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 ID: 264366
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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 ServicesSlide2
Module 18 Objectives
By the end of this module, learners will:
State the
burden of diarrheal illnessesDefine types of diarrheal diseasesDescribe steps in recognizing and classifying diarrheaList causes of diarrhea and ways to prevent diarrheaDescribe management of diarrhea
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Why We Cannot Ignore Diarrhea
in Efforts to Control Malaria
Diarrheal disease:
Is a leading cause of death in children under five years oldIs both preventable and treatableKills 1.5 million children every year
Globally
,
about two billion cases of diarrheal disease occur every year
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Source
: WHO Fact sheet
N°330, August 2009Slide4
More Reasons We Cannot Ignore
Diarrhea
in
Efforts to Control MalariaDiarrheal 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 milkIs 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
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Source: WHO Fact sheet N°330, August 2009Slide5
Global Annual Child Deaths
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Deaths associated with Malnutrition = 54
%
*Acute respiratory infectionSlide6
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 periodDiarrhea 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 DiarrheaDiarrhea 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 age
All three forms are dangerous9Slide10
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 clinicUsually these children can be consoled and calmedThese 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 irritableHas sunken eyesIs thirsty (drinks eagerly and clearly wants to drink)Exhibits a skin pinch that goes back slowly
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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 deathsKey prevention measures include:
P
romoting
adequate nutrition (including breastfeeding and zinc intake)Raising immunization ratesReducing indoor and outdoor access to oral fecal matterRecent 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
F
ecal Matter
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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)
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For Common Diarrhea, Drugs
Are 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 worseTreatment with medicines like kaolin slow down the diarrhea, but also keep the germs in the gutSo, it is better to keep giving fluids, not drugs
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ORS/ORT: Fluids and Food
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Tell us some of the local foods and fluids that can help children with diarrheaSlide20
Sources of Zinc
Diarrhea depletes the body’s stores of zinc
Food (and tablets) with zinc
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Zinc reduces stooling and is found in foods and tablets.Slide21
Case Management Steps for
the Community-Directed Distributor (CDD)
Ask about the frequency and nature of stooling
If one of the three types of diarrhea is recognized, commence case managementMix and begin using ORSExplain the need to continue breastfeeding in a child of appropriate ageReview importance of continued feeding and fluids by asking caregiver the child’s normal diet and suggesting additional items for increasing zinc and fluidsExplain 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
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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 diarrheaPlease remind us of the major causes of diarrheaList the different ways to prevent diarrheaExplain the best case management steps for diarrhea
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