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CDI Module 18: Community Management of Diarrhea. A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services. Module 18 Objectives. By the end of this module, learners will: State the burden of diarrheal illnesses - PowerPoint PPT Presentation
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©Jhpiego CorporationThe Johns Hopkins University
CDI Module 18: Community Management of Diarrhea
A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services
2
Module 18 Objectives
By the end of this module, learners will: State the burden of diarrheal illnesses Define types of diarrheal diseases Describe steps in recognizing and classifying
diarrhea List causes of diarrhea and ways to prevent diarrhea Describe management of diarrhea
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Why We Cannot Ignore Diarrheain Efforts to Control Malaria
Diarrheal disease: Is a leading cause of death in children under five
years old Is both preventable and treatable Kills 1.5 million children every year
Globally, about two billion cases of diarrheal disease occur every year
Source: WHO Fact sheet N°330, August 2009
4
More Reasons We Cannot Ignore Diarrheain Efforts to Control Malaria
Diarrheal disease: Mainly affects children under two years old Is more common in babies under six months of
age who are on infant feeding formula or cow’s milk
Is a leading cause of malnutrition in children under five years old
Any effort to improve overall child survival must make reducing diarrhea’s death toll a priority
Source: WHO Fact sheet N°330, August 2009
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Global Annual Child Deaths
4% 5%
10%
15%
18%
25%
23%
HIV/AIDSMeaslesMalariaDiarrheaARI*OthersPerinatal
Deaths associated
with Malnutrition
= 54%
*Acute respiratory infection
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The Diarrhea Burden
Diarrhea is defined as the passage of three or more loose or watery stools in a 24-hour period
With the use of oral rehydration therapy (ORT), the annual death rate for children under five suffering from acute diarrhea has fallen over the years but: Acute diarrhea continues to exact a high toll of over
one million child deaths annually in developing countries
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Recognizing Diarrhea:Stooling and Dehydration
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Recognizing Diarrhea
Mothers usually know when their children have diarrhea and may use a local word for diarrhea
They may say that the child has loose or watery stools—but frequent passage of normal, formed stools is not diarrhea
Diarrhea is defined as passage of three or more loose or watery stools in a 24-hour period
Diarrhea kills a child through dehydration—the loss of too much fluid
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Three Classifications of Diarrhea
Acute Diarrhea Diarrhea that has lasted less than 14 days Acute diarrhea is a major cause of dehydration and leads
to death among children under five years of agePersistent Diarrhea Diarrhea that lasts 14 days or moreDysentery Blood in the stool, with or without mucus Dysentery is commonly caused by Shigella bacteria in
children under five years of ageAll three forms are dangerous
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Most Important Signs
The child is lethargic or unconscious—general danger sign
The child is restless and irritable all the time, or every time she or he is touched and handled
An infant or child who is calm when breastfeeding but becomes restless and irritable when he or she stops breastfeeding, is classified as "restless and irritable”
Many children are upset just because they are in the clinic Usually these children can be consoled and calmed These children are not classified as "restless and irritable”
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Danger Signs and Symptoms
If the child has two or more of the following signs, he or she is classified as having SOME DEHYDRATION: Is restless and irritable Has sunken eyes Is thirsty (drinks eagerly
and clearly wants to drink) Exhibits a skin pinch that
goes back slowly
Causes and Prevention
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Diarrhea Is Caused by DirtyWater, Food and Hands
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Preventing Diarrhea
Preventing children from developing diarrhea in the first place is essential for reducing child deaths
Key prevention measures include: Promoting adequate nutrition (including breastfeeding and
zinc intake) Raising immunization rates Reducing indoor and outdoor access to oral fecal matter
Recent research also suggests that handwashing plays a role in reducing the incidence of diarrhea
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Preventive Measures: Breastfeeding, Handwashing with Soap and Reduced Access to Oral Fecal Matter
Case Management
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Results of Past Efforts
Diarrhea oral rehydration solution (ORS) and increased fluids have helped but: Only 26% of children <5 years of age with diarrhea
received ORS packets or pre-packaged liquid (Demographic and Health Survey [DHS] 2008)
Only 25% of children <5 years of age with diarrhea received oral rehydration therapy (ORT) or increased fluids with continued feeding, a slight decrease from 28% in 2003 (Millennium Development Goal [MDG] Countdown)
For Common Diarrhea, DrugsAre Generally NOT the Right Choice of Treatment
Generally, if the child continues to receive plenty of fluids and food to replace what is lost through stooling, diarrhea will resolve itself
Unless we really know that the diarrhea is caused by a bacterium like Shigella, treatment with antibiotics can make it worse
Treatment with medicines like kaolin slow down the diarrhea, but also keep the germs in the gut
So, it is better to keep giving fluids, not drugs
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ORS/ORT: Fluids and Food
Tell us some of the local foods and fluids that can help children with diarrhea
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Sources of Zinc
Diarrhea depletes the body’s stores of zinc
Food (and tablets) with zinc
Zinc reduces stooling and is found in foods and tablets.
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Case Management Steps forthe Community-Directed Distributor (CDD) Ask about the frequency and nature of stooling If one of the three types of diarrhea is recognized, commence
case management Mix and begin using ORS Explain the need to continue breastfeeding in a child of appropriate
age Review importance of continued feeding and fluids by asking
caregiver the child’s normal diet and suggesting additional items for increasing zinc and fluids
Explain dangers of drugs and how ORS works Refer any child who is severely dehydrated immediately Explain preventive measures like handwashing and feeding
with clean cups, hands and utensils
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Both ORS and Zinc Are Needed
Facilitators of CDD training should use the following: Role play to help in
recognizing diarrhea Demonstration of ORS
preparation with re-demonstration
Role play of counseling about prevention
23
Summary/Discussion
Diarrhea is a major killer of children and also leads to malnutrition, which kills more children
Please tell us how to recognize a child with diarrhea
Please remind us of the major causes of diarrhea
List the different ways to prevent diarrhea Explain the best case management steps for
diarrhea