloody diarrhoea It also lasts for hours or a few days, the stool contains blood in it and also called dysentery. Persistent diarrhoea This is prolonged diarrhoea and lasts 14 days or longer.

Causes of Diarrhoea:

Causes of Diarrhoea Infections (Gastroenterititis) Organisms involved Viral Infections Rota virus Norovirus (Adults) Adenovirus types 40 and 41 Astroviruses Bacterial Infections Escherichia coli Salmonellae Shigellae Campylobacter Vibrio cholera Clostridium difficile Parasitic Infections Giardia and Entamoeba histolytica

Continued…:

Continued… Sources of infection Poor Personal Hygiene Improper Sanitation Contaminated Water and Food Systemic Infections Urinary tract infection Pneumonia Otitis media Meningitis Septicaemia

Continued…:

Continued… Non infectious Malabsorption ( The inability to absorb food, mostly in the small bowel) Cystic fibrosis, Coeliac disease Food Intolerance or Allergy Lactose Intolerance, Cow's milk Protein Allergy Drug induced- Antibiotics etc Inflammation Ulcerative colitis, Crohn's disease Surgical Conditions Appendicitis, Intussusception, Partial bowel obstruction (volvulus, Hirschsprung's disease, Meckel's diverticulum, short bowel syndrome) Other rare conditions Haemolytic-uraemic syndrome, Pseudomembranous colitis, Toddler diarrhoea

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PART 2

Symptoms and Signs:

Symptoms and Signs May or may not be otherwise unwell Symptoms can range from a mild stomach upset for a day or two with slight diarrhoea, to severe watery diarrhoea for several days or longer. Blood or mucus can appear in the stools with some infections. Crampy pains in the abdomen are common. Pains may ease each time some diarrhoea is passed. Vomiting, high temperature (fever), aching limbs and headache may also develop.

Complications:

Complications Most common complication of diarrhoea in children is dehydration which can be fatal if not taken into account on time. Bacterial bowel infection may rarely cause septicaemia, meningitis and osteomyelitis Very rarely, Infection may also lead to bowel perforation, intussusception, appendicitis or liver abscess.

Dehydration:

Dehydration The most severe threat posed by diarrhoea Water and electrolytes like sodium, chloride, potassium and bicarbonate are lost through liquid stools and vomit

Continued…:

Continued… The degree of dehydration is rated on a scale of three: No dehydration No signs or symptoms of dehydration Moderate dehydration: Thirst Restless or irritable behaviour Decreased skin elasticity Sunken eyes Severe dehydration: Symptoms become more severe Shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin.

Treatment:

Treatment Rehydration ORS Continued Feeding Zinc Supplements Consulting a Health worker if there are signs of Dehydration

Prevention:

Prevention Water, sanitation and hygiene programmes Nutrition Breast Feeding Micronutrient supplementation (including vitamin A and zinc) Immunization (including rotavirus and measles vaccinations)

7- Point Plan for Diarrhoea Control and Prevention:

7- Point Plan for Diarrhoea Control and Prevention Treatment Package Fluid replacement to prevent dehydration Zinc treatment Prevention Package Rotavirus and measles vaccination Promotion of early and exclusive breastfeeding and vitamin A supplementation Promotion of hand washing with soap Improved drinking water supply quantity and quality, including treatment and safe storage of household water Community-wide sanitation promotion

Important Health related Days:

Important Health related Days April 07 August 01-07 August 01-07 October 09-13 October 15 October 17-23 November 05 World health day World breastfeeding week National immunization awareness week National nutrition week Global hand washing day Infection control week National children's day

References:

References Nelson’s Text Book of Paediatrics 18 th Edition http://www.who.int/mediacentre/factsheets/fs330/en/index.html http://www.who.int/mediacentre/news/releases/2009/diarrhoea_research_20090310/en http://www.unicef.org/media/files/Final_Diarrhoea_Report_October_2009_final.pdfx.html http://www.childinfo.org/diarrhoea.html http://pediatrics.about.com/od/weeklyquestion/a/05_diarrhea_inf.htm http://hubpages.com/hub/How-to-treat-diarrhea-infants-children http://www.patient.co.uk/doctor/Childhood-Diarrhoea.htm http://www.medic8.com/healthguide/articles/diarrhoea.html http://raisingchildren.net.au/articles/diarrhoea_a.html http://www.wrongdiagnosis.com/d/diarrhea/stats.htm

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Thank You