Diarrhoeal control programme
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Transcript of Diarrhoeal control programme
Purnima chaudhary
Roll no.-77
MBBS 2011
INTRODUCTION Its now obvious that some known and unknown
organism probably causes diarrhoea .
Regardless of the causative agents or age of patient; the sheet anchor of treatment is oral rehydration therapy such as the one advocated by WHO/ UNICEF.
DIARRHOEAL DISEASE CONTROL PROGRAMME The diarrhoel disease control programme was started in 1978
with the objective of reducing the mortality & morbidity due to diarrohoeal diseases.
from 1992-1993 , the programme has become a part of child survival & safe motherhood programme.
At present, it is a part of NRHM
COMPONENT OF A DIARRHOEAL DISEASES CONTROL PROGRAMMEShort Term Appropriate clinical management
Long Term. Better MCH care practices
.preventive strategies
.preventing diarrhoeal epidemics
Appropriate clinical management1. ORAL REHYDRATION THERAPY The main aim of oral fluid therapy is to prevent
dehydration and reduce mortality.
Oral fluid therapy is based on the observation that glucosegiven orally enhances the intestinal absorption of salt andwater and is capable of correcting the electrolyte and water
deficit.
At 1st the composition of ORS ( oral rehydration salt ) recommended by WHO was sodium bicarbonate based
INCLUSION OF TRISODIUM CITRATE IN PLACE OF SODIUM BICARBONATE
made product more stable
reduces stool output
increase intestinal absorption of sodium & water .
This ORS formulation focuses on reducing osmolarity of ORS solution;
. to avoid adverse effects of hypertonicity on net fluid absorption by reducing concentration of glucose and sodium chloride in solution.
Reduce the sodium concentration of ORS solution to 75 mOsmol/ L ,improved the efficacy of ORS regimen for children with acute non-cholera diarhoea.
Since January 2004 new ORS formulation is the only 1procured by UNICEF .
INDIA was 1st country in world to launch ORS formulation since JUNE 2004
Composition of reduced osmolarity ORS
REDUCEDOSMOLALITY ORS
GRAM/ LITRE
SOD.CHLORIDE 2.6
GLUCOSE, ANHYDROUS
13.5
POTASSIUM CHLORIDE
1.5
TRISODIUM CITRATE , DIHYDRATE
2.9
TOTAL WEIGHT 20.5
REDUCEDOSMOLARITY ORS
Mmol/L
SODIUM 75
CHLORIDE 65
GLUCOSE , ANHYDROUS
75
POTASSIUM 20
CITRATE 10
TOTAL OSMOLARITY
245
How to access the dehydration
MILD SEVERE
PATIENT APPEARANCE THIRSTY, ALERT , RESTLESS
DROWSY, LIMP, COLD ,SWEATY, MAY BE COMATOSE .
RADIAL PULSE NORMAL RATE & VOLUME
RAPID , FEEBLE ,SOMETIMES IMPALPABLE
BLOOD PRESSURE NORMAL <80mm Hg
SKIN ELASTICITY PINCH RETRACTS IMMEDIATELY
PINCH RETRACTS VERY SLOWLY
TONGUE MOIST VERY DRY
URINE FLOW NORMAL LITTLE/ NONE
ANTERIOR FONTANELLE NORMAL VERY SHRUKEN
% BODY WEIGHT LOSS 4-5% 10% Or MORE
GUIDELINES FOR ORAL REHYDRATION THERAPY (FOR ALL AGES /DURING FIRST FOUR HOURS )
AGE Under
4 months
4-11months
1-2 yrs. 2-4 yrs. 5-14 yrs. 15 yrs. or over
WEIGHT (KG)
UNDER 5
5-7.9 2-10.9 11-15.9 16-29.9 30 OROVER
ORS SOLUTION ( IN ml)
200-
400
400-
600
600-
800
800-
1200
1200-
2200
2200-
4000
Amt. of ORS sol.= wt. of child X 75 ml / kg
2. INTRAVENOUS REHYDRATION Intravenous infusion is usually required only for initialrehydration of severely dehydration pt. who is in shock or unable to drink . Such patients are besttransferred to nearest hospital or treatment Centre .
Solution recommended by WHO for intravenous infusion are…….
1.RINGER LACTATION SOLUTION Its also known as Hartmamm’s solution for injection. It is the
best commercially available solution . It supplies adequate concentration of sodium and potassium arid the lactate yields bicarbonate for correction of the acidosis.
2.DIARRHOEAL TREATMENT SOLUTION ( DTS )
Recommended by WHO as ideal polyelectrolyte solution for intravenous infusion . It contains in one litre
Sodium Acetate- 6.5g,
Sodium Chloride- 4g,
Potassium Chloride- 1g
Glucose- 10g.
Normal saline can also be given but its poorest fluid because it will not correct the acidosis and will not replace the potassium losses.
.
Plain glucose and dextrose solution should not be used as they provide only water & glucose.
The initial rehydration should be fast until an easily palpable pulse is present . Reasses the patient every 1-2 hours.
After infusing 1-2 litres of fluid , rehydration should be carried out at a somewhat slower rate until pulse and blood pressure return to normal.
It is most helpful to examine skin elasticity and pulse strength ,both of which should be normal.
3.MAINTENANCE THERAPY After the sign of dehydration has been corrected
oral fluid should be used for maintenance therapy .
AMOUNT OF DIARRHOEA
AMOUNT OF ORAL FLUID
Mild diarrhoea (not more than one stool every
2hrs or longer, or less than 5mlstool per kg)
100 ml /kg body weight per day until diarrhoea stops
Severe diarrhoea
(more than one stool every 2
hours, or more than 5 ml of stool per kg per hour)
Replace stool losses volume for volume , if not measurable give
10-15 ml/kg body weight per hour
4 . APPROPRIATE FEEDING
• Especially relevant for the exclusively breast-fed infants. If the child is breast-fed , nursing should be pursued during treatment with ORS solution.
• Non-breast-fed infants under age 6 months should be given
an additional 100-200 ml of clean water during the first four hour ,when old ORS containing 90 mmol/L is given.
• But additional water is not given along with 75 mmol/L.
• Commercially carbonated beverages , commercial fruits & sweetened tea should not be given as it causes osmotic diarrhoea and hypernatraemia.
• Rice water ,unsalted soup ,yoghurt drinks , green coconut water should be given.
5 . Chemotherapy
• Drug of choice for choleraDOXICYCLINE
TETRACYCLINE,
TMP-SMX
Drug of choice For diarrhoea due to shigellaciprofloxacin.
As shigella resistant to ampicillin & TMP-SMX.
6 . ZINC SUPPLEMENT It reduces episodes duration and severity so recommended
by WHO & UNICEF
10 mg of Zn for infants under 6 months of age 20 mg
for children older than 6 months for 10-14 days
B. BETTER MCH CARE PRACTICES .
a . Maturation nutrition
Improving prenatal nutrition will reduce the low birth weight problem
Prenatal & postnatal nutrition will improve the quality of beast milk .
b. child nutrition
. Promotion of Breast feeding
. Appropriate weaning practices
.Supplementary Feeding
.vitamin A supplementation
C. PREVENTIVE STRATEGIES
1 . SANITATION
2 .HEALTH EDUCATION
3 . IMMUNISATION
4 . FLY CONTROL
Sanitation
It emphasis on personal & domestics hygiene like hand washing
with soap before preparing food
before eating ,
before feeding a child,
after defecation ,
after cleaning a child who has defecated and
after disposing off a child’s stool .
Health Education An important job of health worker is to prevent diarrhoea
by convincing and helping community members to adopt and maintain preventive measures like breast feeding,
improved weaning ,
clean drinking,
use of plenty of water for hygiene,
use of latrine,
proper disposal of stools of young children etc.
IMMUNISATION
Immunization against measles is a potential intervention for diarrhoea control.
Measles vaccine can prevent 25% of diarrhoeal deaths in children under 5 yrs. of age
ROTAVIRUS VACCINE
There are two vaccines ROTARIX –TM ( monovalent human rotavirus vaccine)
ROTA Teq-TM ( pentavelent bovine-human vaccine)
Rotarix-TM …… 2 -dose schedule to 2 -4 months aged child
1 . DOSE - 6 weeks - 12 weeks
2 . DOSE - upto 16 weeks & no later than 24
weeks.
Rota Teq-TM……3 oral dose at ages 2,4,6 months.
FLY CONTROL
Flies breeding in association with human or animal faeces should be controlled.
Control and prevention of diarrhoeal epidemics An intersectoral approach centered upon PHC involving
activities
in fields of water supply & excreta disposal ,communicable disease control,
mother & child health ,
nutrition & health education is regarded as essential for ultimate for ultimate control of diarrhoeal diseases.
THANK U