Guideline for diarrhoeal disease management

GUIDELINE
FOR
DIARRHOEAL DISEASE MANAGEMENT



Diarrhea is loose, watery stools. A person with diarrhea typically passes stool more than three times a day. It is a symptom of more serious diseases such as dysentry, cholera, botulism or food poisoning.

Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and older people and it must be treated promptly to avoid serious health problems. Diarrhoea is the cause of death of 18 lac people each year all over the world. In Bangladesh 1 lac 10 thousand people die of diarrhoea in which 90% are children aged bellow 5 years. Infant mortality is extremely high due to the tropical climate, dense population, poverty and poor access to the reliable health services.


Causative agents

Bacteria (E. coli, Salmonella, Campylobacter, Shigella), viruses (Rotavirus, cytomegalovirus, herpes simplex virus) or parasites (Giardia, Cryptosporidium)
Medicines such as antibiotics
Foods such as milk
Diseases that affect the stomach, small intestine, or colon, such as Crohn's disease and irritable bowel syndrome


Management

Give the patients plenty of food to prevent malnutrition.
Continue to breastfeed frequently.
If the child is not breastfed, give the usual milk. If the child is less than 6 months old and not yet taking solid foods, dilute milk or formula with an equal amount of water for 2 days.
If the child is 6 months or older, or already taking solid foods, also give cereal or another starchy food mixed, if possible, with pulses, vegetables, and meat or fish. Add 1 or 2 teaspoonfuls of vegetable oil to each serving.
Use an oral re-hydration solution (ORS) to replace lost fluids
Encourage the child to eat; offer food at least 6 times a day.
Give the same food after diarrhoea stops, and give an extra meal each day for 2 weeks.
Hospitalize immediately if –

Dry or sticky mouth
Few or no tears when crying
Eyes that look sunken into the head
Soft spot (fontanelle) on top of the head that looks sunken
Lack of urine or wet diapers for 6 to 8 hours in an infant
Lack of urine for 12 hours in an older child
Dry, cool skin
Lethargy or irritability
Fatigue or dizziness in an older child




Preventive Action

Wash hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that are passed from person to person. Dirty hands carry infectious germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, put any part of their hands into their mouths.
Keep bathroom surfaces clean to help prevent the spread of infectious germs.
Wash fruits and vegetables thoroughly before eating, since food and water also can carry infectious germs.
Wash kitchen counters and cooking utensils thoroughly after they've been in contact with raw meat, especially poultry.
Refrigerate meats as soon as possible after bringing them home from the supermarket, and cook them until they're no longer pink. After meals, refrigerate all leftovers as soon as possible.
Never drink from streams, rivers or lakes. In Bangladesh, it may be safer to drink only Tube-well water, bottled water and boiled water or chlorinated water.
Avoid taking prepared foods from street vendors.
Don't wash pet cages or bowls in the same sink that you use to prepare family meals.
Keep pets' feeding areas separate from family eating areas.



Ref: Compiled based on information of ICDDR’B