Module 4: Community Management of Pneumonia

Report
CDI Module 18: Community Management
of Diarrhea
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected 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
 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 Diarrhea
in 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
3
More Reasons We Cannot Ignore Diarrhea
in 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
4
Global Annual Child Deaths
4%
5%
23%
10%
Deaths
associated
with
Malnutrition
= 54%
25%
15%
HIV/AIDS
Measles
Malaria
Diarrhea
ARI*
Others
Perinatal
18%
*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
6
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
8
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
age
Persistent Diarrhea
 Diarrhea that lasts 14 days or more
Dysentery
 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 dangerous
9
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”
10
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
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Causes and Prevention
12
Diarrhea Is Caused by Dirty
Water, Food and Hands
13
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
14
Preventive Measures: Breastfeeding, Handwashing with Soap
and Reduced Access to Oral Fecal Matter
15
Case Management
16
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)
17
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 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
19
Sources of Zinc
Zinc reduces stooling
and is found in foods
and tablets.
Food (and tablets) with zinc
Diarrhea depletes the body’s stores
of zinc
20
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 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
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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
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
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