Diarrhoeal disease: knowledge, Attitudes, and Practices

Diarrhoea is a global public health issue and a leading cause of childhood malnutrition, growth disturbances, and mortality. Diarrhoea is passing loose, watery, and possibly more-frequent bowel movements. It may be present alone or be associated with other symptoms, such as nausea, vomiting, abdominal pain or weight loss.

CAUSES

•  Rotavirus is a common cause of acute childhood diarrhoea. The virus that causes coronavirus disease 2019 (COVID-19) has also been associated with gastrointestinal symptoms, including nausea, vomiting and diarrhoea.
• Bacteria and parasites.Exposure to pathogenic bacteria, parasites through contaminated food or water can leads to diarrhoea. When traveling in developing countries, diarrhoea caused by bacteria and parasites is often called traveller’s diarrhoea. C.Difficile is another type of bacterium that causes diarrhoea, and it can occur after a course of antibiotics or during a hospitalization.
• Some antibiotics, anti-cancer drugs and antacids with magnesium can cause diarrhoea.
• Lactose intolerance.Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhoea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop as you get older.
• Fructose is a sugar found naturally in fruits and honey. It’s sometimes added as a sweetener to certain beverages. Fructose can lead to diarrhoea in people who have trouble digesting it.
• Artificial sweeteners.Artificial sweeteners are nonabsorbable sugars found in chewing gum and other sugar-free products it can cause diarrhoea in some otherwise healthy people.
• Partial intestine or gallbladder removal surgeries can sometimes cause diarrhoea.
• Other digestive disorders.Chronic diarrhoea has a few other causes, such as IBS, Crohn’s disease, ulcerative colitis, celiac disease, microscopic colitis and small intestinal bacterial overgrowth.

COMPLICATIONS

Diarrhoea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems. 

SIGNS AND SYMPTOMS OF DEHYDRATION

• Excessive thirst
• Dry mouth or skin
• Little or no urination
• Weakness, dizziness, or light-headedness
• Fatigue

Dark-coloured urine 

Signs and symptoms of dehydration in infants and young children:

• Not having a wet diaper in three or more hours
• Dry mouth and tongue
• Fever above 102 F (39 C)
• Crying without tears
• Drowsiness, unresponsiveness, or irritability
• Sunken appearance to the abdomen, eyes, or cheeks

Prevention

Wash your hands to prevent the spread of infectious diarrhoea. To ensure adequate handwashing:

• Wash frequently.Wash your hands before and after preparing food. Wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing, and blowing your nose.
• Lather with soap for at least 20 seconds.After putting soap on your hands, rub your hands together for at least 20 seconds. This is about as long as it takes to sing “Happy Birthday” twice through.
• Use hand sanitizer when washing isn’t possible.Use an alcohol-based hand sanitizer when you can’t get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the fronts and backs of both hands. Use a product that contains at least 60% alcohol.

Vaccination

You can help protect your infant from rotavirus, the most common cause of viral diarrhoea in children, with one of two approved vaccines.

TREATMENT

In the case of simple short-term episodes of diarrhoea, which usually clear up by themselves in healthy people, you will probably be able to manage your symptoms through home care.

You should try to do the following:

• Rest at home
• Stay off work or school until you have not had a loose bowel motion for 24 hours.
• Drink clear fluids or oral rehydration solution to replace lost fluids. Take small sips if you feel sick.
• Avoid fruit juice, cordials, and sugary drinks. They will prolong the diarrhoea.
• Avoid alcohol and caffeine.
• Manage your diet until you get back to normal . Avoid fatty foods or those high in insoluble fibre
• Oral rehydration solutions: These are available readily in pharmacy or you can prepare it at home. For older people and children, oral rehydration solutions are a better choice than plain water. They are made specifically to replace both fluids and electrolytes (important minerals that your body needs to function) in the right concentrations.

         How to prepare ORS at home?

• Before preparing the solution, wash hands with soap.
• Take 1 litre or 4 cups (250 mL each) of boiled water (clean drinking water)
• Mix half teaspoon salt and 6 teaspoons of sugar.
• Mix thoroughly.
• Cover the solution and do not use after 24 hours.

Administer ORS immediately to dehydrated patients who can sit up and drink independently. Offer small amounts frequently.

Feed the ORS to child as frequently as possible.

A child under the age of 2 years requires at least ¼- ½ of a large (250ml) cup of the ORS drink after each watery stool.

A child aged 2 years or older requires at least ½ to 1 whole large (250ml) cup of the ORS drink after each watery stool.

When should I see my doctor?

An isolated episode of diarrhoea will generally clear up without any treatment.

Seek medical advice if you have any of the following:

• Ongoing or severe diarrhoea
• Blood/ mucus in your stool
• Fever as well as diarrhoea
• Unexplained weight loss
• Diarrhoea at night
• Signs of dehydration  that already mentioned above like feeling tired, decreased urination, thirst, and dry mouth,drowsiness,sunken eyes etc.

Ongoing diarrhoea can lead to dehydration and an electrolyte imbalance, making it dangerous especially to the very young or older people, who can be affected very quickly.