Treating Measles in Children (Document & Slides) (WHO - OMS, 1997, 60 p.): Part 4. TREATING COMPLICATIONS: 26. Complicated measles - outpatient care 4

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Treating Measles in Children (Document & Slides) (WHO - OMS, 1997, 60 p.)

Part 4. TREATING COMPLICATIONS

		18. Where to manage cases
		19. General management principles
		20. Severe complicated measles - hospital care 1 - reasons for admission
		21. Severe complicated measles - hospital care 2 - management issues
		22. Severe complicated measles - hospital care 3 - isolation of children
		23. Complicated measles - outpatient care 1 - pneumonia
		24. Complicated measles - outpatient care 2 - croup
		25. Complicated measles - outpatient care 3 - ear problems
		26. Complicated measles - outpatient care 4 - diarrhoea
		27. Complicated measles - outpatient care 5 - eye problems
		28. Complicated measles - outpatient care 6 - mouth ulcers
		Summary of Part 4

26. Complicated measles - outpatient care 4 - diarrhoea

Slide 26:

CLASSIFICATION OF DEHYDRATION

No dehydration
Some dehydration
Severe dehydration

DEHYDRATION

Assessment and classification

No dehydration	Well, alert, drinks normally, tears present, moist mouth and tongue, skin pinch goes back quickly

Some dehydration	Two or more of the following signs including at least one marked with an asterisk ():*
	restless or irritable*
	thirsty and drinks eagerly*
	skin pinch goes back slowly*
	dry mouth and tongue
	sunken eyes
	absent tears

Severe dehydration	Two or more of the following signs including at least one marked with an asterisk ():*
	skin pinch goes back very slowly*
	lethargic or unconscious*
	drinks poorly or not at all*
	sunken eyes
	very dry mouth and tongue

DIARRHOEA

Diarrhoea is a common complication of measles and causes problems through the resulting dehydration and secondary malnutrition. First assess and classify the degree of dehydration as shown on this slide, and then treat accordingly.

Assessment

· Diarrhoea is usually defined as the passing of loose or watery stools on three consecutive occasions. The degree of dehydration is assessed and classified as shown on this slide.

· If there is blood in the stools then the child has dysentery. The commonest cause of dysentery is a bacterial infection (Shigella).

· If the diarrhoea lasts for 14 or more days then the child is classified as having persistent diarrhoea. If you see a child with persistent diarrhoea and oral thrush, consider HIV infection as a possible diagnosis.

Treatment

· Children with diarrhoea and dehydration should be treated according to WHO guidelines. Children with some dehydration can be managed with oral rehydration (using oral rehydration salts) and proper feeding, while children with severe dehydration require intravenous fluids. Reassess the child according to the WHO guidelines and adapt the treatment plans accordingly.

· Treat dysentery for 5 days with an oral antibiotic recommended for Shigella in your area, usually cotrimoxazole (See Annex C for dosage).

· Persistent diarrhoea is treated by adjusting the diet. If the child is still breast-feeding, increase the intake of breast milk. If breast-feeding has recently been stopped, consider starting it again. If the child is receiving animal milk products, reduce the usual amount or replace with breast milk or a fermented milk product, such as yoghurt, or replace half the animal milk with nutrient-rich semi-solid food.