2. Diarrhea & Vomiting Dehydration STILL THE #1 KILLER WORLD WIDE IN THE UNDER 5’s

4. Startling Stats re water Approximately 75- 80% of the world’s diseases can be traced to contaminated water Approximately 75- 80% of the world’s diseases can be traced to contaminated water Three fourths of the world’s diseases could be eliminated if everyone had access to clean water Three fourths of the world’s diseases could be eliminated if everyone had access to clean water Every yr. 5 million deaths occur due to diarrheal disease 4 million could be prevented by use of a simple sugar/salt solution (ORS). Every yr. 5 million deaths occur due to diarrheal disease 4 million could be prevented by use of a simple sugar/salt solution (ORS). World wide 10-25 million people die annually from diseases due to unclean or insufficient water and inadequate sanitation. World wide 10-25 million people die annually from diseases due to unclean or insufficient water and inadequate sanitation.

5. Water is a BASIC need! But what if…

6. Contaminated Water!

7. Main Causes of Diarrhea Contaminated water & shortage of water Contaminated water & shortage of water Bacterial & viral infections in the gut Bacterial & viral infections in the gut Poor nutrition Poor nutrition Intestinal parasites Intestinal parasites Infections (ear infections, measles, etc) Infections (ear infections, measles, etc) Malaria (especially Falciparum) Malaria (especially Falciparum) HIV/AIDS HIV/AIDS Food poisoning Food poisoning Purges, laxatives, etc. Purges, laxatives, etc.

8. Diarrhea as the #1 KILLER! What is diarrhea & Why does it kill? What is diarrhea & Why does it kill? Much more dangerous in small children (6mos to 2yrs) Much more dangerous in small children (6mos to 2yrs) Increased danger with malnourished children Increased danger with malnourished children Children die because their body loses more water than it replaces  dehydration. Children die because their body loses more water than it replaces  dehydration.

9. The Dangers of Bottle Feeding! Bottle fed babies have diarrhea 5-6 times more often than breast fed babies

10. Why is bottle feeding dangerous? Use contaminated water to mix formula Use contaminated water to mix formula Use contaminated bottles and nipples Use contaminated bottles and nipples No refrigeration for unused formula No refrigeration for unused formula Formula is very expensive Formula is very expensive Improperly mixed formula results in under- nutrition or malnutrition Improperly mixed formula results in under- nutrition or malnutrition

11. The Vicious Cycle: Diarrhea & Malnutrition

12. Diarrhea  Dehydration  Death

13. What happens to living things with & without water?

14. Fruit: with & without water!

15. What happens to BABIES with & without water?

17. Start rehydration early!

20. Native medicine for sunken fontanel

21. Poor Skin Turgor “Tenting”

23. Unconscious due to Dehydration!

24. Prevention of Diarrhea & Vomiting Teach good nutrition & monitor nutritional status (feed the sick child) Teach good nutrition & monitor nutritional status (feed the sick child) Prevent infection (immunize) Prevent infection (immunize) Continue breastfeeding (before using ORS) Continue breastfeeding (before using ORS) Teach to use clean, boiled water for children & teach how to make & use ORS (teach to filter water/SODIS) Teach to use clean, boiled water for children & teach how to make & use ORS (teach to filter water/SODIS) Encourage good hygiene & the use of latrines Encourage good hygiene & the use of latrines Wash hands after latrine & before fixing food Wash hands after latrine & before fixing food Cover food to keep flies out Cover food to keep flies out

25. Things that often do not work! “Antimotility” drugs: Lomotil & Immodium “Antimotility” drugs: Lomotil & Immodium The “Kaolins”: Do not prevent fluid loss. The “Kaolins”: Do not prevent fluid loss. Antibiotics: Work only if diarrhea is caused by a bacteria. Antibiotics: Work only if diarrhea is caused by a bacteria. Look for the exact CAUSE of the diarrhea Look for the exact CAUSE of the diarrhea REHYDRATION is always the key! REHYDRATION is always the key!

26. Treatment-Rehydration Use what the local people have available Use what the local people have available Herbal/weak tea Herbal/weak tea Coconut milk Coconut milk Rice water Rice water Teach to make the “special drink” Teach to make the “special drink” (ORS) (ORS)

27. Mixing ORS using spoon/glass!

28. Mixing ORS by hand + Fruit Juice (1/2 orange) 10-12 ounces 3-finger Sugar

29. Hand Mixing ORS!

30. Any problems with using these?

31. The importance of Glucose

32. Water absorption-25 times better with glucose added

33. How much ORS to give: Child/Adult

34. Rehydration Tips If ORS will be used quickly, usually want a large quantity to mix so person adult or child can get enough fluid. Should you require boiling, sterilization? Only if it is reasonable to do so –if severely dehydrated start with what is available –work on cleaning and sterilizing water. Start when person first begins to have diarrhea, don’t wait for dehydration. Sick person should sip mixture every 5 minutes – day and night. Continue breast feeding.

35. Rehydration Tips When possible use what is available locally ie. oranges, mango, limes, lemon juice, etc. Ripe banana that is mashed and mixed can be added to the salt and sugar mixture after the person starts to feel better. If honey is available, use honey instead of sugar except for infants. Coconut milk may actually cause diarrhea. But is also often tolerated well if the person is use to drinking coconut milk. It is also sterile if not contaminated when opening the coconut.

36. “The D & V Blues” (“Twinkle, twinkle little star”) Babies who have D & V Babies who have D & V Shrivel up and fail to pee. Shrivel up and fail to pee. To regain their health we oughta To regain their health we oughta Fill them up with LOTS OF WATER! Fill them up with LOTS OF WATER! Making special drink’s a cinch… Making special drink’s a cinch… Sugar 1 palm-full, salt 1 pinch Sugar 1 palm-full, salt 1 pinch Water 1 glass or BIG FAT CUP Water 1 glass or BIG FAT CUP Toss them in and stir it up! Toss them in and stir it up!

37. “The D & V Blues” But careful; you would be at fault But careful; you would be at fault If you put in too much salt! If you put in too much salt! So mix it, taste it, GIVE 3 CHEERS So mix it, taste it, GIVE 3 CHEERS If it’s no saltier than tears! If it’s no saltier than tears! Each time your baby dribbles poop Each time your baby dribbles poop Give one glassful….scoop by scoop Give one glassful….scoop by scoop And if the darling’s on the breast And if the darling’s on the breast Give breast milk too; for BREAST IS BEST! Give breast milk too; for BREAST IS BEST!

38. SODIS (“If you’re happy & you know it”) If you want to have clean water, If you want to have clean water, Do the SODIS If you want to have clean water, If you want to have clean water, Do the SODIS You fill a bottle up, You fill a bottle up, and you put it in the sun, In six hours, it will be safe to drink. In six hours, it will be safe to drink.

39. Stop Here

40. Special treatment for various causes of diarrhea Diarrhea with vomiting Diarrhea with vomiting Diarrhea with mucus & blood -no fever (possibly amebic dysentery) Diarrhea with mucus & blood -no fever (possibly amebic dysentery) Severe diarrhea with blood & fever (bacterial dysentery) Severe diarrhea with blood & fever (bacterial dysentery) Severe diarrhea with fever but no blood (Possibly typhoid fever or Malaria) Severe diarrhea with fever but no blood (Possibly typhoid fever or Malaria) Chronic diarrhea (possibly malnutrition or AIDS) Chronic diarrhea (possibly malnutrition or AIDS)

41. Water borne Dz: Water is the infecting agent (poor sanitation) DiseasePrevention DiseasePrevention CholeraBoil water/wells CholeraBoil water/wells TyphoidLatrines TyphoidLatrines AmebiasisHand washing AmebiasisHand washing Hepatitis AClean food/water & fly control Hepatitis AClean food/water & fly control GiardiasisClean food & water GiardiasisClean food & water

42. Water washed Dz: Inadq am. of water (poor hygiene/waste disposal) Diseases:Ways to Prevent: Diseases:Ways to Prevent: Bacillary dysentery(Same as above) Bacillary dysentery(Same as above) ScabiesPrevent overcrowding ScabiesPrevent overcrowding AscariasisClean water & latrines AscariasisClean water & latrines TrachomaKeep flies off food/eyes TrachomaKeep flies off food/eyes ConjunctivitisClean water & fly control ConjunctivitisClean water & fly control LeprosyPrevent overcrowding LeprosyPrevent overcrowding

43. Water based Dz: Life cycle is in the water. DiseaseWays to Prevent DiseaseWays to Prevent SchistosomiasisDon’t wade in contaminated water SchistosomiasisDon’t wade in contaminated water Guinea WormDon’t urinate in water Guinea WormDon’t urinate in water

44. Water related vectors: Insects breed in the water DiseasesWays to Prevent DiseasesWays to Prevent MalariaMosquito nets MalariaMosquito nets Yellow feverMosquito nets Yellow feverMosquito nets Dengue fever“ Dengue fever“ Filariasis“ Filariasis“ W. Nile fever “ W. Nile fever “ Sleeping sicknessTsetse fly control Sleeping sicknessTsetse fly control