KINE 280 Unit 3 (Childhood Diarrhea) Study Guide

What are the clinical manifestations of childhood diarrhea?

- fever of 37.9 degrees C - vomiting, diarrhea - dehydration, malnutrition and hospitalization

Do cause-specific characteristics of diarrheal pathogens influence the approach to case management and prevention of diarrhea? Why or why not?

- rotavirus can be vaccinated against - cholera cots - somewhat, although treatment varies on disease because cholera kills very quickly versus rotavirus

Consider how Freire's 3 Levels of Conscientization can be applied to health behavior change.

- without awareness of an issue, change will not happen - questioning the public health issue and whether or not it is common or not, how injustice and inequality affect individuals and people - becoming an active agent in changing the reality

What proportion of worldwide child mortality is attributable to childhood diarrhea?

400,000 deaths, about 20-25% of deaths in children under the age of 5 - 3rd leading cause of death in children under 5

What is exclusive breastfeeding? Optimal breastfeeding? What features of breastfeeding make this such an important health behavior?

EBF = first 6 months of life, exclusively breastfeeding and no other substances - lowers risks of infections - reduces risks of newborn deaths by about 20%, under 5 by 13% - SIgA antibodies passed from mother to child, thus helping prevent rotavirus from spreading

Develop an idea to alter the social environment, including environmental cues, as it relates to key-diarrhea preventing behaviors.

HWWS behaviors can be improved by using environmental and societal norms - if after eating, everyone goes to wash their hands, people are likely to wash their hands out of habit or affiliation - affiliation behaviors to wash hands based on how often the people around an individual affects their motivation, affiliation, and comfort levels

Recognize the key prevention and treatment strategies identified in the UNICEF/ WHO 7-Point plan. Discuss how these are related through similar public health efforts.

access to safe water, improved sanitation, HWWS, EBF, good personal and food hygiene, health education on infection spread, rotavirus vaccination

What public health interventions could reduce diarrhea incidence among children?

affiliation amongst caretakers - building habit to wash hands early on and frequently can reduce risks of diarrhea spread by feces - improving sanitation in schools and in hospitals to prevent the spread of rotavirus

Describe why breastfeeding helps to lower diarrhea-related morbidity, as well as other common childhood illnesses?

breastmilk is high in secretory IgA antibodies that transfer from mother to child to help protect their intestinal system - exclusive breastfeeding lowers the risk of infection risks (diarrhea, sepsis, respiratory) - first 6 months of life can prevent aprox. 20% of newborn deaths, 13% of under deaths of children under 5 years

Why is childhood diarrhea considered such a major public health problem?

burden of disease - 1.7 billion cases annually, 3rd leading cause of death (5>) - 400,000 deaths or 20-25% of deaths in children (5>) co-morbid with malnourishment, impaired immunity, and dehydration

Describe the key features of the behaviorist and empowerment/adult learning theories. How does this theory differ from other theories discussed earlier in the semester?

changing lifestyle individually - external forces control choices until realization and the individual is in control of constructing their choices - doesnt consider relapse - questioning the way things are to bring about change, less about fear

Which age range is most at risk for diarrheal infection?

children 6-11 months of age, under 5 years old

Discuss the key health promotion motivations necessary to address to promote hand washing with soap (HWWS)?

disgust, comfort, and affiliation as strong motivators

Critique the concept of health education in relation to key health behaviors necessary for diarrhea prevention.

health behaviors need to be habitual, as fear is not a good motivator behind diarrhea prevention - habitual, motivated, and planned HWWS needs to be instilled in kids and caretakers to prevent the spread of diarrheal disease - cultures that have accepted that diarrhea is normal causes a lack of motivation to change, or disbelief change will occur

How can the diarrheal-malnutrition cycle be broken?

improved sanitation or vaccination to remove the rotavirus, allowing the intestinal system to recover and thus breaking the cycle with improved and healthy GI tract

Appreciate the different biologic bases for mal absorption and secretory diarrhea.

malabsorption: water reabsorption = fecal water loss, so not retaining enough water secretory: GI secretion increases greater than water intake - increased fecal water loss causes watery, loose stools, too much secretions

Describe the relationship between malnutrition and diarrhea. Appreciate the specific nutrient deficiencies that increase diarrhea-related morbidity and mortality

malnutrition can leave the body vulnerable to diarrheal bacterias, which damage the intestinal lining and cause further malnutrition by malabsorption - deficiencies in zinc and vitamin a = increased morbidity

Differentiate between motivations and capacities to perform health behaviors.

motivations encourage a health behavior, whereas a capacity is the ability of someone to fulfill a health behavior - someone may want to practice HWWS, but their capacity to do so may be limited by budgets to purchase soap compared to other basic living needs

What are some ways in which social norms can be changed to promote HWWS?

normalizing HWWS can promote it amongst children and caretakers, regularly and motivated handwashing can create habitual behaviors

What is Oral rehydration therapy? How and why are glucose and salt useful in promoting rehydration during a diarrheal infection? What is the unique historic feature of ORT (i.e. where did it originate?)

oral rehydration therapy reintroduces water into the body with glucose and salts, which are used in cotransporters to move and reabsorb water as fast as possible. glucose is needed to give the cells energy to move the sodium, which in turn leads to reabsorption of water - 1975

Discuss how the simple provision of latrines and toilets stops short of promoting community-level change in sanitation practices?

providing latrines does not make people use them; they must be taught, practiced, and habitual use to encourage real changes in sanitation practices - if a child is only ever taught not to use a latrine and one is suddenly introduced, it may not do anything until that habit has been retaught and a latrine daily usage has been reintroduced

What is MDG Target 7?

reducing by half the proportion of people without access to safe drinking water and sanitation - by 2015 targeted 75% global sanitation coverage by 2015

Discuss the infectious nature of rotavirus and why it is so commonly spread between children.

rotavirus shedding— one gram of feces can have upwards of 10^12 infectious particles, which are resistant to lipid solvent disinfectants + can remain infectious for 7 months at room temperature - only 10-100 particles needed to pass rotavirus, long incubation/survival period, and sheds for 10 days average (but up to 1.5 months) - contagious especially in clinical settings, children acquire in hospitals

How does rotavirus attack enterocytes, and thereby promote malabsorption diarrhea?

rotavirus targets the enterocytes located on the upper intestinal villi — triggers cell death and atrophy of cells, leading to reduced surface area of absorption causing malabsorption of nutrients

What major types of pathogens are responsible for diarrheal infections?

rotovirus, cholera, enterotoxic e.coli, shigella, camplyobacteria, cryptosporidium parnum

What specific features of secretory IgA antibodies enable them to avoid digestion/denaturation in the GI tract?

secretory IgA antibodies have secretory coating that coats the protects immunoglobulins, allowing it to survive in the GI tract

Recognize differences in cholera and rotavirus infection

short intubation period (cholera), painless watery diarrhea in copious amounts - severe dehydration rotavirus has a longer intubation period, highly contagious by hands - can be vaccinated against

Appreciate the general global distribution of deaths related to diarrhea disease. How have diarrheal-related deaths changed over the past 30 years?

slowly decreasing! subsaharan africa seeing lowered death rates from diarrheal disease

What are people's key water-related needs? What are some interventions available to address water quality? at interventions could reduce diarrhea-related mortality among children? Discuss overlapping characteristics of these strategies.

water quantity - is there enough water quality - is it safe enough - centralized purification - chlorination - boiling - solar disinfectant intervention at the environment level - centralized purification, intervention at the personal level = chlorination and boiling