Diarrhoeal Diseases Control Diarrhoeal Diseases Control Programme, 1980Programme, 1980

COMPONENTS:COMPONENTS: Short TermShort Term

- Appropriate Clinical Management- Appropriate Clinical Management

Long TermLong Term

- Better MCH care practices- Better MCH care practices

- Preventive strategies- Preventive strategies

- Preventing diarrhoeal epidemics- Preventing diarrhoeal epidemics

APPROPRIATE CLINICAL APPROPRIATE CLINICAL

MANAGEMENTMANAGEMENT

Oral Rehydration Therapy:Oral Rehydration Therapy:

- Used in treating acute diarrhoeas due to all etiologies, in all age

groups, in all countries.

- Glucose when given orally enhances intestinal absorption of salt

and water and hence corrects the electrolyte and water defecit.

Composition of reduced Composition of reduced osmolarity ORSosmolarity ORS

Reduced Osmolarity ORSReduced Osmolarity ORS Grams/litreGrams/litre

Sodium chlorideSodium chloride 2.62.6

Glucose, anhydrousGlucose, anhydrous 13.513.5

Potassium chloridePotassium chloride 1.51.5

Trisodium citrate, dihydrateTrisodium citrate, dihydrate 2.92.9

Total weightTotal weight 20.520.5

Reduced Osmolarity ORSReduced Osmolarity ORS mmol/litremmol/litre

SodiumSodium 7575

ChlorideChloride 6565

Glucose, anhydrousGlucose, anhydrous 7575

PotassiumPotassium 2020

CitrateCitrate 1010

Total OsmolarityTotal Osmolarity 245245

Features Mild Severe

(1) Patient’s appearance

Thirsty, alert and restless

Drowsy, sweaty, cold, may be comatose

(2) Radial pulse Normal rate and volume

Rapid, feeble, sometimes inpalpable

(3) Blood pressure Normql Less than 80mmHg

(4) Skin elasticity Pinch retracts immediately

Pinch retracts very slowly

(5) Tongue Moist Very dry

(6) Anterior fontanelle

Normal Very sunken

(7) Urine flow Normal Little or none

% body weight loss 4-5% 10% or more

Estimated fluid deficit

40-50ml/kg 100-110ml/kg

Assessment of Dehydration

Assessment of DehydrationAssessment of Dehydration

Obvious signs of dehydration – Obvious signs of dehydration –

Water Deficit is between 50-100 ml per kg body weight.Water Deficit is between 50-100 ml per kg body weight.

Knowledge of child’s weight:Knowledge of child’s weight:

When Known: ORS for first 4hrs calculated with water When Known: ORS for first 4hrs calculated with water deficit to be 75ml per kg.deficit to be 75ml per kg.

When not known: approximate deficit is determined on the When not known: approximate deficit is determined on the basis of age.basis of age.

AgeAge Under Under 4months4months

4-11 4-11 monthsmonths

1-2 yrs1-2 yrs 2-4 2-4 yrsyrs

5-14 5-14 yrsyrs

15yrs 15yrs or overor over

Weight Weight (kg)(kg)

Under 5Under 5 5-7.95-7.9 8-10.98-10.9 11-11-15.915.9

16-29.916-29.9 30 or 30 or overover

ORS ORS (ml)(ml)

200-400200-400 400-400-600600

600-600-800800

800- 800- 12001200

1200- 1200- 22002200

2200- 2200- 40004000

For children under 2yrs, a teaspoon every For children under 2yrs, a teaspoon every

1-2 minutes, estimated amount is given in 1-2 minutes, estimated amount is given in

a 4hr period.a 4hr period.

If the child vomits, give the solution If the child vomits, give the solution

slowly.slowly.

If the child is breast-fed, nursing to be If the child is breast-fed, nursing to be

pursued during treatment.pursued during treatment.

Non breast fed infants under 6months are Non breast fed infants under 6months are

given an additional 100-200ml clean water given an additional 100-200ml clean water

in the first 4hrs.in the first 4hrs.

Preparation of ORSPreparation of ORS

Contents of Oral Rehydration mixture packet are Contents of Oral Rehydration mixture packet are

to be dissolved in 1litre of drinking water, not to to be dissolved in 1litre of drinking water, not to

be sterilised or boiled, to be used within 24hrs.be sterilised or boiled, to be used within 24hrs.

If the WHO mixture is not available, a mixture of If the WHO mixture is not available, a mixture of

table salt 5g and sugar 20g dissolved in 1 litre of table salt 5g and sugar 20g dissolved in 1 litre of

drinking water can be used.drinking water can be used.

INTRAVENOUS INTRAVENOUS REHYDRATIONREHYDRATION

Required only for initial rehydration of severely Required only for initial rehydration of severely dehydrated patients who are in shock or unable dehydrated patients who are in shock or unable to drink.to drink.

Solutions recommended by WHO:Solutions recommended by WHO: (a) Ringer lactate solution-(a) Ringer lactate solution- sodium, potassium, lactatesodium, potassium, lactate (b) Diarrhoea Treatment Solution-(b) Diarrhoea Treatment Solution- sodium chloride, sodium acetate, potassium chloride, sodium chloride, sodium acetate, potassium chloride, glucose.glucose.

Normal Saline if nothing else is available, but Normal Saline if nothing else is available, but never plain glucose and dextrosenever plain glucose and dextrose

TREATMENT PLAN FOR TREATMENT PLAN FOR REHYDRATION THERAPYREHYDRATION THERAPY

Recommended dose: 100ml/kgRecommended dose: 100ml/kg

When the patient can drink oral fluids give ORS When the patient can drink oral fluids give ORS about 5ml/kg/hourabout 5ml/kg/hour

AgeAge First give First give 30ml/kg in30ml/kg in

Then give Then give 70ml/kg in70ml/kg in

Infants Infants

(under 12 (under 12 months)months)

1 hour1 hour 5 hours5 hours

OlderOlder 30minutes30minutes 2 2 ½ ½ hourshours

MAINTENANCE THERAPYMAINTENANCE THERAPY Oral fluid intake = Rate of continuing stool lossOral fluid intake = Rate of continuing stool loss

APPROPRIATE FEEDINGAPPROPRIATE FEEDING

--Normal food intake to be promoted.Normal food intake to be promoted.

-Newborns with minimal signs of dehydration can -Newborns with minimal signs of dehydration can

be treated with breast feeding alone.be treated with breast feeding alone.

-In moderate or severe cases, breast feeding to be -In moderate or severe cases, breast feeding to be

continued with ORS as it helps preventing further continued with ORS as it helps preventing further

infection in spite of its rehydrating and nutritional infection in spite of its rehydrating and nutritional

valuevalue..

CHEMOTHERAPYCHEMOTHERAPY

Antibiotics to be considered only in cases where causes Antibiotics to be considered only in cases where causes have clearly been identified.have clearly been identified.

Medicines not to be used: Medicines not to be used: -neomycin-neomycin -purgatives -purgatives -cardiotonics -cardiotonics -steroids-steroids -oxygen-oxygen

-tincture of opium and atropine.-tincture of opium and atropine. ZINC SUPPLEMENTATIONZINC SUPPLEMENTATION Lowers the episode duration and severity and also the incidents in Lowers the episode duration and severity and also the incidents in

the following 2-3months. the following 2-3months.

WHO Recommendation: 10mg for infants under 6months and WHO Recommendation: 10mg for infants under 6months and

20mg for more than 6months for 10-14days.20mg for more than 6months for 10-14days.

BETTER MCH CARE PRACTICESBETTER MCH CARE PRACTICES MATERNAL NUTRITIONMATERNAL NUTRITION CHILD NUTRITIONCHILD NUTRITION

Promotion of breast feedingPromotion of breast feeding Appropriate weaning practicesAppropriate weaning practices Supplementary feedingSupplementary feeding

SANITATIONSANITATION HEALTH EDUCATIONHEALTH EDUCATION IMMUNIZATION- Measles vaccine & Rotavirus IMMUNIZATION- Measles vaccine & Rotavirus

vaccinevaccine FLY CONTROLFLY CONTROL

PREVENTIVE STRATEGIESPREVENTIVE STRATEGIES

Rotavirus vaccineRotavirus vaccine

The two new live oral attenuated vaccines The two new live oral attenuated vaccines

Rotarix – monovalent human rotavirus vaccine, Rotarix – monovalent human rotavirus vaccine, 2 dose schedule at 2 and 4 months of age.2 dose schedule at 2 and 4 months of age.

Rotateq – pentavalent bovine human Rotateq – pentavalent bovine human reassortant vaccine, 3 dose schedule at 2, 4, 6 reassortant vaccine, 3 dose schedule at 2, 4, 6 months of age.months of age.

The first dose should be administered The first dose should be administered between 6-12weeks and subsequent doses between 6-12weeks and subsequent doses at intervals of 4-10weeks.at intervals of 4-10weeks.

Rotarix to be completed by 24 weeks and Rotarix to be completed by 24 weeks and Rotateq by 32 weeksRotateq by 32 weeks

Control & Prevention of Control & Prevention of Diarrhoeal EpidemicsDiarrhoeal Epidemics Primary Health CarePrimary Health Care

Objective is to reduce the mortality and Objective is to reduce the mortality and morbidity due to diarrhoeal diseases.morbidity due to diarrhoeal diseases.

It has become a part of Child Survival and It has become a part of Child Survival and Safe Motherhood Programme from 1992-93.Safe Motherhood Programme from 1992-93.

Diarrhoeal Disease ControlDiarrhoeal Disease Control

Programme In India - 1978Programme In India - 1978