CDI Module 18: Community Management of Diarrhea

1. 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

3. 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

5. Global Annual Child Deaths Deaths associated with Malnutrition = 54% *Acute respiratory infection

6. 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

7. Recognizing Diarrhea:Stooling and Dehydration

8. 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

9. 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

10. 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”

11. 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

12. Causes and Prevention

13. Diarrhea Is Caused by DirtyWater, Food and Hands

14. 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

15. Preventive Measures: Breastfeeding, Handwashing with Soap and Reduced Access to Oral Fecal Matter

16. Case Management

17. 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)

18. 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

19. ORS/ORT: Fluids and Food Tell us some of the local foods and fluids that can help children with diarrhea

20. 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

21. 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

22. 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