Diarrhoea is a major health problem in the large portion of population as one of the important after effect of recent natural disaster. So many people are affected with diarrhoea as the consequence of devastating flood. Now the most important thing is to be aware of the disease to prevent and know the management as it may turn even to fatality if proper initiative is not taken. Here are some important facts about the disease and its management.

Diarrhoea is the passing of increased amounts (more than 300g in 24 hours) of loose stools. It is often caused by a virus or bacteria and can be acute (short term) or chronic (long term) - lasting more than two to three weeks. Most people are affected by diarrhoea at some time in their lives. It is often accompanied by stomach pains, feeling sick and vomiting. It is usually due to consumption of drinking water contaminated with bacteria, undercooked meat and eggs or inadequate kitchen hygiene - in other words, an infection.

There are so many cases of diarrhoea due to poor quality drinking water and malnutrition, which affects the majority of the population.

The use of water in hygiene is an important preventive measure but contaminated water is also an important cause of diarrhoea. Cholera and dysentery cause severe, sometimes life threatening forms of diarrhoea.

Diarrhoea is the passage of loose or liquid stools more frequently than is normal for the individual. It is primarily a symptom of gastroin-

testinal infection. Depending on the type of infection, the diarrhoea may be watery (for example in cholera) or passed with blood (in dysentery for example).

Diarrhoea due to infection may last a few days, or several weeks, as in persistent diarrhoea. Severe diarrhoea may be life threatening due to fluid loss in watery diarrhoea, particularly in infants and young children, the malnourished and people with impaired immunity.

The impact of repeated or persistent diarrhoea on nutrition and the effect of malnutrition on susceptibility to infectious diarrhoea can be linked in a vicious cycle amongst children.

Diarrhoea is also associated with other infections such as malaria and measles. Chemical irritation of the gut or non-infectious bowel disease can also result in diarrhoea.

What causes diarrhoea?

Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water, which is very important in the flood time and after the flood. It is more common when there is a shortage of clean water for drinking, cooking and cleaning and basic hygiene is important in prevention.

Water contaminated with human faeces for example from municipal sewage, septic tanks and latrines is of special concern. Animal faeces also contain microorganisms that can cause diarrhoea.

Diarrhoea can also spread from person to person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea

when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation, and fish and seafood from polluted water may also contribute to the disease

Diarrhoea occurs when the micro-organisms irritate the mucous membrane of the small or large intestine resulting in an abnormally large quantity of water in the motions. The irritated gut becomes very active, contracting excessively and irregularly (colic). This can be accompanied by nausea, vomiting, and cold sweats. In some cases the motions may include some blood.

Certain bacteria (usually staphylococci) irritate the digestive tract by producing toxins. These toxins affect the mucous membrane much sooner, a few hours after consumption, compared with

bacterial infection. For this reason, people with inflammation or sores on their hands should not prepare food for others.

When taking antibiotics, many people suffer diarrhoea, which may continue after the antibiotic course has finished. The diarrhoea occurs because the antibiotic alters the intestinal bacterial environment. It is not an allergic reaction. In rare cases it requires medical treatment.

Chronic diarrhoea

Chronic diarrhoea can be a symptom of many disorders:

lIrritable bowel syndrome lAcute, recurrent or chronic intestinal infections

lChronic intestinal inflammation (ulcerative colitis and Crohn's

disease)

lChronic pancreatitis, which produces fatty stools lLaxatives

lLactose intolerance

lImproper diet (consumption of too much alcohol, coffee or sweets) lMetabolic disorders such as diabetes and thyrotoxicosis lIntolerance to gluten (wheat protein).

What are the symptoms of diarrhoea?

lFrequent, watery motions.

lLoss of appetite.

lNausea, vomiting.

lStomach pains.

lFever.

lDehydration.

If the diarrhoea lasts more than three weeks, it is considered chronic.

What are the warning signs?

lBlood in the motions.

lPus in the motions (yellow mucus).

lInability to drink liquids because of vomiting.

lDehydration - symptoms include excreting small amounts of dark urine, drowsiness, dry mucous membranes and thirst. Dehydration as a result of diarrhoea is a particular risk for young children and the elderly.

lPronounced drowsiness due to dehydration or intoxication.

lAcute diarrhoea in infants.

lAcute diarrhoea in very old people.

What can be done at home?

The first and foremost duty to manage a case of diarrhoea is to

start Oral Rehydartion Saline (ORS) with the onset of the disease. As long as the loose water stool passes, the patient needs to take ORS regularly. Other normal diet will remain unchanged. never stop the normal diet. Breastfeeding should not be stopped during diarrhoea.

lIn cases of acute diarrhoea it would be wise to drink more fluids (3-4 litres a day), preferably containing sugar and salts. Ready-mixed rehydration sachets can be bought from the pharmacist and added to drinking water.

lA sufficient intake has been obtained when the urine becomes light yellow in colour.

lEat something containing salt, such as crisps or soup.

lMaintain good standards of hygiene.

lEat normally as soon as your appetite returns but if you have suffered an acute attack of diarrhoea, avoid foods containing milk for a couple of days.

When should the doctor be consulted?

lWhen one of the warning signs outlined above is present.

lWhen the diarrhoea has occurred during or following a trip abroad.

lWhen the diarrhoea has lasted more than one to two weeks.

How is diarrhoea treated? Diarrhoea can usually be treated safely 'at home' and normally goes away by itself within a week. Treatment with antibiotics is therefore rarely needed, and may cause side effects, such as chronic diarrhoea.

Medication must be followed after the prescription of a registered physician .