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Essential Measures of Diarrhoea Treatment

by K M. A. Aziz, R. B. Sack and M. R. Islam
IN this summer of 1991 Bangladesh is experiencing a widespread diarrhoea outbreak throughout the country. In the big flood year of 1988 the total number of reported diarrhoeal disease cases were 3.71 1,457. Among these cases there were 3676 deaths for a case fatality rate of 0.09%. Though the number of reported diarrhoea cases after I he flood was very large there were a minimum number of deaths recorded due to proper case management, timely intervention, and adequate preventive measures. In the post-cyclone period of 1991 in Bangladesh similar and further improved measures can keep the deaths from diarrhoea to the lowest level. This article deals with the general information regarding treatment of diarrhoea.
During diarrhoea, salts and water are lost from the body, resulting in dryness or dehydration and other serious complications. This dehydration can be prevented or corrected through timely administration of Oral Rehydratton Solution (ORS).
Every mother, care giver of young children, family and community should take note of the following measures in treating diarrhoea :
(1) It is essential to give a child with diarrhoea plenty of liquids to drink. Dehydration can often be prevented if certain procedures are followed at home as soon as diarrhoea starts. Family members can learn about treatment of diarrhoea from various sources as radio, television, the community health workers, or responsible staff at the local health centre.
(2) The child should be given locally available drink or liquids, such as rice water (bhater mar) or chira water (panlte kachlano chira) mixed with a little bit of salt upto the individual's taste, green coconut water (daber pani). and fruit Juices. When ORS packets are available it should be used after properly dissolving in water. After each loose stool the child should be given 1/4 — 1/2 cup (50-100cc) of Oral Rehydration Solution (ORS) for a child less than two years of age. Half to one cup (100-200cc) may be used for an older child, Adults can take as much as they want If the child vomits, wait for about 5 minutes and then continue slowly giving small amounts by spoon If ORS packets arc not available then alternatively labon gur oral solution can be used by following the same procedure. Labon-gur saline is prepared by mixing a pinch of common salt with the tips of three fingers up to first crease and a fistful of brown sugar (gur) in a half litre of drinking water well stirred. Care should be taken to mix salt, gur and water in right amount. ORS packet solution or labon-gur oral saline should be started promptly soon after the first loose motion and continued as long as diarrhoea persists. It should be remembered that oral saline does not stop diarrhoea but it helps to replace water and salt loss from the body and thereby saves from death. Also, the prepared saline should be discarded after 12 hours because after that bacteria can grow in It.
(3) A child with diarrhoea needs food. There Is a common belief that food aggravates diarrhoea. Unfortunately, this is a misconception which causes restriction or withholding of food to diarrhoea patients. Even breast feeding sometimes is stopped. There is no Justification for such measures. Indeed, lack of nourishment worsens a diarrhoea patient's condition. Children under age five, who are growing rapidly, need ad ditional food. All diarrhoea patients should be allowed usual normal food during diarrhoea.
(4) Breast-fed babies should continue to suckle-Chlldren who are partially breast-fed should continue to suckle and to eat usual normal foods. It is wrong to believe that breast milk can be harmful. Food intake of common preparations such as khichuri. sujt. payesh. fruits, etc. should be increased to help the child to recover from the losses due to diarrhoea
(5) Drugs should not be used for diarrhoea, except on medical advice
(6) In certain cases the body looses water very rapidly leading to the following sings and symptoms :
I Excessive thirst
2. Progressive weakness:
3 Sunken eyes:
4 Depression of the vault of head in babies under 6 months:
5. Hoarseness of voice:
6. Dry tongue:
7. Looseness of skin:
8. Reduced urination:
9 Wrinkled fingers;
10. Low body temperature:
11. Feeble pulse;
12. Repid breathing:
13. Muscle cramps (especially in adults):
14 Convulsions which may be due to fever:
15. Unconsciousness.
Treating a patient promptly with ORS can prevent most of these symptoms. If they appear. a patient immediately should be taken to the nearest treatment centre or to a doc tor.
The treatment of children with diarrhoea is applicable to adults as well. Although in the case of adults, more amount of ORS will be needed. Oral rehydration solution can be used for the treatment of most (about 90%) of the diarrhoeal cases except the severe ones where intravenous therapy will be required.
In summary It should be noted that diarrhoea is both an infectious as well as a nutritional problem. Hence, oral rehydration at home should be started as soon as diarrhoea starts. In severe cases when ORS fails to improve the conditions. the pattent should Immediately be taken to a ( nearby treatment centre for intravenous therapy.