Prevention and treatment https://www.who.

i
Key measures to prevent diarrhoea include: nt/news-room/fact-
 access to safe drinking-water; sheets/detail/diarrh
 use of improved sanitation; oeal-disease
 hand washing with soap;
 exclusive breastfeeding for the first six months of life;
 good personal and food hygiene;
WHO. 2017.
 health education about how infections spread; and
 rotavirus vaccination. Diarrhoeal
Key measures to treat diarrhoea include the following: disease.
 Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean
water, salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small Online.
intestine and replaces the water and electrolytes lost in the faeces. https://ww
 Rehydration: with intravenous fluids in case of severe dehydration or shock.
 Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by w.who.int/n
25% and are associated with a 30% reduction in stool volume. a 10-14 day
supplemental treatment course of dispersible 20 mg zinc tablets shortens diarrheoa
ews-
duration and improves outcomes. room/fact-
 Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by sheets/detai
continuing to give nutrient-rich foods – including breast milk – during an episode,
and by giving a nutritious diet – including exclusive breastfeeding for the first six l/diarrhoeal-
months of life – to children when they are well.
 Consulting a health professional , in particular for management of persistent
disease
diarrhoea or when there is blood in stool or if there are signs of dehydration. diakses pada
WHO response
WHO works with Member States and other partners to:
20
 promote national policies and investments that support case management of November
diarrhoea and its complications as well as increasing access to safe drinking-water
and sanitation in developing countries;
2019
 conduct research to develop and test new diarrhoea prevention and control strategies
in this area;
 build capacity in implementing preventive interventions, including sanitation, source
water improvements, and household water treatment and safe storage;
 develop new health interventions, such as the rotavirus immunization; and
 help to train health workers, especially at community level

Treatment of diarrhoea https://rehydrate.or

The main principles of treatment are as follows: g/diarrhoea/tmsdd/
 Watery diarrhoea requires fluid and electrolyte replacement - irrespective of its 8med.htm
etiology. https://apps.who.in
 Feeding should be continued during all types of diarrhoea to the greatest extent t/iris/bitstream/han
possible, and should be increased during convalescence so as to avoid any adverse dle
effect on nutritional status. /
 Antimicrobials and anti-parasitic agents should not be used routinely: most episodes, 10665/40343/9241
including severe diarrhoea and diarrhoea with fever do not benefit from treatment 544449.pdf?
with antimicrobials or antiparasitic agents. The exceptions are: sequence=1
o dysentery, which should be treated with an antibiotic effective for Shigella;
cases not responding to this treatment should be studied for possible WHO. 1992.
amoebiasis; Readings on
o suspected cases of cholera; and diarrhoea:
student manual.
o persistent diarrhoea, when trophozoites or cysts of Giardia are seen in faeces
Online
or intestinal fluid, or when pathogenic enteric bacteria are identified by stool
https://apps.who
culture.
.int/iris/bitstrea
m/handle/10665/
Prevention of diarrhoea
40343/92415444
1. Measures that interrupt transmission of pathogens (agent)
49.pdf?
Although a wide variety of infectious agents cause diarrhoea, they are all transmitted by
sequence=1
common faecal-oral pathways, such as contaminated water, food, and hands. Measures taken
diakses pada 20
to interrupt the transmission of the causative agents should focus on these pathways.
Important measures of proven efficacy include: November 2019
 giving only breast milk for the first 4-6 months of life;
 avoiding the use of infant feeding bottles;
 improving practices related to the preparation and storage of weaning foods (to
minimize microbial contamination and growth);
 using clean water for drinking;
 washing hands (after defecation or handling faeces, and before preparing food or
eating); and
 safely disposing of faeces, including infant faeces.

2. Measures that strengthen host defences

A number of risk factors for frequent or severe diarrhoea reflect impaired host defences.
Measures that can be taken to improve host defences and thus diminish the risk of diarrhoea
include:
 immunizing against measles;
 continuing to breast-feed for at least the first year of life; and
 improving nutritional status (by improving the nutritional value of weaning foods
and giving children more food).


Preventive Strategies https://www.ncbi.n

The World Health Organization (WHO 2004) recently reevaluated these interventions to lm.nih.gov/books/
determine the extent to which they have been effectively implemented and their effect. NBK11764/
1. Promotion of Exclusive Breastfeeding
Exclusive breastfeeding means no other food or drink, not even water, is permitted, except Keusch GT,
for supplements of vitamins and minerals or necessary medicines. The optimal duration of Fontaine O,
exclusive breastfeeding is six months. A meta-analysis of three observational studies in Bhargava A, et
developing countries shows that breastfed children under age 6 months are 6.1 times less al. Diarrheal
likely to die of diarrhea than infants who are not breastfed. Exclusive breastfeeding protects
very young infants from diarrheal disease in two ways: first, breast milk contains both
Diseases. In:
immune (specific) and nonimmune (nonspecific) antimicrobial factors; second, exclusive Jamison DT,
breastfeeding eliminates the intake of potentially contaminated food and water. Breast milk Breman JG,
also provides all the nutrients most infants need up to age 6 months. When exclusive Measham AR, et
breastfeeding is continued during diarrhea, it also diminishes the adverse impact on al., editors.
nutritional status. Disease Control
Those data underpin the global campaign to promote exclusive breastfeeding for the first six Priorities in
months of life by increasing both the initiation and the duration of exclusive breastfeeding. Developing
The strategies include the following:
Countries. 2nd
 hospital policies and actions to encourage breastfeeding and discourage bottle
edition.
feeding
 counseling and education provided by peers or health workers Washington
 mass media and community education (DC): The
 mothers' support groups. International
Bank for
2. Improved Complementary Feeding Practices Reconstruction
Ideally, complementary foods should be introduced at age 6 months, and breastfeeding and
should continue for up to two years or even longer to increase birth intervals. Malnutrition is Development /
an independent risk predictor for the frequency and severity of diarrheal illness. There is a The World Bank;
vicious cycle in which sequential diarrheal disease leads to increasing nutritional 2006. Chapter
deterioration, impaired immune function, and greater susceptibility to infection. The cycle
19. Available
may be broken by interventions to decrease infection incidence to reduce malnutrition or
improving nutritional status to reduce the burden of infection. Microbial contamination of from:
complementary foods and nutritionally inadequate diets during and after diarrhea episodes https://www.nc
increase the risk. Contamination of complementary foods can potentially be reduced by bi.nlm.nih.gov/b
educating caregivers on hygienic practices, improving home food storage, fermenting foods ooks/NBK11764
to reduce pathogen multiplication, or ingesting nonpathogenic probiotic microorganisms that / Co-published
colonize the gut and help resist pathogens. by Oxford
They demonstrate that it is possible to provide nutritionally improved complementary foods University Press,
in diverse cultural settings and that poor mothers are willing to prepare new foods their New York.
children will eat. However, caregivers face considerable time and resource constraints in
providing such foods, especially during episodes of illness. A pilot study in Brazil that
implemented nutritional counseling through the Integrated Management of Childhood Illness
Program reported significant weight gain in children age one year or more, but not in
younger children. Unfortified complementary foods do not meet all essential micronutrient
requirements. Although improvements in vitamin A status do not significantly reduce the
incidence of diarrhea and other common childhood illnesses, vitamin A supplementation can
reduce the frequency of severe diarrhea and mortality.

3. Immunization
Rotavirus Immunization
Almost all infants acquire rotavirus diarrhea early in life, and rotavirus accounts for at least
one-third of severe and potentially fatal watery diarrhea episodes—primarily in developing
countries, where an estimated 440,000 vaccine-preventable rotavirus deaths per year occur
(Parashar and others 2003) An effective rotavirus vaccine would have a major effect on
diarrhea mortality in developing countries.
Cholera Immunization
Endemic cholera is primarily a pediatric disease, although adult morbidity and mortality are
significant, especially during epidemics. The lethality of cholera is due to the physiological
consequences of rapid and profound dehydration. Oral rehydration therapy has dramatically
improved survival and reduced the cost of treatment. Wherever parenteral and oral
rehydration is readily available, even in epidemic situations, a cholera mortality rate above 1
percent indicates failure of the public health system to provide appropriate case management.
A vaccine would further reduce the morbidity and mortality associated with cholera in
endemic areas; however, developing an effective, safe vaccine has proven difficult. The most
immunogenic and protective vaccines tested thus far are administered orally. Two such
vaccines have been licensed: an attenuated live vaccine and a heat-killed vaccine combined
with recombinant cholera toxin B subunit, which functions as an immunoadjuvant (Graves
and others 2000; Ryan and Calderwood 2000). Many developing countries can produce the
killed vaccine, especially without cholera toxin B. Current oral cholera vaccines appear to be
safe and offer reasonable protection for a limited period; however, the main users have been
individual travelers from industrial countries who may be exposed to the risk of cholera
while traveling in endemic areas.
Analysis of an outbreak in Micronesia suggested that a single dose was useful in limiting the
spread of cholera (Calain and others 2004). But because ORT is so inexpensive and useful in
preventing death, immunization is not a high priority. Only Vietnam routinely deploys
cholera vaccine.
Operational information on the costs, logistics, and availability of vaccines for use by global
programs and on the vulnerable populations in high-risk settings who would benefit from
cholera vaccine remains limited. Although scientific interest in a cholera vaccine remains
high, its public health priority is less than that of a vaccine for rotavirus or Shigella.
Measles Immunization
Measles is known to predispose to diarrheal disease secondary to measles-induced
immunodeficiency. Global measles immunization coverage is now approaching 80 percent,
and the disease has been eliminated from the Americas, raising hopes for global elimination
in the near future (GAVI 2005), with a predictable reduction in diarrhea as well.

4. Improved Water and Sanitary Facilities and Promotion of Personal and

Domestic Hygiene
Human feces are the primary source of diarrheal pathogens. Poor sanitation, lack of access to
clean water, and inadequate personal hygiene are responsible for an estimated 90 percent of
childhood diarrhea (WHO 1997). Promotion of hand washing reduces diarrhea incidence by
an average of 33 percent. It works best when it is part of a package of behavior change
interventions. Effects on mortality have not been demonstrated. However, the required
behavior change is complex, and significant resources are needed. Antiseptic soaps are more
costly than plain hand soap and confer little advantage. Washing hands after defecating or
handling children's feces and before handling food is recommended, but it entails an average
of 32 hand washes a day and consumes 20 liters of water (Graef, Elder, and Booth 1993). If
soap is too costly, ash or mud can be used, but access to water remains essential (Esrey
1996).
The greatest effect of improving sanitation systems will be in areas of high population
density and wherever the entire community, rather than single households, adopts the
intervention. Current technology can be costly and difficult to maintain, and in some settings
it is simply not feasible.
Protect, Prevent and Treat Framework https://data.unicef.
Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea org/topic/child-
(GAPPD) health/diarrhoeal-
disease/

Source: Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea
(GAPPD)
Protective interventions provide the foundations for keeping children healthy and free
of disease
 Exclusive breastfeeding: For the first 6 months of life, exclusive breastfeeding
(without additional foods or liquids, including water) protects infants from disease
and guarantees them a food source that is safe, clean, accessible and perfectly
tailored to their needs. Nearly half of all diarrhoea episodes and one-third of all
respiratory infections could be prevented with increased breastfeeding in low and
middle-income countries.
 Adequate complementary feeding and continued breastfeeding: Good nutrition
supports strong immune systems and provides protection from disease. From 6
months to 2 years of age, adequate complementary feeding – providing children with
adequate quantities of safe, nutritious and age appropriate foods alongside continued
breastfeeding – can reduce child deaths, including those due to pneumonia and
diarrhoea.
 Vitamin A supplementation: High-dose vitamin A supplementation helps maintain
strong immune systems and can reduce all-cause mortality by 24 per cent and cases
of diarrhea by 15 per cent. Children between the ages of 6-59 months should be
protected with 2 high-dose supplements of vitamin A every year in countries with
high under-five mortality or where vitamin A deficiency is a public health problem.
Preventative interventions help stop disease transmission and prevent children from
becoming ill
 Immunization: The rotavirus vaccine provides protection against one of the most
common causes of childhood diarrhoea-related death.
 Safe drinking water, sanitation and hygiene: Almost 60 percent of deaths due to
diarrhoea worldwide are attributable to unsafe drinking water and poor hygiene and
sanitation. Hand washing with soap alone can cut the risk of diarrhoea by at least 40
per cent and significantly lower the risk of respiratory infections. Clean home
environments and good hygiene are important for preventing the spread of both
pneumonia and diarrhoea, and safe drinking water and proper disposal of human
waste, including child faeces, are vital to stopping the spread of diarrhoeal disease
among children and adults.
Diarrhea: Proven Ways to Save Lives https://www.cdc.gov/
 Vaccinate for rotavirus healthywater/global/
 Provide diarrhea-burden.html
o Safe water
Centers for Disease
o Adequate sanitation and human waste disposal Control and
 Promote Prevention (CDC).
o Handwashing with soap 2015. Diarrhea:
o Breastfeeding to reduce exposure to contaminated water Common
 Treat appropriately with oral rehydration therapy and antibiotics Illness, Global
 Train health care providers and community health workers on diarrhea treatment Killer. Online
 Educate mothers and caretakers about caring for ill children and when to seek https://www.cd
medical assistance c.gov/healthyw
 Build laboratory diagnostic capability and identify the causes of diarrhea ater/pdf/global/
programs/Globa
ldiarrhea508c.p
df diakses pada
20 November
2019

What Can Be Done

Use effective interventions and proven treatment for diarrhea.
Governments and ministries of health can:
 Provide rotavirus vaccination
 Invest in safe drinking water, hygiene, and sanitation infrastructure
 Monitor progress and needs through the collection, analysis, and reporting of quality
data
 Support clear and targeted health promotion and behavior change programs
Non-governmental/aid organizations can:
 Increase the adoption of proven measures against diarrhea
o Rotavirus vaccination
o Breastfeeding
o Oral rehydration therapy
o Household and community systems for treating and storing water
 Educate communities on the importance of safe water, sanitation, and hygiene
 Enhance and support government initiatives that invest in safe drinking water,
sanitation, and hygiene infrastructure
 Ensure the sustainability of interventions
 Focus on the provision of safe water, sanitation, and hygiene when responding to
emergency and conflict situations
Health care providers and clinical facilities can:
 Ensure availability of adequate medical supplies such as oral rehydration solution
 Improve training programs for health workers and educate them on the proper
treatment of diarrhea
 Ensure that facilities for handwashing, provision of safe water, and proper disposal
 of human waste are provided at ALL healthcare facilities
Encourage appropriate antibiotic use
Meet demand for health workers
Support community health workers
o Improve training programs
o Seek creative ways to motivate them
Communities can:
 Support and promote the importance of community health workers
 Ensure safe water is provided close to people’s homes
 Discourage/eliminate open defecation
 Develop strategies for proper disposal of human waste
 Construct basic sanitation facilities
 Promote handwashing

In 1982 the Diarrhoeal Diseases Control Programme of WHO (WHO/CDD) initiated a http://citeseerx.ist.
systematic study of interventions that might play a role in diarrhoea control, excluding the psu.edu/viewdoc/d
clinical and case-management interventions. A list of 18 interventions was drawn up (Table ownload?
2) mobilized to analyse the evidence concerning the effective- ness and feasibility of these doi=10.1.1.819.782
interventions. For interventions found to be effective and feasible, more detailed studies of 3&rep=rep1&type
costs and cost- effectiveness have been initiated. =pdf
Several interventions have been found to be ineffective or of limited feasibility or too costly
and so do not appear to have a major role in diarrhoeal diseases control programmes in
developing countries in the foreseeable future.

These are:
• enhancing lactation.
• supplementary feeding programmes.
• • chemoprophylaxis.
• • fly control.
• Other interventions are of uncertain effectiveness, feasibility or cost and require more
research before their potential role in diarrhoeal diseases control programmes can be
assessed. These are:
• preventing low-weight births,
• using growth charts,
• increasing child spacing,
• vitamin A supplementation,
• improving food hygiene,
• control of zoonotic reservoirs,
• epidemic control.
The final group of interventions are those for which the evidence for high
effectiveness and feasibility is reasonably strong. These are:
- promotion of breast feeding.
- improving weaning practices.
- rotavirus immunization.
- cholera immunization (in special circumstances).
- measles immunization.
- improving water supply and sanitation facilities.
• promoting personal and domestic hygiene.

1. First, those seven interventions known to be effective and feasible must be

operationalized in developing countries. Not all interventions are appropriate
everywhere. For instance, in rural India it would not in general be necessary to
promote breast feeding, whereas in Latin America, and in urban areas throughout the
world, this intervention is likely to be a highly cost-effective method of controlling
diarrhoea morbidity and mortality. In Latin America, cholera vaccination would not
be appropriate and, indeed, in most countries it will be much less cost-effective than
the data for Bangladesh, reported here, suggest. Both rotavirus and cholera
vaccination must await the results of the current field trials of the new vaccines.
2. Each country must decide for itself which package of interventions is likely to be
most effective and feasible. The method of implementation of these interventions
will vary widely by intervention and by country. Measles immunization and water
supply and sanitation are already being implemented in many countries, primarily for
reasons other than diarrhoea control. The diarrhoea control programme in a country
should liaise closely with those responsible for these interventions and try to ensure
that the benefits to diarrhoea control from these activities are realized in practice.
3. The three educationally-based interventions, aimed at improving breast feeding,
weaning and hygiene, are not being vigorously carried out in most countries today.
There is great scope for new initiatives in this field, with carefully designed and
targeted messages being delivered through multiple channels. The techniques of
social marketing may have much to offer. Lastly, inclusion of rotavirus or cholera
immunization must await the results of field trials of the new vaccines. Much will
depend on the recommended vaccination schedule. For instance, rotavirus
vaccination will be most easily and cheaply incorporated into existing EPI
programmes if it is given at the same time as oral polio vaccine. By contrast, cholera
vaccination will be most problematic, in terms of cost and coverage, if it is given in
multiple doses in the second year of life. There may be trade-offs between the
optimum age of vaccina- tion for the individual and the optimum for the community,
bearing in mind that coverage may fall as recommended vaccination age rises.
4. Second, the predictions about effectiveness and cost made in the desk study reported
here must be tested in the field. Interventions should be closely monitored and data
on their impact on diarrhoea, their costs and many operational features should be
collected and analysed. For some interventions, such as water supply and sanitation,
there is already an enormous amount of accumulated operational experience. For
others, most notably weaning and hygiene promotion, relatively little is known and
many countries have no prior experience of these activities. Detailed studies will
sometimes be required to design educational programmes that are capable of
reaching mothers with compre- hensible, relevant and feasible advice.
5. Third, each analysis in the series (Table 2) specifies areas of scientific uncertainty
that require further research. Such research is especially important for the seven
effective interventions and for the additional seven, listed on page 111 of this paper,
for which effectiveness or feasibility cannot yet be determined. A new generation of
intervention- focused research is required to address questions which will assist in
the design or implementation of specific interventions. WHO/CDD have recently
announced a new initiative to promote and fund research of this kind.

Prevention https://www.chp.go
1. Maintain good personal hygiene v.hk/en/healthtopic
 Perform hand hygiene frequently, especially before handling food or eating, and after s/content/24/10.ht
using the toilet. ml
 Wash hands with liquid soap and water, and rub for at least 20 seconds. Then rinse
with water and dry with a disposable paper towel or hand dryer. If hand washing
facilities are not available, or when hands are not visibly soiled, hand hygiene with
70 to 80% alcohol-based handrub is an effective alternative.
 Wear gloves and a surgical mask while disposing of or handling vomitus and faeces,
and wash hands thoroughly afterwards.
 Refrain from work or attending school, and seek medical advice if suffering from
 vomiting or diarrhoea.
2. Maintain good food hygiene
 Adopt the 5 Keys to Food Safety in handling food, i.e. Choose (Choose safe raw
materials); Clean (Keep hands and utensils clean); Separate (Separate raw and
cooked food); Cook (Cook thoroughly); and Safe Temperature (Keep food at safe
temperature) to prevent foodborne diseases.
 Drink only boiled water from the mains or bottled drinks from reliable sources.
 Avoid drinks with ice of unknown origin.
 Purchase fresh food from hygienic and reliable sources. Do not patronise illegal
hawkers.
 Wash and peel fruit by yourself and avoid eating raw vegetables.
 Cook all food thoroughly before consumption, particularly seafood and shellfish.
3. Maintain good environmental hygiene
 Regularly clean and disinfect frequently touched surfaces such as furniture, toys and
commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25%
bleach with 99 parts of water), leave for 15 to 30 minutes, and then rinse with water
and keep dry. For metallic surface, disinfect with 70% alcohol.
 Use absorbent disposable towels to wipe away obvious contaminant such as vomitus
or faecal spillage. Then disinfect the surface and neighbouring areas with 1:49
diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water),
leave for 15 to 30 minutes and then rinse with water and keep dry. For metallic
surface, disinfect with 70% alcohol.
 Maintain good indoor ventilation.
 Maintain proper sanitary facilities and drainage system.
 Clean and disinfect toilet used by infected persons and soiled areas.

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial,
viral and parasitic organisms. Common infective causative agents include bacteria such as Salmonella and Vibrio
parahaemolyticus, and viruses such as norovirus, rotavirus, sapovirus and astrovirus. Less common causative
agents include the bacteria causing bacillary dysentery, cholera and Shiga toxin-producing Escherichia coli
infection, etc. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result
of poor hygiene.

https://www.pharmacytimes.com/publications/issue/2018/july2018/diarrhea-causes-management-and-prevention-
strategies
Viral infections cause most cases of diarrhea and are typically associated with mild-to-moderate symptoms with
frequent, watery bowel movements, abdominal cramps, and a low-grade fever. Viral diarrhea generally lasts
approximately three to seven days.
The following are the common causes of diarrhea caused by viral infections (viral gastroenteritis):
 Rotavirus is a common cause of diarrhea in infants.
 Norovirus (for example, Norwalk virus, caliciviruses) is the most common cause of epidemics of diarrhea
among adults and school-age children (for example, cruise ship infection, schools, nursing homes, day care
facilities, and restaurants).
 Adenovirus infections are common in all age groups.
Bacterial infections cause the more serious cases of infectious diarrhea. Typically, infection with bacteria occurs
after eating contaminated food or drinks (food poisoning). Bacterial infections also cause severe symptoms, often
with vomiting, fever, and severe abdominal cramps or abdominal pain. Bowel movements occur frequently and may
be watery and individuals may experience "explosive diarrhea" which is a very forceful, almost violent, expulsion of
loose, watery stool along with gas.
The following are examples of diarrhea caused by bacterial infections:
 In more serious cases, the stool may contain mucus, pus, or blood. Most of these infections are associated
with local outbreaks of disease. Family members or others eating the same food may have similar illnesses.
 Foreign travel is a common way for a person to contract traveler's diarrhea. (Traveler's diarrhea also may be
caused by unfamiliar viruses or parasites.)
 Campylobacter, salmonellae, and Shigella organisms are the most common causes of bacterial diarrhea.
 Less common causes are Escherichia coli (commonly called E. coli) Yersinia, and Listeria.
 Medications that one takes long-term may cause chronic diarrhea, including antibiotic-associated diarrhea.
Use of antibiotics can lead to an overgrowth of Clostridium difficile (C diff) bacteria in the intestines.
Parasites cause infection of the digestive system by the use of contaminated water. Common parasitic causes of
diarrheal disease include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
Intestinal disorders or diseases (including those that affect the small intestine or colon) including inflammatory
bowel disease including ulcerative colitis and Crohn's disease, irritable bowel syndrome (IBS), diverticulitis,
microscopic colitis, and celiac disease, and malabsorption (trouble digesting certain nutrients) are non-infectious
causes of chronic diarrhea. Many of these disorders can cause the diarrhea to be yellow in color.
Reaction to certain medications can cause drug-induced diarrhea including antibiotics, blood pressure medications,
cancer drugs, gout medications, weight loss drugs, and antacids (especially those containing magnesium).
Intolerance or allergies to foods such as artificial sweeteners found in sugar-free foods and lactose intolerance (to
the sugar found in milk) can cause chronic diarrhea.
Alcohol abuse can cause diarrhea. Both binge drinking and chronic alcoholism may lead to loose stools.
Laxative abuse is one of the biggest self-induced causes of diarrhea, by taking too many laxatives, or taking them
too frequently.
Diabetic diarrhea can be a complication of diabetes.
Radiation therapy or chemotherapy may cause loose stools and the diarrhea may last for up to three weeks after
treatment ends.
Some cancers are more likely to cause diarrhea, including carcinoid syndrome, colon cancer, lymphoma, medullary
carcinoma of the thyroid, pancreatic cancer, and pheochromocytoma.
Digestive surgery including stomach or intestinal surgery may cause diarrhea.
Running can cause diarrhea (sometimes referred to as "runner's trots"). This usually happens after longer distances
over 10K or particularly hard runs.

https://media.neliti.com/media/publications/283648-pelaksanaan-program-penanggulangan-diare-a2f2c372.pdf
https://media.neliti.com/media/publications/161509-ID-persepsi-masyarakat-tentang-diare-dan-pe.pdf

1. Agent: Mikroba (Bakteri, virus, parasit) dan nonmikroba

2. Host : Karakter individu, PHBS, Status gizi, Imunitas
3. Lingkungan : Fisik (kualitas fisik sumber air = keruh, warna, bau)
Biologis (mikroba di air dan di makanan)
Kimia (kandungan bahan kimia yg berbahaya dalam air dan makanan)
Kondisi sosial, ekonomi, dan budaya
Kualitas pelayanan kesehatan sekitar
Ada beberapa faktor yang menjadi penyebab terjadinya diare diantaranya, faktor infeksi oleh karena mikroorganisme
tertentu, faktor malabsorbsi dan faktor makanan. Serta beberapa faktor yang mempengaruhi diare meliputi faktor
lingkungan, faktor perilaku, faktor gizi, dan faktor sosial ekonomi (Suharyono, 2008). Faktor lingkungan yang paling
dominan yaitu sarana air bersih dan pembuangan tinja. Kedua faktor ini berinteraksi bersama dengan perilaku
manusia. Apabila faktor lingkungan tidak sehat karena tercemar kuman diare dan berakumulasi dengan perilaku
manusia yang tidak sehat pula, maka penularan diare dengan mudah dapat terjadi (Depkes, 2005). Faktor gizi juga
ikut mempengaruhi diare, dimana semakin buruk gizi seorang balita, ternyata semakin banyak episode diare yang
dialami. Selain itu, faktor lainnya adalah sosial ekonomi yang juga berpengaruh terhadap diare pada balita. Dimana
meliputi pendidikan, pekerjaan, pendapatan dan kepemilikan kekayaan dan fasilitasi (Suharyono,2008). Penelitian
yang dilakukan Melina (2014) menunjukkan bahwa ada pengaruh yang signifikan antara tingkat pendidikan dengan
kejadian diare pada balita. Tingkat pendidikan ibu yang rendah menjadikan mereka sulit diberitahu mengenai
pentingnya kebersihan perorangan dan sanitasi lingkungan untuk mencegah terjadinya penyakit menular, yang salah
satunya diare (Sander, 2005). Sedangkan hasil penelitian Sulistioratih (2002) menunjukkan bahwa ada pengaruh
antara tingkat pendapatan dengan kejadian diare pada balita. Keluarga dengan tingkat pendapatan rendah lebih
banyak menderita diare dibandingkan dengan keluarga yang tingkat pendapatannya tinggi.
Upaya pencegahan diare tergantung kepada kedisiplinan seseorang dalam menjaga kebersihan makanan dan
minuman. Dengan menerapkan kebiasaan bersih, seseorang dapat terhindar dari virus atau mikroorganisme lain yang
dapat menyebabkan diare. Jika ditinjau dari aspek triad epidemologi penyakit infeksi, munculnya diare bisa
dipengaruhi 3 aspek yaitu aspek host, agen penyebab diare, dan lingkungannya. Berikut ini merupakan bentuk bentuk
upaya pencegahan yang bisa dilakukan jika ditinjau dari 3 aspek pemicu diare.

1. Faktor Patogen atau Mikroba (agen)

Berbagai macam agen infeksi yang dapat menyebabkan diare secara umum ditularkan melalui jalur fecal-
oral seperti air yang terkontaminasi, makanan, dan tangan. Langkah-langkah yang dapat diambil untuk
menurunkan angka diare dapat difokuskan pada jalur ini adalah sebagai berikut.
a. Memberikan ASI selama 4-6 bulan pertama kehidupan.
Selama 6 bulan pertama kehidupan, pemberian ASI eksklusif (tanpa makanan atau cairan tambahan,
termasuk air) melindungi bayi dari penyakit dan menjamin sumber makanan yang aman, bersih, mudah
diakses, dan sesuai dengan kebutuhannya. Menyusui eksklusif melindungi bayi dari penyakit diare
dengan dua cara: pertama, ASI mengandung faktor antimikroba imun (spesifik) dan nonimun (tidak
spesifik); kedua, pemberian ASI eksklusif menghilangkan asupan makanan dan air yang berpotensi
terkontaminasi. ASI juga menyediakan semua nutrisi yang dibutuhkan bayi hingga usia 6 bulan. Ketika
pemberian ASI eksklusif dilanjutkan selama diare, itu juga mengurangi dampak buruk pada status gizi.
Strategi tersebut meliputi:
1. kebijakan dan tindakan rumah sakit untuk mendorong pemberian ASI dan mencegah pemberian
susu botol
2. konseling dan pendidikan yang diberikan oleh teman sebaya atau petugas kesehatan
3. media massa dan pendidikan komunitas
4. kelompok pendukung ibu.
b. Menghindari penggunaan botol susu bayi;
c. Meningkatkan pengetahuan dan kemampuan ibu terkait dengan penyapihan bayi untuk meminimalkan
kontaminasi mikroba;
d. Memberi probiotik
Probiotik tersebut terbukti bermakna pada pencegahan diare akibat rotavirus dan diare terkait
penggunaan antibiotik (antibiotic associated diarrhea-AAD), namun efektivitasnya pada pengobatan
diare akut belum banyak diteliti. Mekanisme kerja probiotik adalah berkompetisi untuk berlekatan pada
enterosit usus, sehingga enterosit yang telah jenuh dengan probiotik tidak dapat lagi berlekatan dengan
bakteri lain sehingga menghambat pertumbuhan kuman patogen selain berkompetisi dengan patogen
untuk mendapatkan tempat dan nutrisi (Shinta, dkk. 2011).

2. Faktor Host
Beberapa faktor risiko pada diare yang berat dapat mencerminkan gangguan imunitas host. Langkah-langkah
yang dapat diambil untuk meningkatkan imunitas inang hingga dapat mengurangi risiko diare termasuk:
a. Imunisasi
- Imunisasi Rotavirus
Hampir semua bayi mendapatkan rotavirus diare di awal kehidupan, dan rotavirus menyumbang
setidaknya sepertiga dari episode diare berair yang parah dan berpotensi fatal-terutama di negara-
negara berkembang, di mana diperkirakan 440.000 kematian rotavirus yang dapat dicegah dengan
vaksin per tahun terjadi. Vaksin rotavirus yang efektif akan memiliki efek besar pada kematian diare di
negara-negara berkembang.
 - Imunisasi Kolera
Kolera endemik terutama merupakan penyakit anak-anak, walaupun morbiditas dan mortalitas dewasa
adalah signifikan, terutama selama epidemi. Kematian kolera disebabkan oleh konsekuensi fisiologis
dari dehidrasi yang cepat dan berat. Terapi rehidrasi oral telah sudah sangat mampu meningkatkan
kelangsungan hidup dan mengurangi biaya perawatan Vaksin kolera oral saat ini tampak aman dan
bisa cukup melindungi dalam jangka waktu terbatas. Namun, pengguna utama vaksin ini adalah
dikhusukan pada turis dari negara-negara industri yang mungkin terpapar risiko kolera saat bepergian
di daerah endemis. Analisis wabah diare menunjukkan bahwa dosis tunggal sudah bisa membatasi
penyebaran kolera (Calain dkk. 2004). Tetapi karena ORS sangat murah dan berguna dalam mencegah
kematian, imunisasi bukanlah prioritas tinggi. Hanya negara tetentu saja yang secara rutin
menyebarkan vaksin kolera, seperti Vietnam.
- Imunisasi Campak
Campak diketahui merupakan predisposisi penyakit diare sekunder akibat imunodefisiensi. Cakupan
imunisasi campak global kini mendekati 80 persen, dan penyakit ini telah dieliminasi dari Amerika,
meningkatkan harapan untuk eliminasi global dalam waktu dekat (GAVI 2005), dengan penurunan
diare yang dapat diprediksi juga.
b. Suplementasi Vitamin A
Suplementasi vitamin A dosis tinggi membantu menjaga sistem kekebalan tubuh yang kuat dan dapat
mengurangi kasus diare hingga 15 persen. Meskipun perbaikan dalam status vitamin A tidak secara
signifikan mengurangi kejadian diare dan penyakit anak-anak lainnya, suplemen vitamin A dapat
mengurangi frekuensi diare dan kematian yang parah. Anak-anak antara usia 6-59 bulan harus
dilindungi dengan 2 suplemen vitamin A dosis tinggi setiap tahun di negara-negara dengan angka
kematian balita yang tinggi atau di mana kekurangan vitamin A merupakan masalah kesehatan
masyarakat..
c. Menerapkan perilaku hidup sehat
Hampir 60 persen kematian akibat diare di seluruh dunia disebabkan oleh air minum yang tidak aman
dan kebersihan dan sanitasi yang buruk. Mencuci tangan dengan sabun saja dapat mengurangi risiko
diare sedikitnya 40 persen dan secara signifikan menurunkan risiko infeksi pernapasan. Lingkungan
rumah yang bersih dan kebersihan yang baik adalah penting untuk mencegah penyebaran pneumonia dan
diare, dan air minum yang aman dan pembuangan kotoran manusia yang tepat, termasuk kotoran anak,
sangat penting untuk menghentikan penyebaran penyakit diare pada anak-anak dan orang dewasa.
d. Meningkatkan status gizi dengan mengonsunsi makanan yang sehat
Nutrisi yang baik mendukung sistem kekebalan yang kuat dan memberikan perlindungan dari penyakit
sehingga dapat mengurangi insidensi diare. Malnutrisi adalah prediktor risiko independen untuk
frekuensi dan tingkat keparahan penyakit diare. Ada lingkaran setan di mana penyakit diare berurutan
menyebabkan peningkatan penurunan gizi, gangguan fungsi kekebalan tubuh, dan kerentanan host yang
lebih besar terhadap infeksi. Siklus tersebut dapat diputuskan oleh intervensi dengan mengurangi
kejadian infeksi, mengurangi malnutrisi, atau meningkatkan status gizi untuk mengurangi beban infeksi.
Kontaminasi mikroba dari makanan pelengkap dan diet yang kurang gizi selama dan setelah episode
diare meningkatkan risiko diare. Makanan pendamping yang tidak difortifikasi yang tidak memenuhi
semua persyaratan mikronutrien esensial pun bisa juga berperan pada pemicu risiko diare. Kontaminasi
makanan pelengkap berpotensi dapat dikurangi dengan mendidik pengasuh pada praktik higienis,
meningkatkan penyimpanan makanan di rumah, memfermentasi makanan untuk mengurangi multiplikasi
patogen, atau menelan mikroorganisme probiotik nonpathogenik yang menjajah usus dan membantu
melawan patogen.
e. Memperhatikan kebersihan makanan dan minuman
Mengedepankan 5 Kunci Keamanan Pangan dalam menangani makanan, yaitu Pilih (Pilih bahan baku
yang aman); Bersihkan (Jaga kebersihan tangan dan peralatan); Pisahkan (Pisahkan makanan mentah dan
matang); Masak (Masak sampai matang); dan Suhu Aman (Simpan makanan pada suhu yang aman)
untuk mencegah penyakit yang terbawa melalui makanan. Minum hanya air matang ataupun minuman
dari sumber yang dapat dijamin. menghindari minuman dengan es yang tidak diketahui asalnya.
f. Menjaga kebersihan pribadi
g. Menggunakan air bersih untuk kebutuhan air sehari-hari
h. Mencuci tangan sebelum dan sesudah memulai sesuatu, terutama sebelum dan sesudah menyiapkan
makan, serta setelah buang air besar maupun kecil.
Promosi mencuci tangan mengurangi kejadian diare dengan rata-rata 33 persen. Hal ini merupakan salah
satu intervensi pada perubahan perilaku. Dianjurkan untuk mencuci tangan setelah buang air besar atau
memegang feses anak-anak dan sebelum menangani makanan, tetapi hal itu memerlukan rata-rata 32
mencuci tangan sehari dan mengonsumsi 20 liter air (Graef, Elder, dan Booth 1993). Cuci tangan dengan
sabun cair dan air, dan gosok setidaknya selama 20 detik. Kemudian dibilas dengan air dan keringkan
 dengan handuk kertas sekali pakai atau pengering tangan. Jika fasilitas mencuci tangan tidak tersedia,
atau ketika tangan tidak terlihat kotor, kebersihan tangan dengan 70 hingga 80% antiseptik berbasis
alkohol adalah alternatif yang efektif. Jika sabun terlalu mahal, abu atau lumpur dapat digunakan dengan
tetap mengedepankan akses penggunaan air.
i. Membuang kotoran dengan aman, termasuk kotoran bayi.
Kotoran manusia adalah sumber utama patogen diare. Sanitasi yang buruk, kurangnya akses ke air
bersih, dan kebersihan pribadi yang tidak memadai bertanggung jawab atas 90 persen diare pada masa
kanak-kanak (WHO 1997). Efek terbesar dari peningkatan sistem sanitasi akan berada di daerah dengan
kepadatan populasi tinggi dan di mana pun seluruh masyarakat, daripada rumah tangga tunggal,
mengadopsi intervensi. Teknologi saat ini dapat mahal dan sulit untuk dipertahankan, dan dalam
beberapa pengaturan itu tidak layak.

3. Faktor Lingkungan
 Menjaga kebersihan lingkungan sebaik mungkin
Secara teratur bersihkan dan disinfeksi permukaan yang sering disentuh seperti furnitur, mainan dan
barang-barang yang biasa digunakan bersama dengan 1:99 pemutih rumah tangga yang sudah
diencerkan (pencampuran 1 bagian pemutih 5,25% dengan 99 bagian air), biarkan selama 15 hingga 30
menit, lalu bilas dengan air dan tetap kering. Untuk permukaan logam, desinfektan dengan alkohol 70%.
menggunakan handuk sekali pakai penyerap untuk membersihkan kontaminan yang jelas seperti muntah
atau tumpahan kotoran. Kemudian desinfektan permukaan dan daerah sekitarnya dengan 1:49 pemutih
rumah tangga yang diencerkan (pencampuran 1 bagian dari 5,25% pemutih dengan 49 bagian air),
biarkan selama 15 hingga 30 menit dan kemudian bilas dengan air dan tetap kering. Untuk permukaan
logam, desinfektan dengan alkohol 70%.
 mempertahankan ventilasi dalam ruangan dan lingkungan dengan baik.
 memperbaiki kualitas sumber air yang dipakai untuk kebutuhan sehari-hari
pemutusan rantai penularan diare salah satu intervensinya adalah penyediaan air bersih yang memenuhi
syarat kesehatan termasuk lokasi sumber air bersih serta tempat penyimpanan untuk mencegah
terjadinya pencemaran khususnya oleh tinja
 memperbaiki kondisi jamban yang ada di rumah ataupun jamban umum di masyarakat
 mengupayakan perbaikan dan menjaga sanitasi lingkungan dan sistem drainase
 meningkatkan pengetahuan masyarakat tentang segala hal terkait diare
hal ini bisa dilakukan dengan peran aktif tenaga kesehatan untuk memberikan penyeluhan dan edukasi
kepada masyarakat terhadap bahayanya diare dan upaya pencegahannya
Penyakit diare saat ini lebih banyak dihubungkan dengan perilaku dibandingkan dengan infrastruktur atau
akses air. Saat ini teknologi sudah sangat pesat berkembang, hingga selama ada air, maka kualitas dapat direkayasa
agar memenuhi ambang batas konsumsi. Di Indonesia, walaupun seringkali musim kemarau berkepanjangan
melanda, tapi curah hujannya pun tinggi. Jadi selama masyarakat mampu mempertahankan suplai airnya, maka
kualitas air dapat dipertahankan dengan menggunakan berbagai teknologi penyaringan (filter) hingga membran. Oleh
karena itu, komponen yang tersisa tinggal perilaku bersih dan sehat, yang sering disingkat menjadi PHBS (Clasen
2007). Sebagian besar intervensi memang difokuskan ke perilaku hidup bersih dan intervensi sumber air di rumah
tangga, terakhir adalah intervensi pengobatan. https://www.bmj.com/content/334/7597/782
Khusus masalah diare, upaya pencegahan haruslah terpadu dan tidak bisa memfokuskan pada satu faktor
karena ketiga faktor tersebut saling tumpang-tindih. Seperti contoh, untuk menghindari kontaminasi dengan mikroba
patogen penyebab diare yang ada di air sebaiknya dengan mencegah perilaku manusia untuk buang air besar
sembarangan dan meningkatkan kebersihan pribadi dan lingkungannya. Hal ini karena sangat susah untuk melakukan
eradikasi mikroba penyebab diare tersebut secara langsung. Sehingga satu satunya hal yang bisa dilakukan adalah
mengubah perilaku hidup manusia agar lebih sehat yang akan berdampak pula pada kesehatan lingkungan.

KESIMPULAN:
Beberapa upaya yang dapat dilakukan untuk mencegah diare pada masyarakat adalah dengan
vaksinasi untuk rotavirus, menyediakan air yang aman dan sanitasi dan pembuangan limbah
manusia yang memadai, memajukan program cuci tangan dengan sabun dan menyusui untuk
mengurangi paparan air yang terkontaminasi, mengobati dengan tepat dengan terapi rehidrasi oral
dan antibiotik, melatih penyedia layanan kesehatan dan petugas kesehatan masyarakat tentang
pengobatan diare, mendidik ibu dan pengasuh tentang merawat anak yang sakit dan kapan harus
mencari bantuan medis, membangun kemampuan diagnostik laboratorium dan mengidentifikasi
penyebab diare
Langkah-langkah utama untuk mengobati diare meliputi:
 Rehidrasi
Rehidrasi bisa dengan larutan garam rehidrasi oral (ORS). ORS adalah campuran air bersih,
garam dan gula. Harganya terjangkau. ORS diserap di usus kecil dan menggantikan air dan
elektrolit yang hilang. Ataupun bisa juga dengan cairan intravena jika dehidrasi parah atau
syok.
 Suplemen Zn
Suplemen Zn atau zinc atau seng dapat mengurangi durasi episode diare hingga 25% dan
dapat pula menurunkan 30% volume feses.
 Makanan kaya nutrisi
Lingkaran setan kekurangan gizi dan diare dapat diputuskan dengan memberikan makanan
kaya nutrisi, termasuk ASI, dan dengan memberikan diet bergizi, termasuk menyusui eksklusif
selama enam bulan pertama kehidupan.
 Konsultasikan dengan profesional kesehatan, khususnya untuk manajemen diare persisten
atau ketika ada darah dalam tinja atau jika ada tanda-tanda dehidrasi.

Peran WHO
WHO bekerja dengan Negara-negara Anggota dan institusi lainnya untuk:
 mempromosikan kebijakan dan investasi nasional yang mendukung manajemen kasus diare
dan komplikasinya serta meningkatkan akses ke air minum dan sanitasi yang aman di negara-
negara berkembang;
 melakukan penelitian untuk mengembangkan dan menguji strategi pencegahan dan
pengendalian diare baru di bidang ini;
 membangun kapasitas dalam mengimplementasikan intervensi preventif, termasuk sanitasi,
peningkatan sumber air, dan pengolahan air rumah tangga dan penyimpanan air yang aman;
 mengembangkan intervensi kesehatan baru, seperti imunisasi rotavirus; dan
 membantu melatih petugas kesehatan, khususnya di tingkat masyarakat
Pemerintah dan kementerian kesehatan dapat:
 Berikan vaksinasi rotavirus
 Berinvestasi dalam infrastruktur air minum, kebersihan, dan sanitasi yang aman
 Memantau kemajuan dan kebutuhan melalui pengumpulan, analisis, dan pelaporan data
berkualitas
 Mendukung program promosi kesehatan dan perubahan perilaku yang jelas dan ditargetkan
Organisasi non-pemerintah
 Menggalakkan program yang telah dicanangkan, seperti Vaksinasi rotavirus, program ASI
eksklusif, Terapi rehidrasi oral, Sistem rumah tangga dan masyarakat untuk mengolah dan
menyimpan air
 Mendidik masyarakat tentang pentingnya air bersih, sanitasi, dan kebersihan
 Meningkatkan dan mendukung prakarsa pemerintah yang berinvestasi dalam infrastruktur
air minum, sanitasi, dan kebersihan yang aman
 Memastikan keberlanjutan intervensi masksyarakat dan pemerintah
 Fokus pada penyediaan air bersih, sanitasi, dan kebersihan saat merespons situasi darurat
dan konflik
Penyedia perawatan kesehatan dan fasilitas klinis
 Pastikan ketersediaan pasokan medis yang memadai seperti solusi rehidrasi oral
 Meningkatkan program pelatihan bagi petugas kesehatan dan mendidik mereka tentang
pengobatan diare yang tepat
 Pastikan bahwa fasilitas untuk mencuci tangan, penyediaan air bersih, dan pembuangan
limbah manusia yang tepat disediakan di SEMUA fasilitas perawatan kesehatan
 Dorong penggunaan antibiotik yang tepat
 Mendukung petugas kesehatan masyarakat dengan meningkatkan program pelatihan dan
mencari cara-cara kreatif untuk memotivasi masyarakat
Masyarakat
 Melaksanan program sebaik mungkin
 Menjaga kebersihan diri, sanitasi lingkungan dengan penuh tanggung jawab
 Mencegah buang air besar sembarangan
 Membangun fasilitas sanitasi dasar
 Melakukan dan mempromosikan mencuci tangan
 Mendukung dan mempromosikan pentingnya petugas kesehatan masyarakat
 Pastikan air bersih disediakan dekat dengan rumah-rumah penduduk
 Mengembangkan strategi untuk pembuangan limbah manusia dengan tepat