Diarrheal Diseases in Low- and Middle-Income Countries: Incidence, Prevention and Management

Diarrheal Diseases in Low- and Middle-Income Countries: Incidence,Prevention and ManagementJill W. Ahs*Wenjing Tao Jenny LfgrenBirger C. Forsberg

Oleh: Mentari Inggit A (1015112)

Pembimbing : dr. Franky Saputra, Sp. A.

INTRODUCTIONDiarrheal diseases constitute a major burden of disease in the world, especially in low- and middle-income countries (LMIC).Dehydration resulting from diarrhea causes approximately 1.8 million deaths every year.Around 90% of all diarrhea related deaths occur in children under five years of age living in LMIC.

Many of the risk factors for contracting diarrheal illnesses are associated with poor socioeconomic conditions, such as lacking access to safe water and sanitation, poor hygiene practices and unsafe human waste disposalChildren in households with lower socioeconomic status receive oral rehydration therapy less often than children in households with higher socioeconomic statusMECHANISM OF DIARRHEA AND SUBSEQUENTDEHYDRATIONDiarrhea can be described as the passing of loose or liquid stools.In LMIC, diarrhea is most often a symptom of gastrointestinal infection caused by bacteria, viruses orparasites.Commonly, these pathogens are transmitted via the fecal-oral route, where the pathogens are excreted from the intestinal tract of a person or animal carrying the illness and are ingested by another.In the intestinal tract, the movement of fluids is guided principally by the active secretion of chloride ions across the epithelium.Diarrhea occurs when the absorption and secretion of ions and solute across the intestinal epithelium is disrupted, such that water moves into the lumen in an attempt to restore the appropriate ion concentrations.Dehydration occurs when water and electrolytes are lost and not adequately replaced.Early stagesthirst, restlessness or irritability, loss of skin turgor, sunken eyes, and a sunken fontanelle in infants.A severely dehydrated lethargy, diminished consciousness, a decreased or complete lack of urine output, low blood pressure, a rapid pulse that may be hard to detect, and cool moist extremities that may appear cyanoticETIOLOGYRotavirusShigellaVibrio CholeraeEscherichia coliEnterotoxigenic E. ColiEnteropathogenic E. ColiEnteroaggregative E. ColiSalmonellaREDUCING INFECTIOUS DIARRHEAL ILLNESSESImproved Water QualityImproved Quantity and Ease of Access to WaterImproved Hand Hygiene PracticesSanitation and FliesBreastfeeding and Hygienic Food PreparationVaccinesSYNDROMIC DIAGNOSIS OF DIARRHEAAcute Watery DiarrheaAgents causing this noninflammatory type of enteric illness often produce enterotoxins, as in the case of V. cholerae or ETEC. Cases of watery diarrhea lasting 7 days or longer can have a resulting nutritional penaltyDysentery or Bloody DiarrheaBloody diarrhea is the term used to describe stools that may either visibly contain blood or that contain blood detectable by microscopy. Dysentery describes characteristically small-volume bloody or mucoid stools accompanied by abdominal cramping and tenesmus.Persistent DiarrheaPersistent DiarrheaPersistent diarrhea lasts longer than 14 days. The causes of persistent diarrhea include multiple successive gastrointestinal infections or an infection that has not been resolved. Though persistent diarrhea can be the result of any one of many different enteric pathogens, the most important are Giardia, Cryptosporidium spp., EAEC and EPEC.CASE MANAGEMENT OF INFECTIOUS DIARRHEA

AntibioticsAntibiotics are only recommended for treating dysentery, cholera, and for certain cases of persistent diarrhea in children. For other instances of acute watery diarrhea, antibiotics do not have an important role in treatment.Management of Persistent DiarrheaIn non-bloody persistent diarrhea in children, there is limited evidence to support use of antibiotics. Children with persistent diarrhea need general treatment for diarrhea, special attention and supervision and often, nutritional rehabilitation.CONCLUSIONSIn low-and middle-income countries, diarrheal diseases continue to be an overwhelming problem.For children under five years of age, diarrhea is one of the leading causes of death. With correct treatment, the overwhelming majority of deaths in children from these diseases can be avoided.The lives of many children could be saved by promoting the use of simple treatments like oral rehydration therapy to the public through health services, community health workers and media