CHAPTER 11. Worms, Diarrhoea and Dehydration

UNIT 7 COMMON DISEASE
P. 2 TERM 3

Objectives: By the end of this topic pupils should be able to: 1. Describe how each worm enters and harms the body. 2. Name signs and symptoms of worm infestation. 3. Describe some ways of preventing worm infestation. 4. Describe diarrhoea. 5. Name possible causes of diarrhoea. 6. Demonstrate simple ways of treating it. 7. Describe ways of preventing it. 8. Explain the effects of diarrhoea.

Behavioural Changes:

Pupils should:

1. Always wash their hands before eating and after using the toilet.

2. Have a place at home and school where there is water. With for washing hands.

3. Urinate and defecate in a latrine.

4. Keep home and school latrine/toilet clean.

4. Make water safe for drinking and protect it. Avoid buying rotting food and protect food from flies. They should teach family members how to do this, and the reasons for it.

5. Pupils should purify drinking water and protect it from contamination.

6. Pupils should clean all cooking and eating utensils and never feed a baby from a dirty bottle or on dirty water milk or food.

7. Guard against becoming dehydrated by drinking plenty of fluids when they have diarrhoea.

8. Mix ORS correctly and give ORS and extra fluids to their families teach friends how to mix and give ORS.

Sub Topics:

a) Worms, Cause, Effect, Prevention and Treatment of Tape and Round worms.
b) Causes and effect of diarrhoea
c) Prevention of diarrhoea
d) How to treat diarrhoea
e) How to make oral rehydration solution

Main Ideas:

1. Worm infestation can be prevented through simple health habits.

2. All worms can cause discomfort in the stomach and abdomen.

3. Roundworms are dangerous because they can cause a blockage.

4. Diarrhoea can lead to dehydration and death especially in children under five years of age.

5. Diarrhoea can be caused by bad or rotting food, drinking dirty water, eating with dirty hands, and utensils.

6. Viruses, bacterial and worms are found in dirty water, dirty utensils and contaminated food.

7. Flies or fingers can carry germs from feaces to food and cause diarrhoea.

8. Diarrhoea can be prevented by simple health habits.

9. Diarrhoea can be treated by drinking plenty of fluids and continuing to feed.

10. Babies should be breast fed.

Notes for the Teacher:

1. Roundworms

The Problem: Roundworms are about 20 cm long and live in the intestines and stomach. They cause pain and diarrhoea. If they are many, they may cause blockage in the intestines. This prevents food from being digested, and may contribute to malnutrition, and can cause death.

How they are spread: Roundworms are present in the faeces of an infected person. They reach the mouth through dirty hands, and eating raw vegetables which have not been washed. The eggs are swallowed and they hatch into larvae and go into the bloodstream. They get carried into the lungs and are then coughed up and swallowed. In the stomach and the intestines they grow into adult worms.

How to Recognise and Treat Roundworms: Worms cause diarrhoea and general ill-health. Children will have swollen abdomens and become malnourished. Take children to the health centre for worm medicine.

How to prevent roundworms:

1. Use latrines for defecating.
2. Protect food from flies.
3. Wash hands after defecating.
4. Wash hands before preparing or eating food.
5. Wash fruits and vegetables.

2. Tapeworms

The Problem: Tapeworms are long, flat and thin with segmented bodies. The head is small and has sucking discs and often booklets, by which means it holds on to the intestinal wall. The old segments with mature eggs in them, drop from the lower end of the tapeworm and pass out with stools. They can cause diarrhoea and stomach ache.

How they are spread: The eggs may chance to be eaten by cattle or pigs, in whose intestines or stomach they hatch into larvae. These larvae find their way into the muscles or other parts of the animals' body. They become dormant until the flesh of the animal is eaten by a human being or other suitable host.

Prevention of Tapeworm disease: Children should be taught the importance of avoiding eating raw or insufficiently cooked meat. Meat prepared as "mchomo" is very common particularly in Uganda. But the buyers of this meat must be sure that it is sufficiently roasted.

3. Diarrhoea and Dehydration

Why Diarrhoea can be Dangerous: Diarrhoea is where a person has loose, watery stools, (faeces), passed frequently. When a lot of fluids is lost and if it is not replaced a person can become "dehydrated", ill and becomes weak. Children under five years of age who become severely dehydrated, often die. Diarrhoea prevents food being absorbed so it increases malnutrition.

Malnutrition and dehydration from diarrhoea cause many deaths of children.

Causes of Diarrhoea:

Diarrhoea can have many causes, mainly from different viruses and some bacteria found in:

1. Bad food or rotting food.
2. Dirty drinking water.
3. Dirty hands.
4. Dirty eating and cooking utensils (also bottles used for babies).
5. Worms.

Other causes can be:

6. Eating too much unripe fruits (e.g. green mangoes) or heavy, greasy food.

7. Allegies to certain foods.

8. Side effects of some medicines.

9. Some types of malaria.

10. Poor nutrition, malnourished children often get more infection than well nourished children. They get frequent diarrhoea. They also do not absorb food so easily.

How Germs Causing Diarrhoea are passed on:

Germs causing diarrhoea are passed on through dirty water, hands, utensils. The most common way of passing on germs causing diarrhoea is known as the Four Fs.

This is how it happens.

FLIES

These eat faeces and carry the germs into our food.

Figure

FAECES

These contain the viruses, bacteria and parasites which cause diarrhoea.

If people defecate on the ground, small children or animals can pick up the germs.

If people defecate in or near water used in the home, the germs will find their way into the water and in our bodies.

FINGERS

You may touch places where FLIES or FAECES have been and get the germs which cause diarrhoea.

Figure

FOOD

Most germs stay alive in food.

The germs may have come from flies or children or animals. They may also get to food from dirty plates and utensils.

If we eat this food without washing and cooking it, we will get diarrhoea.

How we can prevent diarrhoea:

Simple health habits will prevent diarrhoea.

1. Defecate in a latrine/toilet. Never defecate in or near water, because children playing nearby can get the germs from the feaces. Water may be collected for home use and will have germs in it.

2. Wash hands with soap after using the latrine/toilet and again before touching, cooking, or eating food. Washing helps to get rid of germs.

3. Wash all utensils, after each time they have been used. Store them in a place where flies and dirt cannot fall on them.

4. It is good to breastfeed a baby. Babies who are fed with bottles may get diarrhoea from a dirty bottle or dirty water which is used for washing the bottle. Dirty water or milk may also pass germs to the baby. Breast milk is clean, cheap, convenient and gives some protection to the baby against germs. Even when a baby has diarrhoea they should continue breastfeeding.

5. If food is rotting or bad, do not buy it. If it is rotting at home, throw it away. Keep food away from flies and animals, keep it under a net, in a cupboard, or refrigerator.

6. Purify drinking water. This can be done in different ways:

a) By boiling until water bubles. (This time is needed to kill the germs).

b) Two pot settling way. This is described in the Primary School Health Kit on Water and Sanitation cleaning Dirty Water Instruction Sheet.

c) Using a Water Filter.

Figure

Figure

Sometimes people prefer to use the Two-pot settling way or the water filter because it does not use fuel. It does take time, but children could do it. Boiling water takes fuel and also could be dangerous if pots for boiling water are spilled, or children are left to play near fires.

Figure

7. Protect clean water. Keep protected springs and pumps clean and working properly. Store clean water at home in a pot or container which is clean and covered.

How we can treat diarrhoea:

A person with diarrhoea looses a lot of fluid. This loss of fluid can be very dangerous particularly in young children.

There are four simple rules to follow to help a person with diarrhoea.

In older children and adults give liquids e.g.

· weak sweetened tea.
· soups.
· fruit juices.
· rice water.
· ORS.

Make sure they take a drink after every time they pass diarrhoea.

2. Continue giving the child food.

Feed young children 5 or 7 times a day. Give foods which are easy to digest, such as:

- porridge or posho
- soups
- fish
- eggs.

Also give fruits rich in potassium (as we loose a lot of it in diarrhoea). This is in:

- bananas,
- oranges and lemons,
- passionfruits.

3. Watch for signs of dehydration.

Figure

If young children show these signs, give them plenty to drink and take them to a health centre immediately. If adults show these signs, increase the fluid for them to drink. If they are unable to drink, take them to the health centre.

4. If the sick person has blood or mucous in their diarrhoea or has fever, take them to the health centre the same day.

ORAL REHYDRATION SOLUTION (ORS):

The special drink (ORS) is a mixture of certain important salts and sugar in water. It will prevent dehydration. There are two ways to prepare it.

How to Mix Oral Rehydration Salts from Packets

How to Make Oral Rehydration Solution from Salt and Sugar

MATERIALS REQUIRED:

· Plants.
· Gourds or bottles.
· Water.
· ORS packets.
· Salt and sugar.
· Teaspoon.
· Fruits (quava, orange or passion fruits).
· Tumpeco mug.
· Blue band/kimbo tin or beer bottle.
· The school health kit on control of diarrhoeal diseases and water sanitation.
· The UNEPI/CDD handbook (if available).

SOME ACTIVITIES FOR PUPILS:

1. Have two plants, one with plenty of water, the other without water. Ask pupils to observe and record what happens to each over a period of one week. Compare what happens to the plants with ourselves if we do not have enough water.

2. How we dry up

How fruits dry up.

Take fruits, such as guavas or passion-fruit. Put them in a hot sunny place. Let pupils observe and record what happens to the fruits. Ask them to compare the skin of the fruit to the skin of a person who is dehydrated.

3. How we loose fluid or

Water in a baby with diarrhoea

Children can see the effects of loosing much fluid through this activity.

1. Cut the top off a dry gourd or plastic bottle.
2. Fill the gourd or bottle to the top with water.

(Please draw the pictures in teachers guide volume 2 page 17)

3. Make holes for "tears" and "urine" to pass out.
4. Cover the top with a thin wet cloth.
5. Pull the plug out and get children to observe what happens.

4. How we get and prevent diarrhoea:

Use the "Dirty Habits" story. Either use the pictures to tell the class a story or get them to put the pictures in sequence and different children tell part of the story on each picture.

Use the same cards to get children to correct the habits in the pictures.

Questions to ask the children:

a) What happened to the baby?

b) What happened to the cloth on top? (It should sink in). This is like the soft spot on the top of a baby's head. It sinks in when the baby is dehydrated. Only babies have their soft spot).

c) What do we need to do to make the soft spot rise again?

d) What happened to the tears?

Figure

e) What happened to the urine?

(Both "tears" and "urine" will dry up when a child also vomits. It loses water even faster than when it has diarrhoea alone).

f) What do we need to do to make the bay able to cry with tears and urinate again?

5. Treatment of Diarrhoea

a) Ask children whether they have had diarrhoea in the last two weeks. How was it treated? Make a list of all different ways used locally to treat diarrhoea.

b) Teach them how to mix ORS.

c) Get each child to demonstrate in turn to the class.

d) Ask each child to keep a record in their family of who gets diarrhoea how they helped and how long it lasted.

e) Get children to act out a role play. One is a mother. She brings her baby with diarrhoea to a friend for advice. What advice would the class give?

SKILLS TO DEVELOP:

Pupils should be able to:

1. Write simple works (e.g. names of people in their family).
2. Make a list (e.g. of treatment for diarrhoea).
3. Observe (e.g. the plant and a baby with diarrhoea).
4. Follow instructions (for mixing ORS).
5. Record (e.g. what happens to the plants).
6. Interprete diagrams (e.g. the pictures of dehydrated baby and adult).

EVALUATION:

Ask children to:

1. Name the causes of diarrhoea.
2. List ways of preventing diarrhoea.
3. Describe signs of diarrhoea. (they could draw this)
4. List fluids suitable for a person with diarrhoea.

FOLLOW UP:

· Observe children washing hands after using a latrine and before eating food.

TEST YOURSELF:

(What have you learnt from this chapter?)

1. What is diarrhoea?
2. Explain the dangers of diarrhoea.
3. Describe the 4 F's mentioned in this chapter.
4. How can diarrhoea be prevented?
5. Explain how diarrhoea can be treated?
6. Describe how you can make oral rehydration solution from sugar and salt.