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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
View the documentMosquitos
View the documentAIDS

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?

Guinea worm (for parts of Africa and India)

One of the favourite gathering places in our community is a large, open well with steps. But drinking water from the well has infected people with guinea worm. Other people became sick by drinking out of ponds or puddles in the fields.

“No one will get guinea worm if we drink only water from protected wells and stand-pipes,” the school teacher explained at a water committee meeting.

“Boiling water makes it safe from guinea worm. You can also filter drinking water through a linen cloth or simple nylon gauze to keep your water free from this disease,” she explained.

“Filtering through a cloth protects us from guinea worm, but not from other diseases,” we were reminded.

“It is a good idea to boil or chlorinate unsafe water if we can.”

Guinea worm eggs in the water are too small to be seen. When the eggs are swallowed they hatch inside the body and grow into large worms.

These fester under the skin, causing so much discomfort for sufferers that they are unable to plant or harvest crops or go to school. A person with guinea worm has itchy blisters which form after the worm has moved close to the surface of the skin.

People with the disease put their feet in cold water for relief from the terrible itching caused by the guinea worm. But the guinea worm also likes cold water. The worm pushes through the skin, hangs through the hole, and lays its eggs.


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Schistosomiasis

“Schistosomiasis (sometimes called bilharzia) is a terrible illness caused by people who have the disease urinating or defecating in water,” the school teacher told us.

“People with schistosomiasis suffer from swollen bellies with pain in the abdomen. They will often have blood in their urine.”

“This disease will disappear if no one urinates or defecates in or near water. It is that simple,” the teacher told us.


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“Schistosomiasis worm eggs are carried in urine and people’s faeces.”

“That is easy to say, but how are we going to get children to follow this rule?” said one mother.

“Mothers are children’s first and greatest teachers,” a neighbour replied.

“Even the urine from young children can carry tiny worms which make others sick,” the teacher explained.

“Older children can see to it that younger ones urinate before playing or swimming in water.

“We have posters in school that children made about preventing the ‘bloody urine disease’.”

“Did you hear the Schisto Song on radio,” some boys shouted before singing:

You can play and splash
when you take a bath,
but water can be mean.

If you have to pee go to a latrine,
never in a river, swamp or stream.

For “one” and “two”
a latrine will defend you,
from bloated bellies and
the bloody urine disease.

Suggestions

Arrange with the health worker and the school teacher to hold a poster drawing competition for children on the subject “how to prevent schistosomiasis”. The best posters could be displayed in the community.

Discussion

Do many children in your community have swollen bellies and blood in their urine?

Are children afraid to use the latrines because the hole is too big, or because they are dark and smelly?

Mosquitos

In one of our water committee meetings we were all annoyed by buzzing and biting mosquitos.

“They are not only annoying, but they also carry malaria and other diseases,” we all complained. “How are we going to get rid of them? They are everywhere.”

“There are also mosquitos that do not buzz. Sometimes you cannot even feel when they bite - but they are still dangerous. Mosquitos are a real problem for us,” said the schoolteacher.

“But where do they come from?” asked a young man.

“I heard on the radio how mosquitos can breed in less than a cup of water,” a woman replied. “Puddles and rubbish near our houses must be full of them. When we leave old containers lying around they fill up with water and mosquitos come to breed.”

“That means if we fill in puddles, unblock drains, and clean up rubbish and old containers, we will be able to get rid of most of the mosquitos,” the young man responded.

“We should also cover any water containers we use.”


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A health worker explained how people near her home filled in puddles.

“Some even turned them into beautiful gardens.”

Ponds can also be stocked with certain kinds of local fish to eat baby mosquitos which are called larvae,” she continued.


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“It would help to cut the grass around our houses because mosquitos use tall grass for resting. Rats and snakes also hide in the grass, so it is a good idea to keep it cut short.”


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One couple with several children told us they protected their family from mosquitos by using mosquito nets.

“We repair the nets regularly.”

“That is a very good way to prevent mosquitos from biting you,” the health worker said.

“You can also protect yourself by wearing clothing which covers your arms and legs, especially after dark.”

“Mosquitos carry several diseases, the most important of which is malaria,” the health worker continued.

“What if we take precautions and still get malaria?” a worried woman asked.

“It must be treated quickly,” the health worker replied.

“If you have a high fever and think you may have malaria, go immediately to the clinic or health practitioner.

“Usually malaria can be treated very effectively with chloroquine or other tablets, if treatment begins straight away.”

“Or you could go to the injection doctor,’’ said a man from the back of the room.

Before the health worker could reply, another man spoke out. “My young son had a fever. We took him to an untrained person who gave him an injection. After the injection, he developed a painful infection. He almost died.”

“Many people think that injections are better than tablets for malaria. This is not so,” the health worker said. “Injections of chloroquine are not better than tablets or syrups. They do not work more quickly.”

She explained that in those cases when injections are really necessary, they should only be given by trained people who have properly sterilized the needle and syringe.

Unsterile injections spread dangerous germs causing abscesses, jaundice and AIDS.

Children can be crippled if the injection is not administered in the proper way.

Fortunately, this tragedy can be avoided in the treatment of malaria because the tablets or syrups are just as effective as injections, except when a child is unconscious, cannot swallow, or is continually vomiting.

“I can see why it is a good idea to deal with our mosquito problem,” an older woman said.

“Fewer mosquitos means less malaria!”

The health worker reminded us that in areas where malaria is a big problem, young children (under five years old) should be treated with an anti-malaria drug within 12-24 hours of first having a fever.

Also, in these areas, all pregnant women should take anti-malaria tablets regularly

AIDS

One day, when our health worker was sitting near the pump chatting to a group of people, a young man said, “Everybody is talking about a virus called HIV and a disease called AIDS, but I do not really understand about this disease.”

The health worker said that she was very pleased that he had asked about AIDS: “HIV is the Human Immunodeficiency Virus. This is the virus which causes people to get AIDS.

“AIDS is the Acquired Immunodeficiency Syndrome, also called Slim in some countries.”

“Many people in our country have HIV and after some time - months or years - get sick with AIDS. Many people have friends and relatives who have HIV infection or the disease AIDS.

“It is time for us all to understand what HIV is and how we can prevent it from spreading. We need to know so that we can help ourselves and others.”

“What is HIV?” we asked.

“HIV is a very small germ called a virus. HIV makes the body go weak and less able to fight sickness. People with HIV in their body go on to become sick with AIDS.”


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How HIV is spread

The health worker carefully explained the different ways in which HIV is spread. “HIV is found in the blood and in the sexual fluids (semen in men and vaginal secretions in women).”

This means that HIV is spread in three main ways:

1. Sex

Most people get HIV from having sex with someone who already has HIV.

2. From infected blood

People get HIV when HIV infected blood enters their blood. This infected blood can come from a blood transfusion. It can also come from a needle or a blade that has been used on a person with HIV and not sterilized afterwards.

3. Mothers to babies

Women with HIV can pass it on to their babies.

The baby becomes infected while in the mother’s womb or as it is being born. There is also some risk of transmission through breast milk.

But breast-feeding is recommended even if the mother or the baby or both have HIV, unless your health worker gives you special reasons not to do so.

Breastmilk is almost always the best food for babies.

“HIV is not spread by sharing food, touching, hugging, shaking hands, crying, sitting close to other people or holding other people in normal ways,” the health worker said.

“You cannot give or get HIV by sharing combs, sheets, towels or clothes.

Sharing toilets or latrines is also safe.”

“Can you get HIV from a mosquito bite?” we asked.

“No. You cannot get HIV from mosquitos, bedbugs or any other insect or animal.”

How HIV infection can be prevented

“How can we avoid becoming infected with HIV?” said an anxious looking woman.

“Here are some ways of keeping safe,” said the health worker.

“As we said, most people get HIV from having sex so the first three ways are the most important:

1. Do not have sex until you get married and then stay faithful to that partner.

2. If you know that you are uninfected and are already sexually active, have sex only with a mutually faithful partner who you know to be uninfected.

3. In all other situations use a condom during sex.”

Other ways of keeping safe are:

4. Women with HIV should seek advice before getting pregnant because they may pass the HIV to the baby.

5. Avoid the need for blood transfusions. Seek medical treatment for hookworm and malaria before you become anaemic.

6. If you cannot avoid a blood transfusion, insist on having blood which has been tested for HIV

7. When you cannot avoid skin-piercing instruments like blades, needles and syringes, insist on having sterilized instruments.

8. Do not share razor blades, because they might come into contact with cut skin.

How can we know if we have contracted the virus?

“Can someone know if they have contracted HIV?” we asked.

“Most people with HIV feel healthy at first, for months or even years.

“They do not know that they have HIV. If you are healthy the only way to know whether you have HIV is to have a special blood test.

“It is important for someone to explain about the test before you take it and to make sure someone is there to talk to after the test,” the health worker explained.

Caring for people with AIDS

“My sister has just found out that she has AIDS,” said one woman, shyly. “I want to look after her, but I am afraid that I could become infected.”

“Do not be afraid,” the health worker reassured her. “Take some simple precautions like covering any cuts or wounds you or she may have with waterproof plasters. If you do not have any plasters, use a piece of clean cloth to cover the wounds. Keep the home very clean. Be careful with any bloodstained clothes or sheets or cloths. Wash them with plenty of soap and water and hang them to dry. The HIV germ cannot survive exposure to sunshine or dryness.

“Remember that your sister needs your love and help. People with HIV or AIDS need support from family members, friends and neighbours.

“We can help make sure that they get medical help, that they have plenty of nutritious food and drink, and that they get enough rest and relaxation.”


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Key points
Unit 2: Coping with our special health problems

· Diarrhoea is one of our special health problems. We can help prevent it by keeping food and water clean, by using latrines and keeping them clean, by breast-feeding and by immunizing children. A child with diarrhoea needs plenty of liquids, food and, if the diarrhoea is severe, trained medical help.

· Guinea worm is also a problem, but can be prevented by boiling or filtering water.

· Schistosomiasis will go away if people do not urinate or defecate near and in water.

· Mosquitos will be less of a problem if we fill in puddles, cut long grass and put fish in our ponds. We can avoid malaria by protecting ourselves from bites. If we get malaria we need medical help.

· Simple precautions can help us protect ourselves from getting AIDS. We can care for people without the risk of becoming ill.