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Diarrhoea Management
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Diarrhoea
Management
Intended to target mothers’ confusion and lack of understanding about how to
recognize, assess the degree of, and treat diarrhoeal dehydration. Mothers
will be taught the crucial need for immediate fluid replacement, increased
fluids and food, how to correctly prepare home-made and packaged ORS,
cereal-based ORS, when and why to use it, and continuous feeding, including
breastfeeding. |
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Chronically Undernourished
40% of both mothers and children in Maharashtra, India are chronically
undernourished, and under-five mortality occurs at 58 deaths per 1000 live
births, or 1 in every 17 children. A very large number of these deaths are
caused by dehydration from diarrhoea, the most easily preventable cause of
childhood mortality. |
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Continuous Feeding
During Diarrhoea
Experience shows that food should not be withheld from infants and children
with acute diarrhoea. Depending on their feeding status, children should
receive breast-milk or diluted milk feeds; in cases of dehydration, these
should be offered as soon as initial rehydration therapy has been completed.
Appropriate locally available foods (cereals) should be offered as soon as
the appetite returns. After the diarrhoea ceases, more than the usual amount
of food should b given for a short period. The routine use of any special
infant formula (lactose-free products) for diarrhoea cases should be strongly
discouraged as they are only rarely necessary and are costly. |
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Recognizing Dehydration
If mothers could recognize and treat dehydration early
on at home, the great majority of children would not need additional medical
care. While only 41% of mothers in Maharashtra can correctly identify
symptoms suggesting a child needs medical treatment for dehydration, 77% take
a child with diarrhoea to a health facility. In this way, better practice and
education would save mothers the trouble and expense of travelling to the
health centre (and also prevent them from spending money on unnecessary
drugs), and it would release some of the burden on health facilities,
allowing better treatment for children who are severely ill. |
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Correcting Dehydration with Home-made Solutions
Define and Promote Home-Made Solutions--define clear definitions for
home-made solutions (tea, rice water with extra rice, etc.)
The first-level health worker, a community health worker who has a crucial
role to play in disseminating knowledge and skills for the management of
diarrhoea, as regards the use of both home remedies and ORS. ORS packets
should be available in adequate supply at this level and throughout the
entire health system. If this is not possible, maximum efforts should
continue towards this end and, in the meantime, as complete a formulation as
possibly should be used, recognizing its limitations. When potassium is a
missing ingredient, patients should be encouraged to drink fluids that are
rich in potassium (fruit juices).
Increased fluids and Preparation of home-made and packaged solutions. For the preparation of ORS solution the
safest water should be used. |
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Measuring Sugar, Salt and Water
Correct the confusion created by years of mixed messages regarding
measurement of the ingredients in rehydration solutions. Mothers will receive
a plastic one-litre bottle, with a label about how to recognize signs and
degrees of dehydration, how to prepare home fluids for rehydration, and how
to mix and prepare home-made and packaged ORS. Additionally, they will
receive a 2-sided spoon to correctly measure salt and sugar. |
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Cereal Based ORT
Oral rehydration therapy, if properly practiced, can cut infant and child
mortality rates by at least half and obviate the need for countless millions
of costly visits to hospitals, health centres, and clinics in all countries.
But is this feasible? Packets of oral rehydration salts (ORS) are not
universally available and the simpler sugar-salt solution can have dangerous
effects if it is improperly mixed or administered. Cereal-based ORT can
overcome both of these disadvantages by providing yet another option for oral
rehydration therapy. |
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Zinc Supplementation
ORS and Zinc : Treatment of diarrhoea is now more effective
Prevent deaths from diarrhoea and decrease child susceptibility to diarrhoea
after episodes by educating all health-care providers and mothers about zinc
supplementation. Through focused and integrated campaigns, and through
partnerships with local manufacturers, we will increase availability of zinc
supplements. |
Diarrhoea Prevention
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Breastfeeding
Protect against diseases through the promotion of clear guidelines about
proper feeding practices and the benefits of immunity. Promote the practice of
providing colostrum to the child within the first half hour after birth,
exclusive breastfeeding during the first six months of a child’s life, with
appropriate complementary feeding from six months and continued breastfeeding
for two years or beyond, with supplementation of vitamin A and other
micronutrients as needed. |
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Complementary Feeding
Complementary feeding means giving foods in addition to breastmilk.
Malnutrition can result from suboptimal breastfeeding practices, poor
quality complementary foods, detrimental feeding practices, and
contamination of complementary food and feeding utensils. The second half
of an infant's first year is an especially vulnerable time because infants
are learning to eat and must be fed soft foods frequently and patiently.
If nutritional intake is inadequate, the consequences persist throughout
life. |
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Nurturing Newborns
Skilled attendance during pregnancy, childbirth and the immediate
postpartum period. Mothers will be provided with training for breastfeeding
from the nurse or midwife, encouraged about the importance of providing
colostrum within the first half hour after birth, and advised about other
questions they may have about their newborn or postpartum period. |
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Timing Births
Encourage the culture of having children later in life and having a child at
least 24 months after a previous birth. Reduce health risks for children born
to mothers under the age of 18 by educating about the importance of timing
births as it relates to the dangers of diarrhoea. |
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Measles Immunization
Reduce incidence of diarrhoea by promoting measles vaccination within the
first year of a child’s life. 100% immunization coverage against measles is
the programme goal. |
Safe Water Management
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Safe Water Systems
Safe Water Systems are water quality interventions that employ simple,
inexpensive and robust technologies appropriate for the developing world. The
objective is to make water safe through disinfection and safe storage at the
point of use. The basis of the intervention is:
Point-of-use treatment of contaminated water using sodium hypochlorite
solution purchased locally and produced in the community from water and salt
using an electrolytic cell;
Safe water storage in plastic containers with a narrow mouth, lid, and
a spigot to prevent recontamination;
Behaviour change techniques, including social marketing, community
mobilization, motivational interviewing, communication, and education, to
increase awareness of the link between contaminated water and disease and the
benefits of safe water, and to influence hygiene behaviours including the
purchase and proper use of the water storage vessel and disinfectant. |
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Water Disinfection
Treat soiled water and prevent the spread of disease by promoting the
practice of boiling water and the usage of chlorine, iodine, or even
household bleach, to conduct home water disinfection. Health workers will be
trained to use these practices, and will convey the techniques to mothers. |
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Solar Disinfection
of Water
Disinfect soiled water with this free and easy technique using solar
radiation. This simple process of filling transparent containers with water,
and exposing them to full sunlight for about five hours, destroys pathogens
in the water. |
General Health Education
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Hand Washing with Soap and Water
Promote the habit of Hand Washing with Soap and Water to decrease episodes
of diarrhoea. To ensure the sufficient availability of soap, campaigns,
collaborated with local manufacturers, will be used to promote this practice. |
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Facts for Life Wall Calendar
This 13-month calendar, corresponding to the 13 Facts for Life messages,
makes life-saving information easily available to everyone. It presents
important health information about an issue or concern that every family has
a right to know. The messages are simple, and people in Maharashtra can act
on them. The calendar will also indicate state health days, and health
educational mass media events. |
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Television Broadcasts
Educate the entire community about health issues through documentaries,
commercials, news programs, public service announcements, and other TV
programs. The broadcasts, linked to the Facts for Life Calendar, will
advertise health days, and health educational mass media events and other
monthly TV health shows. |
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Radio Broadcasts
and Community Radio
Educate the general public and mothers about health issues through an
informal dialogue in various radio formats (interviews, documentaries, quiz
shows). The radio programme will educate with the same messages as the TV
broadcasts, but reach a wider audience. |
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