Diarrhea Management in

the Community
 What is
Diarrhea?
• Any Change in number or consistency of stools
in exclusively breast-fed children.
• Passage of 3 or more than 3 loose or watery
stools in 24 hours in children over 2 months of
age.
• Diarrheal illness may be of the following types-
acute watery diarrhea and chronic or persistent
diarrhea (lasting for ≥14 days).
• Blood in stools-Dysentery.
• Usually seen in children between 2 months and
5 years of age.
When is it NOT Diarrhea?
• Frequent passage of soft, semi-
solid stools in an exclusively
breast-fed child.
• No change in consistency or
number of stools.
 Diarrhea and Dehydration
Cause
•Passage of 3 or more than
3 loose or watery stools in
24 hours.
•Any Change in number or
consistency of stools.
•Often associated with
vomiting.
Effect
•During diarrhea
and/vomiting, there is loss of
water and electrolytes.
•Dehydration occurs when
these losses are not
replaced adequately and a
deficit of water and
electrolytes develops.
 What are our challenges in the
treatment of diarrhea?
• Low ORS use rates
• Use of zinc as an adjunct to ORS
• Inappropriate management of dehydration
• Inadequate emphasis on feeding
• Irrational use of antimicrobials & other drugs
• Hand washing
Two simple rules for effective
management of Diarrhea

•ORS
•ZINC
 ORS
ORAL REHYDRATION
SOLUTION
 ORS-Benefits
• Replaces water and salts lost during
diarrhea.
• Reduces dehydration and need for
hospitalization.
• Decrease in severity of diarrhea and
vomiting.
• Decrease in duration of illness.
Preparation of ORS
Three Important Rules

CLEAN HANDS

CLEAN WATER

CLEAN UTENSILS
Preparation of ORS
WHAT IS ZINC?
What are it’s benefits?
 What is Zinc?
• Zinc is a micro-nutrient and promotes immunity.
• It is an important antioxidant and preserves cellular membrane
integrity.
• Promotes the growth and development of the nervous system.
• Rich sources of Zinc are foods of animal origin, such as meat and
fish.
• Zinc is also present in nuts, seeds, legumes, and whole grain cereal,
but the high phytate content of these foods interferes with its
absorption.
• Zinc cannot be stored in the body, and zinc excretion through the
gastrointestinal tract is increased during episodes of diarrhea.

• Young children who have frequent episodes of

diarrhea and have diets low in animal products and
high in phytate-rich foods are most at risk of Zinc
deficiency.
 ZINC- Benefits
• Zinc reduces the fluid and salt loss in stools by
improving mucosal permeability.
• Zinc improves absorption of ORS.
• Reduces the severity and duration of illness.
• Reduces need for antibiotics.
• Acts as a general tonic-improves appetite and
promotes growth.
 Cost Effectiveness of ORS and
Zinc Supplementation
• Decreases the duration and severity of the
episode
• Decreases the need for expensive
hospitalization
• Decreases the use of unnecessary
antibiotics and other drugs
• Further cost-benefit analyses are
underway
Robberstad, Strand, Sommerfelt, and Black. Bull WHO 2004.
Baqui, Black, Arifeen. J Health Pop Nutr. 2004.
 Dosage of Zinc
• Available as ZINC Tablets.
• Given for 14 days for full benefits.
• 20 milligrams per day for children older
than six months.
• 10 mg per day in those younger
than six months.
 Administration of
ZINC
Age Tablet Preparation Duration
Less than 2 Not required
months

2 months – 6 ½ tablet Dissolved in 1 14 days

months (10 mg) tsp of breast
milk

6 months- 5 1 tablet Dissolved in 1 14 days

years (20 mg) tsp of breast
milk/ORS/clean
drinking water
 Diarrhea

Water + Zinc Loss

Electrolytes Loss

Dehydration Lessen absorption capacity

Decreases Immunity

ORS Zinc Tablets

Faster Recovery of Intestine Mucosa

Rehydration Increase in absorption capacity
Increase in immunity
Assessment of a child with
Diarrhea
 PLAN A
Home therapy to prevent dehydration and malnutrition
Children with no signs of dehydration need extra fluid and salt to replace their losses of
water and electrolytes due to diarrhea.

Fluids to be given
ORS
Salted drinks e.g. salted rice water, salted yoghurt drink ,green coconut water.
Home based ORS.
Plain water should also be given.
Commercial fizzy drinks, fruit juices, sweetened tea, coffee, medicinal tea should be
avoided.

How much to give?

Give as much fluid as the child wants until diarrhea stops.
Children < 2 years of age : 50-100 ml of fluid.
Children 2 years - 10 years : 100-200 ml.
Older children and adults : As much as they want.

Zinc supplement
Give 10 / 20 mg (depending on age of the child) every day for 14 days.

What feeds to give?

Breastfeeding should always be continued.
The infant's usual diet should be continued during diarrhea and increased afterwards.
.Emphasize washing of Hands
 PLAN B

For children with severe

dehydration
• Refer the patient.
• Preferred treatment is rapid
intravenous rehydration.
 Prevention of diarrhea
• Exclusive breast feeding for 6 months
• Complementary feeding at 6 months
• Hand washing
• Safe drinking water
• Environmental sanitation and safe
disposal of excreta
THANK YOU