CDI Module 18: Community Management of Diarrhea - PowerPoint Presentation

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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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