Intercepció de la radiació solar per la coberta vegetal del cep

definitions Suspected cholera

In areas where cholera unknown to be present:

ƒ A patient over the age of five years old develops severe dehydration or dies following acute watery diarrhoea.

In an area where cholera is endemic:

ƒ A patient over five years develops acute watery diarrhoea.

Confirmed cholera

Isolation of V. cholera O1 or O139 from stool or vomit of suspected case.

Suspected shigella

When there is an unusual increase in the weekly number of cases or number of deaths from bloody diarrhoea.

Confirmed shigella

Confirmed by evidence of acute onset of bloody diarrhoea with visible blood in stool. In some situations, the presence of blood is verified by a health worker.

Case management of diarrhoeal diseases

The goal of case management for diarrhoeal diseases is preventing death from dehydration and circulatory collapse. Early diagnosis of patients with a diarrhoeal illness should be followed by prompt treatment to prevent death from dehydration. The main treatment for acute diarrhoea is rehydration. Stool losses should be replaced with appropriate fluids, feeding should be continued and unnecessary medicines avoided. The same principles can be applied to the treatment of persistent diarrhoea. Health care professionals, volunteers and community health workers (CHWs) must be trained to classify the level of dehydration among diarrhoea patients and manage as described in the table below.

Table 7-27: Classification and management of dehydration among diarrhoea patients

Clinical features Recommended rehydration therapy

Diarrhoea +/- mild

dehydration

ƒ < 4 fluid stools/day. ƒ Alert.

ƒ Not thirsty and drinks normally. ƒ Little or no vomiting.

ƒ General condition normal. ƒ No signs of dehydration. ƒ Skin pinch goes back quickly.

Increase fluid intake at home

Teach caregivers, especially mothers of children with diarrhoea, to administer ORT 50 ml/kg body weight after each diarrhoea episode. Advise caregivers to return if watery stools increase, if child is eating or drinking poorly, has marked thirst, is vomiting, or develops other signs.*

Moderate dehydration

ƒ 4-10 liquid stools/day. ƒ Thirsty and drinks eagerly. ƒ Dry conjunctiva, lips and inside of

mouth.

ƒ Urine flow reduced and concentrated.

ƒ Skin loses elasticity and pinch reacts slowly.

ƒ Pulse rapid. ƒ Respiration deep.

Oral rehydration therapy at an ORT unit or diarrhoea corner

ƒ 100ml/kg body weight in 4 hours. ƒ Reassess patient every 4 hours to

Control of communicable

diseases

Clinical features Recommended rehydration therapy

Severe dehydration

ƒ 10 liquid stools/day. ƒ Frequently lethargic.

ƒ Drinks poorly or unable to drink. ƒ Fluid loss > 8% of body weight. ƒ No urine flow in previous 8-12

hours.

ƒ Eyes deeply sunken.

ƒ Skin pinch reacts very slowly. ƒ Pulse may be rapid or barely

detectable.

ƒ Respiration deep and rapid.

Rapid intravenous rehydration at health facility

ƒ Ringer’s lactate (Hartmann’s solution) 150ml/kg body weight in 4-6 hours.

ƒ Oral rehydration therapy to be instituted as soon as a person can take ORS.

The following table defines other treatment approaches for different diarrhoeal diseases: Table 7-28: Summary of treatment for diarrhoeal diseases

Other diarrhoeal

diseases

Cholera Dysentery

ORS Effective for

diarrhoea due to rotavirus, E. Coli (enterotoxigenic).

Mainstay of treatment for

80-90% of cases. Can be useful.

IVF Required for cases

with severe dehydration.

Required for 1% cases who develop severe

dehydration.

Not often required.

Antibiotics Not useful at all. Appropriate for moderate

or severe dehydration. Selective drug prophylaxis for close contacts.

Mainstay of treatment 5-day course Specific drugs Metronidazole (flagyl) for amoebiasis and giardiasis. Tetracycline, cotrimoxazole, erythromycin, doxycycline, chloramphenicol, furazolidone. ƒ Ampicillin and cotrimoxazole not effective in recent ourtbreaks of SD 1vi. ƒ Increasing resistance to nalidixic acid. ƒ Ciprofloxacin effective but costly. Dietary therapy

Increase fluids and

food intake. Increase fluids and food intake.

Measles

ƒ Measles remains a major childhood killer, despite the availability of a safe and effective vaccine. In 2006, an estimated 242.000 people died of measles; about 217.000 of these deaths were among children under five years old who are the most vulnerable to measles. In 2006, about 74% of all measles deaths occurred in the WHO region of South-East Asia and only 15% in Africa

(http://www.redcross.org/static/file_cont7323_lang0_3016.pdf).

Nearly 600 children under five die from measles each day. Despite the efforts of the global Expanded Programme of Immunisation (EPI), measles is still endemic in many developing countries, especially where conflict prevents routine

Control of communicable

diseases

Bangladesh - One of 150 students at Sahen Cadet Play School in Tangail, receives a measles vaccination during the largest ever vaccination campaign in history. Photo: American Red Cross

immunisation.6 Considerable progress has been made in reducing the measles mortality by 68% worldwide (91% in sub-Saharan Africa), through the founding of the Measles Initiative in 2001, a partnership of the American Red Cross, CDC, WHO, UNICEF and United Nations Foundation. Reference the Measles mortality reduction strategy (attached in fact sheet).

http://www.measlesinitiative.org/index3.asp

ƒ Measles is an acute infection of the virus, Morbillivirus of the family Paramyxoviridae. The disease is spread through close respiratory contact with contagious air droplets. Infected persons can transmit the disease to susceptible hosts even before the appearance of the measles rash. Life-long immunity is acquired after measles infection. The case fatality rate in developing countries is generally in the range of 1 to 5%, but may be as high as 25% in populations with high levels of malnutrition and poor access to health care. People who recover from measles are immune for the rest of their lives2, 32

http://www.who.int/mediacentre/factsheets/fs286/en/).

ƒ Measles can be particularly deadly in countries experiencing or recovering from war, civil strife or a natural disaster. Infection rates soar because damage to infrastructure and health services interrupts routine immunization and overcrowding in camps for refugees and internally displaced people greatly increases the risk of infection Measles outbreaks commonly occur in refugee settings, especially during the acute emergency phase. In general, even with relatively high immunisation coverage (<90%) a number of cases and epidemics occur after a massive population movement and disasters. Major outbreaks have occurred after disasters, notably after the 1991 Mt.

Pinatubo volcanic eruption, after the 2005 South East Asia earthquake and the tsunami in Aceh.38 The following factors may promote the transmission and poor outcome from measles:

ƒ Environment: Overcrowding increases the risk of secondary infection, which increases the severity of disease in all age groups.21 _{Health workers might fail to}

recognise measles cases and not give proper care to people with severe infection.4, 33 _{Disruption of power}

supplies and immunisation services interrupt the delivery of measles vaccine to children. General lack of awareness about measles within the community results in failing to seek appropriate health care for the sick and the spread of disease to others;

ƒ Host: All unvaccinated persons are at risk of developing measles, but the risk of death is highest among children between the age of six months and five years. Immunisation non-responders, poor vaccination practices, malnutrition, chronic vitamin A deficiency, and pre-existing diseases increase the risk of death from measles by decreasing the body’s immunity.

Measles can affect many body systems and most deaths occur

due to secondary infections of the respiratory system and/or Gastro-Intestinal Tract (GIT). This is summarised in the table below. Remember that the incubation period of measles before onset of fever lasts between ten and twelve days. Measles is mostly infectious after four days before the rash until one or two days after the onset of the rash.

Control of communicable

diseases

Table 7-12: Clinical presentation of measles

Clinical measles Complications of measles

Prodromal fever Conjunctivitis Cough Koplik spots Measles rash

Respiratory — croup, bronchiolitis, pneumonia, bacterial super- infections

GIT — diarrhoea, severe dehydration, malnutrition CNS — convulsions, encephalitis

Blood — anaemia Skin — mouth ulcers

Eyes — infections, blindness (Vitamin A deficiency) Ears, nose, Throat (ENT) — middle ear infections, deafness

Note: Very sick children are more likely to develop and die from the viral complications and secondary bacterial infections. Severely malnourished children may have a milder rash but more severe disease.