Control Of Add
- 1. Control of ADD By M.Ayswariya Roll No.15
- 2. Diarrhoeal Diseases Control Programme, 1980 COMPONENTS: Short Term - Appropriate Clinical Management Long Term - Better MCH care practices - Preventive strategies - Preventing diarrhoeal epidemics
- 3. APPROPRIATE CLINICAL MANAGEMENT Oral Rehydration Therapy: - Used in treating acute diarrhoeas due to all etiologies, in all age groups, in all countries. - Glucose when given orally enhances intestinal absorption of salt and water and hence corrects the electrolyte and water defecit.
- 4. Composition of reduced osmolarity ORS Reduced Osmolarity ORS Grams/litre Sodium chloride 2.6 Glucose, anhydrous 13.5 Potassium chloride 1.5 Trisodium citrate, dihydrate 2.9 Total weight 20.5 Reduced Osmolarity ORS mmol/litre Sodium 75 Chloride 65 Glucose, anhydrous 75 Potassium 20 Citrate 10 Total Osmolarity 245
- 5. Assessment of Dehydration Features Mild Severe (1) Patient’s appearance Thirsty, alert and restless Drowsy, sweaty, cold, may be comatose (2) Radial pulse Normal rate and volume Rapid, feeble, sometimes inpalpable (3) Blood pressure Normql Less than 80mmHg (4) Skin elasticity Pinch retracts immediately Pinch retracts very slowly (5) Tongue Moist Very dry (6) Anterior fontanelle Normal Very sunken (7) Urine flow Normal Little or none % body weight loss 4-5% 10% or more Estimated fluid deficit 40-50ml/kg 100-110ml/kg
- 6. Assessment of Dehydration Obvious signs of dehydration – Water Deficit is between 50-100 ml per kg body weight. Knowledge of child’s weight: When Known: ORS for first 4hrs calculated with water deficit to be 75ml per kg. When not known: approximate deficit is determined on the basis of age. Age Under 4months 4-11 months 1-2 yrs 2-4 yrs 5-14 yrs 15yrs or over Weight (kg) Under 5 5-7.9 8-10.9 11-15.9 16-29.9 30 or over ORS (ml) 200-400 400-600 600-800 800- 1200 1200- 2200 2200- 4000
- 7. For children under 2yrs, a teaspoon every 1-2 minutes, estimated amount is given in a 4hr period. If the child vomits, give the solution slowly. If the child is breast-fed, nursing to be pursued during treatment. Non breast fed infants under 6months are given an additional 100-200ml clean water in the first 4hrs.
- 8. Preparation of ORS Contents of Oral Rehydration mixture packet are to be dissolved in 1litre of drinking water, not to be sterilised or boiled, to be used within 24hrs. If the WHO mixture is not available, a mixture of table salt 5g and sugar 20g dissolved in 1 litre of drinking water can be used.
- 9. INTRAVENOUS REHYDRATION Required only for initial rehydration of severely dehydrated patients who are in shock or unable to drink. Solutions recommended by WHO: (a) Ringer lactate solution- sodium, potassium, lactate (b) Diarrhoea Treatment Solution- sodium chloride, sodium acetate, potassium chloride, glucose. Normal Saline if nothing else is available, but never plain glucose and dextrose
- 10. TREATMENT PLAN FOR REHYDRATION THERAPY Recommended dose: 100ml/kg When the patient can drink oral fluids give ORS about 5ml/kg/hour Age First give 30ml/kg in Then give 70ml/kg in Infants (under 12 months) 1 hour 5 hours Older 30minutes 2 ½ hours
- 11. MAINTENANCE THERAPY Oral fluid intake = Rate of continuing stool loss APPROPRIATE FEEDING - Normal food intake to be promoted. -Newborns with minimal signs of dehydration can be treated with breast feeding alone. -In moderate or severe cases, breast feeding to be continued with ORS as it helps preventing further infection in spite of its rehydrating and nutritional value .
- 12. CHEMOTHERAPY Antibiotics to be considered only in cases where causes have clearly been identified. Medicines not to be used: -neomycin -purgatives -cardiotonics -steroids -oxygen -tincture of opium and atropine. ZINC SUPPLEMENTATION Lowers the episode duration and severity and also the incidents in the following 2-3months. WHO Recommendation: 10mg for infants under 6months and 20mg for more than 6months for 10-14days.
- 13. BETTER MCH CARE PRACTICES MATERNAL NUTRITION CHILD NUTRITION Promotion of breast feeding Appropriate weaning practices Supplementary feeding SANITATION HEALTH EDUCATION IMMUNIZATION- Measles vaccine & Rotavirus vaccine FLY CONTROL PREVENTIVE STRATEGIES
- 14. Rotavirus vaccine The two new live oral attenuated vaccines Rotarix – monovalent human rotavirus vaccine, 2 dose schedule at 2 and 4 months of age. Rotateq – pentavalent bovine human reassortant vaccine, 3 dose schedule at 2, 4, 6 months of age. The first dose should be administered between 6-12weeks and subsequent doses at intervals of 4-10weeks. Rotarix to be completed by 24 weeks and Rotateq by 32 weeks
- 15. Control & Prevention of Diarrhoeal Epidemics Primary Health Care Objective is to reduce the mortality and morbidity due to diarrhoeal diseases. It has become a part of Child Survival and Safe Motherhood Programme from 1992-93. Diarrhoeal Disease Control Programme In India - 1978
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