Over 90% of deaths from diarrhoea in under-fives would be prevented by:

• giving extra home fluids or Salt Sugar Solution (SSS) at home at onset of diarrhoea (prevent dehydration);

• continuing breast feeding and other feeding throughout the attack of diarrhoea (prevent malnutrition);

• making sure mothers know when to take the child to a health facility;

• correct assessment, treatment and continued feeding at the health facility level (See MOH Chart and Manual);

• treatment of invasive diarrhoea (bloody stool) with antibiotics;

• clear instructions on discharge from the health facility for continuing above treatments and when it may be necessary to return for further treatment;

• referring to hospital for investigation and treatment: severe malnutrition, persistent diarrhoea (lasting > 14 days).

APPROPRIATE Use of antibiotics, NO antidiarrheal and antiemetic drugs.

Assessment and management are summarized on a chart, included here in a form of tables. Further information, copies of the Diarrhoea Management Chart and Diarrhoea Training Manual can be obtained from the Unit of Maternal and Child Health, Ministry of Health.

Special Notes on Assessment

Other signs may be useful in assessing severe dehydration:

• weight loss over a short period;
• signs of hypovolemic shock, fast weak pulses, cold extremities, oliguria or anuria;
• Hyperventilation, deep and fast breathing indicating acidosis.