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close this bookFood, Water and Family Health: A Manual for Community Educators (UNDP - WHO, 1994, 108 p.)
close this folderUnit 2: Coping with some of our special health problems
View the documentDiarrhoea
View the documentGuinea worm (for parts of Africa and India)
View the documentSchistosomiasis
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Diarrhoea

All the mothers in our community worry that their children will get diarrhoea.

Diarrhoea is loose watery faeces. Someone who has three or more loose faeces in a day has diarrhoea. In the past many of our children suffered from diarrhoea.

We want to know how to avoid diarrhoea and also what to do if our child has diarrhoea. We decided to ask the health worker about diarrhoea.

Why diarrhoea is so dangerous

“Diarrhoea is dangerous to both children and adults, but it is especially dangerous for children.

“Many children in our country die from diarrhoea because they lose too much liquid from their bodies.

“When a child loses water with diarrhoea, the child begins to dry up, like a plant does when it has no water. This drying up happens especially quickly in young children who have diarrhoea,” the I health worker told the group of women sitting in the shade under a big tree.

“The second reason why diarrhoea can be very dangerous is that some people believe that we should stop feeding, and particularly breast-feeding, children with diarrhoea.

“This is not true. It is very important to feed children with diarrhoea regularly. If a breast-fed child gets diarrhoea, continue to breast-feed the child,” she explained.


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Reducing the risk of diarrhoea

“How can we reduce the risk of our children getting diarrhoea?” asked one young mother.

The health worker told us about four important ways of avoiding diarrhoea:

· Keep food and water clean

Diarrhoea is caused by germs from faeces entering the mouth. These germs can be spread in water, by flies, by dirty food.

Dirty utensils and babies’ bottles increase the risk of getting diarrhoea.

Children may also get diarrhoea if their mothers had dirty hands or dirt under their nails while they prepared food for their children.


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Use the cleanest water possible for drinking. It is very important to keep food and water clean, covered and away from flies. Always wash hands before preparing or eating food.


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If possible food should be thoroughly cooked, and prepared just before eating. Do not leave it standing or it will collect germs.


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· Use latrines and keep them clean

Children and adults should use latrines, and we should quickly clear up the faeces of young children and put them in a latrine.

· Breast-feed

We can also reduce the risk of our children getting diarrhoea and other illnesses by breast-feeding. We should only give breastmilk for the first four to six months of life and continue to breastfeed for at least two years.

· Immunize children against measles

There is no vaccine to prevent ordinary diarrhoea, but because measles often leads to serious diarrhoea, it is very important to immunize children against measles and other common childhood diseases.


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What to do when a child has diarrhoea

“What should we do when a child has diarrhoea?” we asked.

“There are three important rules to remember when looking after a child with diarrhoea,” said the health worker.

Rule 1: Give a child with diarrhoea plenty of liquids to drink

“Rule 1 is to give the child more fluids than usual. Diarrhoea can cause death by draining liquid from a person’s body. You must replace the fluids and energy washed out of your child by the flood of diarrhoea,” she explained.” It is very important to give plenty of liquids to a child with diarrhoea.”

“Give any of the following fluids:

· Breast milk (you must continue breast-feeding when your baby has diarrhoea)
· Oral Rehydration Salts
· Cooked cereal
· Plain water, preferably boiled and cooled
· Food-based drinks, such as soup, rice water and yoghurt
· Fresh fruit juice
· Weak tea
· Coconut water (from a young coconut)

“Do not give soft drinks and sweetened fruit drinks. If milk made with powder or animal milk has to be used, give it to the child from a cup instead of a bottle.

“Always use the cleanest water available.

“Water from open wells, springs and rivers should be brought to a boil or chlorinated and preferably filtered and covered before use.

“The drink should be given from a cup because feeding bottles are too difficult to clean properly.”

How much should the child drink?” we asked.

“Give as much fluids as the child will take. The child should drink every time watery faeces are passed.

“Give a child under 2 years of age between a quarter and one half of a large cup of fluid, with a spoon.

“Older children can sip between a half and a whole cup of fluid. These drinks should be given until the diarrhoea has stopped. This usually takes from three to five days.

“If the child vomits, wait for ten minutes and then begin again, giving the liquid to the child, small sips at a time.”

Oral Rehydration Salts (ORS)

“When my brother’s child had diarrhoea the health worker in his village gave my sister-in-law some packets of special powder. She had to mix the powder with clean water and give the drink to the child to stop her from becoming dehydrated,” my neighbour told us.

“What are these powders?” we all asked the health worker.

“In almost all countries, special drinks for children with diarrhoea are available in pharmacies, shops or health centres” the health worker explained. “Usually these come in the form of packets of Oral Rehydration Salts (ORS). They have to be mixed with the recommended amount of clean water. These salts are specially made to treat dehydration, but we can also use them in the home to prevent dehydration. Do not mix the ORS with liquids such as milk, soup, fruit juice or soft drinks - only mix them with clean water.”

Method for mixing oral rehydration salts (ORS):

· Wash your hands.

· Measure 1 litre, or the correct amount for the packet used, of clean drinking water (boiled and cooled if possible) into a clean container.

· Pour all the powder from one packet into the water and mix well until the powder has completely dissolved. Give to the child to drink.

After each loose stool give the following amount of ORS:

A child of less than 24 months - Half a cup
A child of between 2 and 10 years - One cup

A child of 10 years or more - As much as wanted


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Rule 2: A child with diarrhoea needs food

“Should we feed children with diarrhoea?” asked one young woman, who looked confused.

Before the health worker could reply, a woman with a lively, healthy child on her knee told us her story.

“When my 9 month old son had diarrhoea last year, I did not know whether to feed him or not.

“I asked my aunt and she told me not to feed him. I followed her advice, but my son became very thin and weak.

“I was very worried and went to the health centre in the next village to ask what to do. The nurse there told me that my aunt was not right.

“She said that, as well as giving my child with diarrhoea liquids, it was very important to give him plenty of food.

“I went home and breast-fed my son often and gave him soups, clean boiled water and small amounts of healthy food regularly. He soon recovered and you can all see what a strong child he is now.”

“Now you understand why Rule 2 is that children with diarrhoea need plenty of food. Children must eat many kinds of good foods to stay strong and healthy.

Children who do not eat well are more likely to suffer from diarrhoea and other diseases,” the health worker explained.

While the child is sick

“It is important to feed a sick child. Some mothers think that a child with diarrhoea needs to stop eating.

“This is not true. A sick child should be encouraged to drink clean water and other liquids and to eat nutritious food,” she said.

“Continue to breast-feed frequently. If children are already taking solid or semi-solid food make sure that they get all the different kinds of food that they need.

“These children need soft well-mashed mixtures of the staple food and, if possible, pulses, vegetables, and meat or fish.

“Remember always to add some fat or oil. Fresh fruit juice or mashed banana provide potassium.

“The child may prefer soft foods when sick, so cook and mash or grind the food well. Gently persuade and encourage the child to eat. Offer food at least six times a day.”

After a child has been sick

“When a child recovers he or she will need extra food to regain lost weight.

“Give the same foods after the diarrhoea stops, and give an extra meal each day for the next two weeks.”

Rule 3: Trained help is needed if the diarrhoea is more serious than usual

“Rule 3 is that we should take children to the health worker if they do not get better in 3 days or if they show:

· Marked thirst
· Many watery stools
· Blood in the stools
· Fever
· Eating or drinking poorly
· Repeated vomiting

Suggestions

Arrange for training sessions by the health worker on preventing and treating diarrhoea, especially for older women and traditional healers.

Discussion

Who do mothers consult when their children are sick?

What are the local customs about giving food and fluids to babies and young children with diarrhoea?