Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual
Classification :
1. Acute diarrhoea (<2 wks)
- Acute watery diarrhoea
- Dysentery
2. Persistent diarrhoea (2-4 weeks)
3. Chronic diarrhoea (>4 weeks)
Mode of Transmission: Faeco-oral
Etiology:
-Infective
-Non-infective
Infective Causes:
1. Bacterial:
-E.coli,Shigella,Vibrio cholerae,campylobacter,Salmonella,bacillus cereus, stahylococcus aureus
2. Reo=Respiratory and Enteric Orphans ; Most important Reo virus is ROTA ,
Noro ( Norwalk, Astro, Calici) , Adeno ( adenovirus 40,41 )
3. Parasitic ( amoebiasis, giardiasis)
4. Parenteral ( URTI, otitis media, UTI )
Non-Infective Causes :
• 1.Inflammatory Bowel Disease – crohn’s, Ulcerative colitis
• 2.Anatomic & mechanical causes – short bowel syndrome, fistula, Hirschprung
• 3.Pancreatic & Hepatic disorders – cirrhosis, hepatitis, biliary atresia
• 4.Biochemical causes – coeliac disease, glucose galactose malabsorption
• 5. Neoplastic causes – carcinoid, adenocarcinoma
• 6.Immune deficiencies – AIDS
• 7.Endocrinoathies – hyperthyroidism, Addison’s
• 8.Malnutrition- protein calorie malnutrition, marasmus
• 9.Dietary factors – overfeeding,introduction of new food
• 10.food intolerance – allergic gastroenteropathy
• 11.Psychogenic / functional disorders- irritable bowel syndrome
• 12.Toxic diarrhoea – ingestion of heavy metal eg.arsenic, lead
Scope of the Problem
•Amongst the poor and especially in developing countries, diarrhoea is a major killer.
•In 1998, diarrhoea was estimated to have killed 2.2 million people, most of whom were under 5 years of age (WHO, 2000).
•Each year there are approximately 4 billion cases of diarrhoea worldwide.
•Diarrhoea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. It is most commonly caused by gastrointestinal infections which kill around 2.2 million people globally each year, mostly children in developing countries.
• World-wide around 1.1 billion people lack access to improved water sources and 2.4 billion have no basic sanitation.
• Diarrhoea due to infection is widespread throughout the developing world.
• In Southeast Asia and Africa, diarrhoea is responsible for as much as 8.5% and 7.7% of all deaths respectively.
• Generally, the highest incidence occurs in the first two years of life, followed by a decline
• with increasing age. In children under the age of 5, an estimated 4 billion acute cases of diarrhea occur each year, resulting in 2 million deaths.
Rotaviruses (RV) are the leading cause of severe diarrhoeal disease and dehydration in infants and children under the age of 5 worldwide
As of 31 March 2007, the World Health Organization estimates that globally
527 000 (475 000 - 580 000) child deaths occurred during 2004 due to rotavirus infection
Organizational Hierarchy
International:
WHO , Geneva
CDC, Atlanta
Malaysia:
Ministry of Health
Public Health Department
Disease Control Division
Communicable Disease Control Section
Food and Water Borne Diseases Control Unit
The Food and Waterborne Diseases Unit (FWBD) is responsible in prevention and control activities for food and waterborne diseases in Malaysia.
• One of the main activities is surveillance of food and waterborne diseases namely cholera, typhoid and paratyphoid fevers, viral hepatitis A, food poisoning and dysentery through the mandatory notifiable diseases surveillance system.
• Through this system, surveillance data is collected through physician-based surveillance and outbreak investigations as there is mandatory requirement for notification of communicable diseases by the Prevention and Control of Infectious Disease Act 1988 (PCID 1988).
• Notification is received from government health facilities consisting of health centers, outpatient departments and hospitals and also from the private hospitals and general medical practitioners.
The surveillance system has been improved recently through the introduction of the Communicable Diseases Information System (CDCIS), an electronic version of reporting, directly linking between hospital record offices' to the district, state and national communicable diseases surveillance system.
As a referral center for food and waterborne disease, the FWBD Control Unit is responsible in providing a guideline and technical support to the State Health Department and District Health Office in any activity related to FWBD including management of FWBD crisis or outbreak, development of plan of action, research, training and health promotion.
• This unit also responsible to communicate with other units or departments within or outside MOH to coordinate activities with regard to control and prevention of food and water borne diseases, if the need arises.
Communication has also been tied with international agencies such as the World Health Organization (WHO) and the Centre of Disease Control (CDC) USA.
Food And Waterborne Diseases Unit
• Vision
• Toward a nation that is continuously free and protected from food and water borne diseases.
• Mission
• To serve as the focus for developing and applying disease prevention and control activities for food and water borne diseases, aimed at improving the health of the people of Malaysia.
• General Objective
• To reduce morbidity and mortality due to food and water borne diseases so that they will no longer be a public health problem in the country.
• Specific Objective
• To maintain surveillance network of food and waterborne disease through epidemiologic and laboratory investigations, data collection, analysis and distribution.
• To identify and define preventable health problems relating to food and water borne diseases.
• To design, implement and evaluate operational programs aimed at developing effective diseases prevention and control.
• In carrying our the above functions, collaborates, as appropriate, with other division in the Ministry of Health and other agencies.
LAW : Communicable Disease Prevention and Control(1988) Act 342.
Key measures to reduce the number of cases of diarrhoea include:
• Access to safe drinking water.
• Improved sanitation.
• Good personal and food hygiene.
• Health education about how infections spread.
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