Model Answer
0 min readIntroduction
Acute diarrhoea, characterized by the sudden onset of three or more loose or watery stools in 24 hours lasting less than 14 days, remains a significant global health challenge, particularly affecting children under five. It is a leading cause of childhood morbidity and mortality worldwide. In India, despite declining trends, diarrhoeal diseases continue to be a major contributor to under-five deaths. Effective nutritional management during an acute episode and robust preventive strategies are critical to mitigate its impact, prevent dehydration, malnutrition, and ultimately reduce child mortality rates. Adherence to evidence-based guidelines from organizations like WHO and UNICEF is paramount in this endeavor.
Nutritional Management of Acute Diarrhoea
The primary goals of nutritional management during acute diarrhoea are to prevent dehydration, reduce the duration and severity of the illness, and prevent nutritional deterioration. The World Health Organization (WHO) and UNICEF advocate a multi-pronged approach that includes oral rehydration therapy, zinc supplementation, and continued feeding.1. Oral Rehydration Therapy (ORT) with Low-Osmolarity Oral Rehydration Solution (ORS)
ORT is the cornerstone of diarrhoea management. ORS is a solution of clean water, sugar, and salts that helps replenish fluids and electrolytes lost due to diarrhoea. The current recommendation is for low-osmolarity ORS, which has a total osmolarity of 245 mOsm/L, proven to be more effective than older formulations in reducing stool output, vomiting, and the need for intravenous fluids.
- Mechanism: Glucose in ORS facilitates the absorption of sodium and water in the small intestine through sodium-glucose co-transport mechanisms.
- Administration: ORS should be offered frequently in small sips, even if the child is vomiting. The quantity depends on the degree of dehydration and age.
2. Zinc Supplementation
Zinc is a vital micronutrient that plays a crucial role in immune function and intestinal integrity. Its supplementation is recommended as an adjunct to ORS.
- Dosage: WHO and UNICEF recommend daily 20 mg zinc supplements for 10-14 days for children with acute diarrhoea, and 10 mg per day for infants under six months old.
- Benefits: Zinc supplementation reduces the duration and severity of diarrhoeal episodes and the likelihood of subsequent infections for 2-3 months. Studies have shown it can reduce the duration of acute diarrhoea by approximately half a day and prevent one in four diarrhoea deaths.
3. Continued Feeding
Contrary to older practices of withholding food, continued feeding is crucial during and after an acute diarrhoeal episode to prevent malnutrition and promote recovery.
- Breastfeeding: Exclusively breastfed infants should continue breastfeeding frequently and for as long as they desire.
- Complementary Foods: Children receiving complementary foods should continue their usual diet, including nutrient-rich, easily digestible foods. Avoiding dilution of milk and routine use of lactose-free formula is generally recommended, except in specific cases of severe malnutrition or persistent diarrhoea where lactose intolerance might be a concern.
- Post-Diarrhoea Feeding: After the diarrhoeal episode subsides, mothers should be advised to provide extra feeds to help children recover lost weight and prevent further nutritional setbacks. Nutrient-dense mixtures of common foods are advisable for compensatory growth.
Steps for Prevention of Acute Diarrhoea
Preventing acute diarrhoea requires a multi-sectoral approach focusing on improving hygiene, sanitation, access to safe water, and vaccination.1. Safe Water and Sanitation (WASH)
- Access to Safe Drinking Water: Ensuring communities have access to treated and safely stored drinking water. Household water treatment methods can also play a role.
- Improved Sanitation: Promoting the use of proper toilets and latrines, and safe disposal of human faeces, especially for infants and young children.
- Handwashing with Soap: Advocating frequent handwashing with soap and water, particularly after defecation, after handling human or animal faeces, and before food preparation and eating.
2. Good Personal and Food Hygiene
- Food Safety: Emphasizing safe food preparation, storage, and handling practices to prevent contamination. This includes cooking food thoroughly, eating it promptly, storing it safely, reheating it thoroughly, and using safe water and raw materials.
- Personal Hygiene: Regular bathing and maintaining overall cleanliness.
3. Exclusive Breastfeeding and Appropriate Complementary Feeding
- Exclusive Breastfeeding: Promoting exclusive breastfeeding for the first six months of life significantly reduces the risk of diarrhoeal diseases by providing antibodies and protecting against contaminated foods and water.
- Timely and Appropriate Complementary Feeding: Introducing safe, nutritious, and appropriate complementary foods from six months of age while continuing breastfeeding up to two years or beyond.
4. Immunization
- Rotavirus Vaccine: The Rotavirus vaccine is a critical intervention against rotavirus, a leading cause of severe diarrhoea in children. India introduced the Rotavirus vaccine into its Universal Immunization Programme (UIP) in a phased manner starting in 2016, with plans for nationwide coverage.
- Measles Vaccine: Measles infection can lead to severe diarrhoea, so measles vaccination also plays an indirect role in preventing diarrhoea-related complications.
5. Nutritional Interventions
- Vitamin A Supplementation: Routine vitamin A supplementation helps boost immunity and reduces the severity of diarrhoeal episodes.
- Promotion of Zinc-Rich Foods: Encouraging the consumption of zinc-rich foods in the diet can help maintain adequate zinc levels.
Conclusion
The effective management of acute diarrhoea hinges on a two-pronged strategy encompassing both timely nutritional intervention during illness and comprehensive preventive measures. Implementing WHO and UNICEF guidelines for Oral Rehydration Solution and zinc supplementation, coupled with sustained feeding practices, can drastically reduce morbidity and mortality. Simultaneously, investing in improved WASH facilities, promoting rigorous hygiene, advocating exclusive breastfeeding, and ensuring high vaccination coverage, especially for rotavirus, are indispensable for preventing diarrhoeal episodes. India's commitment to these strategies, as seen through its Universal Immunization Programme and sanitation initiatives, holds the key to safeguarding child health and achieving broader public health goals.
Answer Length
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