The New Nation - Internet Edition

Dr. Md. Anisur Rahaman

Diarrhoea is a very common health problem in Bangladesh. It is defined as the passage of stool more than three times a day or when the stool is liquid or semisolid, passage of stool irrespective of frequency is defined as diarrhoea Urgency of defecation and faecal incontinence is a common feature of any variety of diarrhoea In thp developing country diarrhoea is one of the major killer of children. Atack of diarrhoea is found more in children than other human groups. Geographically Southern part of Bangladesh is more prone to diarrhoea. Sometimes diarrhoea become an epidemic form after flood. Diarrhoea mainly two types e.g acute and chronic diarrhoea Acute type is more life threating than chronic. Mainly acute diarrhoea causes death to human being. It plays a bigger role in child mortality rate. Diarrhoea causes dehydration in human body. Dehydration is the primary and important management of diarrhoea.

Factors causing Diarrhoea

1. Agent factors:

a. Biological agents:

Viruses e.g rota virus (Infant specially). Norwalk virus, Entero virus

Bacteria e.g salmonella. shigella. E. coil. V cholera staphylococcus, Campylobacter

Parasites e.g E. histolytica, Giardia.

Others e.g Fungi. Candida. albicans.

b. Nutrient agents: Proteins, fats. vitamins. minerals and water.

c. Social agents: Poverty. unhealthy life styles

2. Host factors:

a. Demographic:

· Age-Children under 5 years

· Sex - All groups

b. Social and economic: Housing, Education., Occupation, stress (acute psychological)

Factors causing Diarrhoea

C. life style factors: living habit nutrition.

3. Environmental factors:

a. Physical environmental-Applied to non-living things physical factors e.g Water. climate, geography.

b. Biological Environment: Microbial agent, animal and plants.

c. Psychosocial Environment-Customs, habit, beliefs.

4. Other factors:

Drugs, e.g Magnesium containing antacids, Antibiotics, (Ampicillin,

Amoxycillin), Purgatives.

Organic disease e.g I. B.S Ulcerative colitis

Food allergy, diabetes, Postvagotomy, Measles, Pnuemonia, Meningitis, Otitis media. Tongilitis. malabsorption syndrome.

Some statistical information

In the developing countries every year about 2 million children aged under 5 years die of Diarrhoea.

Children are affected by diarrhoea 3-4 times per year.

In our country about 17-20%children die of diarrhoea per year. (According to another statistics the rate is 25%)

Three children of every four who become night blindness have a history of diarrhoea atack before 4 weeks.

20%-30% children suffer from chronic diarrhoea who have already atacked by Diarrhoea.

2 month to 3 years aged group of children are more prone to diarrhoea.

6 month to 3 year aged group of children are usually affected by Rota virus.

About 4 million children die of diarrhoea in the world. Among them 80% aged under 2 years.

Breast feeding reduces 25% child mortality rate.

During diarrhoeal atack food consumption of Children reduce to 30%

Determining Factors of Diarrhoea

Key Signs for sever dehydration:

1. Radial pulse-Rapid, Feeble, sometimes, impalpable.

2. Skin elasticity- Pinch reacts very slow ( >2 second)

3. Eye-Deep sunken.

4. Tears-Absent

5. Urine flow-None passed for several hours.

Assessment of dehydration by % of body weight loss

1. Mild dehydration-4-5% body weight loss

2. Moderate dehydration-6-9% body weight loss.

3. Severe dehydration-1 0% or more body weigl1t loss.

Hospitalisation of Patient

If dehydration does not remove within 24 hours although taking oral rehydration saline (ORS)

If loose motion does not reduce within 48 hours.

If there is no micturation within 12 hours.

If there is an abnormal abdominal distension.

If there is a severe vomiting.

If there is an asthmatic condition

If there is a convulsive condition.

If there is high temperature/fever.

If there is an unconsciousness condition

Some complications:

Vitamin-A deficiency leading to night blindness.

Reduced kidney function leading to kidney failure.

Shock (Volumic)

Lathery

Convulsion.

Management of Diarrhoea.

B. Table-3 Antimicrobials commonly used in the treatment specific causes of acute diarrhoea.

Cause Drug (S) of choice Alternative

Cholera Tetracycline 50 mg/kg/ day in divided doses x 3 days Furazolidone 5 mg/kg/day in 4 divided doses x 3 days.Erythromycin 30 mg/kg/day in 4 divided x 3 days.

Shigellosis Nalidixic Acid 55 mg/kg/day in 4 divided doses x 5-7 days (all ages) Co-trimoxazole TMP 10mg/kg/day and SMX 50 mg/kg/day twice daily x 7 days. Ampicilling 100 mg/kg/day in 4 divided doses x 5 days.Pivmecillin Selxid) 40- 50mg/kg/day in 4 divided doses x 7 days.

Acute intestinal amoebiasis Metronidazole 30 mg/kg day x 5-10 days Tinidazole 60 mg/kg/day x 3 days.

Acute giardiasis Metronidazole 20 mg/kg/day x 5 days Quinacrine 5-7 mg/kg/day in divided dosesx 5 days.

Management of Diarrhoea.

C. Dietetory therapy:

Liquid food

Marh of rice

Water of Chira

Lemon syrup

Water of Green coconut

Syrup of gurh/ugar

Soft jaou of Price flower

D. Psychotherapy:

Diarrhoea of psychogenic origin are usually chronic in nature which require anti

depressant drugs along with proper survey for anxiety producing mechanism.

Differential Diagnosis (D/D

1. Dysentery (Shigellosis)

2. Campylobacter enteritis.

3. Diverticular diseases

4. Ulcerative colitis.

5. Ischemic colitis.

Preventive measures

Defaecation should be in a certain place or in a sanitary latrine Outside of dwelling place should be cleaned,

Preparing the meal for children juts before feeding,

Use hand or spoon to feed children

Vaccination of measles as well as other infections diseases Ensure only breast feeding for 6 month (for infant)

Ensure the use of pure drinking water,

Hand washing before and after taking foods,

Ensure hand washing after defaecation with soap or ashes, Avoid the use of artificial milk for infant

Being free from superstitions and wrong thought

Avoiding of over crowded living style,

Foods should be covered to resist flies.

Diarrhoea is a bigger health hazard in Bangladesh as well as in the developing country It is a killer of our future generation, The mortality rate due to diarrhoea IS not less than any other diseases, Specially children aged under 5 years are the victims. It affects our health indicator. Diarrhoea is a preventable disease, For prevention it consciousness relating to diarrhoea is the beter system, Here health education can playa vital role to grow consciousness e,g Education about washing the hand can reduce the secondary atack rate of diarrhoea within family by 85%, Improved hygiene including proper disposition of excreta also has the added benefits of reducing diarrhoea caused by gut parasites, If we fail to make the nation aware as well as its consequences. we might face its epidemic form, So all sort of possibility causing diarrhoea should be cut off initially to prevent the final break out