DIARRHEA MODULE FOR TEACHERS

OBJECTIVES Define diarrhea Present major causes and symptoms associated with diarrhea Provide guidance as to when to seek medical attention for diarrhea Students should know: When diarrhea requires medical attention When to recognize and manage dehydration

Diarrhea is “an abnormal increase in the frequency and liquidity DEFINITION Diarrhea is “an abnormal increase in the frequency and liquidity of one’s stools”

SCOPE OF THE PROBLEM Incidence of diarrhea varies significantly in different countries In the Philippines, as of January 2006 per FHSIS Annual Report - diarrhea is the No. 1 cause of morbidity (illness) in the Philippines

CAUSES OF DIARRHEA INFECTIOUS NON-INFECTIOUS Viral Bacterial Parasitic Certain medications Stress Changes in diet Other medical conditions Medical conditions Diabetes Lactose intolerance Inflammatory bowel disease Hyperthyroidism Gallbladder disease Hepatitis Malabsorption syndrome

COMMON SIGNS & SYMPTOMS OF DIARRHEA Nausea and vomiting Loss of appetite Bloating and gas Abdominal cramps and pain Fever

COMMON SIGNS & SYMPTOMS OF DIARRHEA General weakness or feeling faint Malaise and headache Blood in stool Mucus in stool

When MUST a person with diarrhea consult a doctor? If there is blood or mucus in the stool If the patient has fever If the patient has diarrhea lasting > 24 hours If the patient has persistent vomiting If the patient has signs of dehydration (dehydration is the most common complication of diarrhea)

What are the signs of dehydration? Dryness of the mouth Thirst Reduced amount of urine Weakness and lightheadedness

TREATMENT All diarrheas are “treatable”. Dehydration can be avoided with adequate fluid replacement.

Give Oral Rehydration Therapy (ORT). It is important to start early TREATMENT Give Oral Rehydration Therapy (ORT). It is important to start early and continue giving ORT throughout the diarrheal illness

How to prepare ORT Ingredients: 1 liter of treated or clean water 2 tablespoons of sugar ½ teaspoon of salt Dissolve sugar and salt in water. Advise the patient to drink 1 cup after each loose bowel movement

TREATMENT Give small, frequent and soft feedings as tolerated. Avoid milk, milk products, alcohol, caffeine and oily foods. If diarrhea persists for more than 24 hours or is severe at the onset, consult a physician.

PREVENTION OF FOOD AND WATER-BORNE DISEASES MODULE FOR TEACHERS

BACKGROUND AND OBJECTIVES Primary strategy in preventing diarrhea is the avoidance of food and water contaminated with bacteria from stools. Students should understand the following: All untreated water and food that was not properly prepared are probably contaminated and could be dangerous to your health. Be aware of water and food-borne diseases and how transmission occurs. Know the proper methods of food and water preparation.

BASIC PREVENTIVE MEASURES Always wash your hands before handling food (preparation or consumption). Keep your hands away from your mouth. Always wash your hands after using the bathroom! Dispose of waste properly.

WATER PREPARATION Tap water may be contaminated unless it is known to be safe: i.e., potential bacteria are removed or inactivated. Bottled water may be the best advice.

WATER PREPARATION Two preferred methods of water disinfection – effective against all pathogens Boil for at least 3 minutes. Filter using a 1-2 micron pore-size filter FOLLOWED by treatment with iodine or chlorine Chlorine bleach 2 drops/liter, let stand for 15 minutes Iodine 2% 5 drops/liter, let stand for 15 minutes Iodine tablets ½ tablet/liter, let stand for 15 minutes

FOOD PREPARATION Fresh fruits and vegetables All fruits and vegetables that can be peeled are safe once washed and peeled. Any fruit or vegetable that is not or cannot be peeled should be washed and soaked. Soak items in a solution of strictly one tbsp. (15 ml) household bleach per gallon for 15 minutes and then rinse in treated water.

FOOD PREPARATION Meat preparation All meats should be cooked thoroughly. Adequate cooking will prevent parasitic and bacterial infections.

FOOD PREPARATION Milk products Other tips: Bring all fresh (unpasteurized) milk to boil before consuming. Other tips: Canned foods are generally safe if consumed before the expiration date. Freezing does not disinfect food. Food should be eaten immediately after cooking and should be protected from flies and other sources of recontamination.

REFERENCES “Diarrhea” module, Pre-Service Health Training for Volunteers Binder, Peace Corps Office of Medical Services “Food and Water Preparation” module, Pre-Service Health Training for Volunteers Binder, Peace Corps Office of Medical Services Protocare Corporation 1997

Philippine Society of Gastroenterology The Philippine College of Physicians wishes to acknowledge the following for their invaluable efforts in the preparation of this module Philippine Society of Gastroenterology Ma Lourdes O. Daez, MD