DIARRHEAL DISEASES

1. DIARRHEAL DISEASES

2. Top Ten Causes of Deaths in Low-Income Countries http://www.who.int/mediacentre/factsheets/fs310/en/index.html

3. Top Ten Causes of Deaths World-Wide http://www.who.int/mediacentre/factsheets/fs310/en/index.html

4. Importance of Diarrhea According to the World Health Organization, the incidence of diarrheal diseases (2,533 million cases) topped all other diseases in the Southeast Asian (SEARO) and Western Pacific (WPRO) regions in 2004, accounting for 72.8 million disability-adjusted life years (DALYS) - 4.8% of all DALYS worldwide due to both infectious and non-infectious diseases

5. Importance of Diarrheal Diseases • According to the World Health Organization in 2005, 1.8 million people died of diarrheal diseases, nearly 70% of whom were young children • Worldwide, diarrheal diseases are the third leading cause of mortality and morbidity (exceeded only by lower respiratory infections and cardiovascular diseases) • Globally there were 1.7 billion cases of diarrhea in 2013 • Diarrhea is a leading cause of malnutrition in children younger than 5 years

6. WATERTRUMPSOIL

7. "Next to oxygen, water is indisputably the most precious resource we have, and the shortage of freshwater is the biggest long-term problem facing the planet Earth. Even energy is a distant second--with energy, we have alternatives. With water there are none." Gil Grosvenor, chairman of the National Geographic Society World Water Day event focuses on growing thirst. National Geographic 2010

8. The burden of thirst. National Geographic 2010

9. The burden of thirst. National Geographic 2010

10. Water Sources and Usage Nearly 97% of the planet's water is salt water in seas and oceans Close to 2% of Earth's water is frozen in polar ice sheets and glaciers Only a fraction of 1% is available for drinking, irrigation, and industrial use Agriculture accounts for 70% of all water use

11. Lack of Clean Water and Safe Waste Disposal The average American uses a hundred gallons of water at home every day In developing countries, nearly one billion people worldwide have no access to clean water 2.5 billion people (40% of world’s population) have no safe way to dispose of human waste

12. Dirty Water and Lack of Hygiene Dirty water and lack of a toilet and proper hygiene kill 3.3 million people around the world annually, most of them children under age five

13. Reasons for Lack of Clean Water • Climate (drought, deforestation, climate changes) and dropping water tables worldwide (unsustainable rate of water use) • Poverty (inability to build wells or to afford piped water or water purification tablets if available) • Rural dwellers- remote, sparsely populated, drought-stricken villages of the world are least likely to be reached for water provision, education, etc. • Pollution

14. Steps to Reduce Waterborne Diseases • Safe disposal of human waste (latrines) • Hand washing • Education about sanitation • Piped, treated water • Food safety Clasen T, Sugden S. Water and sanitation. Oxford Textbook of Public Health, 5th ed. Oxford Press, England.

15. Politics of Water The United Nation's General Assembly voted to make water a basic human right. But 41 countries, including the United States, opted out, saying they were waiting for more data!

21. Characteristics of Diarrheal Diseases • Oral-fecal route of infection (contaminated water and food) • Leads to rapid dehydration and inability to absorb nutrients from food; survivors may have impaired growth and development, malnutrition, long-term GI disorders, reduced immunity

22. Diarrhea Incidence

23. COMMON CAUSES OF DIARRHEA (1) • Bacteria • Escherichia coli • Salmonella (S. typhii, etc.) • Shigella (S. flexinari , dysenteria, sonnei, etc.) • Campylobacter • Vibrio cholerae

24. COMMON CAUSES OF DIARRHEA (2) • Viruses • Rotavirus • Protozoa • Giardia lamblia • Cryptosporidium parvum • Entamoeba histolytica • Cyclospora cayetanensis

25. IMPACT OF DIARRHEAL AGENTS ON GUT • Directly pathogenic organism • Production of toxin by specific organisms • Disruption of gut mucosa and gut function • Overcome commensal (good) gut organisms • Inflammation of gut mucosa

26. TRANSMISSION ROUTES Direct: fecal-oral Indirect: • Water (e.g. V. cholerae, Norwalk virus) • Food (e.g., salmonella, campylobacter, E. coli, O157:H7) • Eating utensils (e.g., baby bottles, nipples, cups, spoons) • Animals (e.g., C. jejuni, C. perfringens, E. coli, O157:H7) • Flies (carrier, ingested – Shigella) • Poor hygiene (inadequate/infrequent hand washing and non-hygienic feces disposal Promiscuous drug use – overtreatment of humans and antibiotics in animal feed promotes drug resistance

29. HOST RISK FACTORS FOR DIARRHEA Malnutrition (up to 70% increased risk) Micronutrient deficiency (e.g. vitamin A and zinc) Low gastric acid/hypochlorhydria (H. pylori) Reduced gastric acid acidity (e.g. associated with some medications) Compromised cell-mediated immune capacity/response Genetic profile (e.g., blood group O increases susceptibility to V. cholerae)

30. COMMUNITY STRATEGIES TO REDUCE DIARRHEA • Promotion of breast feeding and better weaning practices • Safe water provision and waste disposal • Promotion of hand washing • Measles vaccination • Cholera vaccination in high risk areas • Zinc and vitamin A supplementation • Rotavirus vaccination: Rota Teq, Rotarix

31. Prevention of Diarrheal Diseases Provision of accessible clean water Safe disposal of waste (sanitation) Education of mothers Making home treatment and storage of water inexpensive and feasible Provision of latrines Promotion of hand-washing and personal hygiene Reduce fly population Promotion of breastfeeding and proper weaning POLITICAL WILL MONEY

32. TREATMENT OF ACUTE DIARRHEA Oral rehydration Appropriate energy (food) intake Zinc supplementation for 10-14 days Referral to health facility if not improving on above regimen Antibiotics (dysentery, typhoid fever, cholera only) Intravenous saline (severe cases only)