Q. Can Acute Watery Diarrhea spread from person to person?

• Person-to-person transmission is extremely rare, even to healthcare workers during epidemics.
• Drinking water and food contaminated with micro organism from the fecal maters of an infected person is the most common source of AWD infections.

Note the following points:

• Water can be contaminated at its source, during storage or during usage
• Foods can become contaminated when they come into contact with contaminated water, hands and utensils.
• Vegetables that have been fertilized with human excreta (night soil) or “freshen” with contaminated water also become contaminated.
• Soiled hands can also contaminate clean drinking water and food
• Fish taken from contaminated water and eaten raw or insufficiently cooked.
• Flies can also contaminate our food or utensils and also water.

Q. How is Acute Watery Diarrhea and Vomiting treated?

• Most (80 – 90 percent) of AWD patients can be rehydrated with oral rehydration (ORS) therapy alone
• Some (10-20 percent) of severely dehydrated patients require rapid fluid replacement with intravenous (IV) fluids
• Give ORS during and after intravenous (IV) therapy as soon as the patient can drink.
• ORS helps reverse dehydration and correct electrolyte in-balance following the onset of acute sudden watery diarrhea.
• Antibiotics can also be given to severe cases to reduce severity, duration of illness and further transmission.

Q. What are AWD risk factors?

• Acute Watery Diarrhea is naturally found in the environment in many areas around the world
• Under developed countries, during and or post natural and manmade disasters like:
  • Flood
  • Drought,
  • Earth quick
  • War and others
• It can spread from place to place via contaminated water, food, or infected people.

Q. How can AWD  prevented? AWD can be prevented by following Basic AWD Preventive methods:

1. Drink and use safe water
   • Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use
   • Use safe water to brush your teeth, wash and prepare food, and to make ice
   • Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse
   • Piped water sources, drinks sold in cups or bags, or ice may not be safe and should be boiled or treated with chlorine.
   To be sure water is safe to drink and use:
   • Boil it or treat it with a chlorine products
   • If boiling, bring your water to a complete boil for at least 1 minute
   • To treat your water with chlorine, use one of the locally available treatment products and follow the instructions
   • Always store your treated water in a clean, covered container
2. Wash your hands habitually with soap and safe water
   • Before you prepare, handle and eat  food
   • Before feeding/lactating your children
   • After using the latrine or toilet
   • After cleaning your child’s bottom
   • After taking care of someone ill with disease
   • After caring the dead body of same diseases
   • If no soap is available, scrub hands properly with ash or sand and rinse with safe water.
3. Use latrines or bury faeces
   • Do not defecate near water points or on the open field
   • Use latrines or other sanitation systems, like trench latrine, to dispose of fecal matter
   • Wash hands with soap and safe water after defecating
   • Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach  to 9 parts water
   What if there is no a latrine or toilet?
   • Defecate at least 30 meters away from water points and then bury your faeces
   • Dispose of plastic bags containing faeces in latrines, at collection points if available, or bury it in the ground
   • Dig new latrines or temporary toilets:
     • at least a half-meter deep
     • at least 30 meters away from any water points
     • at least 6 meters away from tents or residential places
4. Cook foods well (especially sea foods)
   • keep all foods covered,
   • eat foods hot, and
   • peel fruits and vegetables
   • Avoid raw foods other than fruits and vegetables you have peeled yourself

Q: What are proper hand washing steps? Steps to follow while washing hands are:

• Wet your hands with safe water & Lather thoroughly with soap.
• If there is no soap, scrub your hands with ash or sand.

Q: How AWD does progress?

• The incubation period (the period from when the person ingests contaminated water/food to when they first become ill) ranges from a few hours to 5 days (usually 2 – 3 days).
• Most persons infected with AWD will have very mild illness or not feel ill at all.
• Mild AWD presents as a diarrheal illness with no or moderate dehydration.
• In its severe form, AWD typically presents as follows:
  • sudden onset of illness
  • diarrhea which is profuse, painless and watery, with flecks of mucus in the stool (“rice water” stools)
  • vomiting may occur, usually early in the illness
  • most persons don’t have fever, although children may develop fever
  • Dehydration occurs rapidly because up to 1L of diarrhea may be produced within an hour

How do prepare an Oral Rehydration Solution (ORS) at home?

• If ORS packets are not available at home, mix an oral rehydration solution using the following recipes; depending on ingredients and container availability:
• Formula for making a 1 liter ORS solution using sugar, salt and water
  • Clean or treated Water – 1 liter
  • Sugar – six (6) level teaspoons
  • Salt half (1/2) level teaspoon
  • Stir the mixture till the sugar dissolves
  • Use the solution until the patient arrived at CTC

How water is treated at home?

• Water can be treated with different alternative ways, such, as boiling and chlorination
• Boiling: to achieve complete sterilization of water, it needs to follow the next processes:
  • Boiling must continue for 5-10 minutes after reaching the boiling point.
  • Immediately cool and safely store boiled water for consumption since it may be re-contaminated through poor handling and storage.
• Chlorination: The aim of chlorination is to destroy the pathogens that cause diseases through chemical methods.
  • ;To achieve this, a chlorine dose must be sufficient to:
  • ;Meet the chlorine demand of the water, that is, it must oxidize the contaminants (including reacting with any organic or inorganic substances).
  • Leave a residual, in order to protect against further contamination by ensuring a free residual of 0.2-0.5 mg/l of chlorine in the disinfected water.
  • If the residual chlorine is higher than 0.5mg/l, it may give an unpleasant taste.
• Common chlorine chemicals which are used for clear and turbid water treatments include:
  1. Woha Agar (Water Guard)
     • Pour 20 liters of untreated water into a jerry can.
     • Use the cap of the bottle and pour 1 cap of water Guard and add it to the 20 liters of water.
     • Close the jerry can and shake to mix the contents.
     • Wait for 30 minutes until the micro organism dies.
     • The water is ready to be used after 30 minutes.
     • If necessary pour the treated water into another container.
     • To avoid contamination close the water container.
     • Use separate jug to fetch water from the container
     • Don’t immerse the jug in to the water container
  2. Aqua tab:
     • Prepare 20 liters of water to be treated,
     • If the water is not turbid, treat by adding one tablet.
     • If the water is turbid, filter through a cloth and then add 2 tablets
     • After adding the tablets, mix the tablets with the water thoroughly
     • Wait at least for 30 minutes and then use the water for intended purposes
  3. PUR (Purifier of Water):
     • Prepare 10 liters of water to be treated
     • Open the sachet and add the contents to an open bucket containing 10 liters of water
     • Stir for 5 minutes,
     • let the solids settle to the bottom of the bucket
     • Strain or filter the water through a clean cotton cloth into a second container and
     • Wait 20 minutes for the hypochlorite to inactivate the microorganisms.
     • Use the water intended purposes.
  4. Bishangari
     • Prepare 20 liters of water to be treated
     • Open the sachet and add the contents to an open bucket containing 20 liters of water
     • Stir for 5 minutes, let the solids settle to the bottom of the bucket
     • Strain or filter the water through a cotton cloth into a second container, and wait 20 minutes for the hypochlorite to inactivate the microorganisms.
     • Use the water intended purposes.
     •  Solar disinfection of water (SODIS):
     • The aim of solar disinfection is to destroy pathogenic germs that may be present in the water based on the principle of pasteurization.
     • SODIS is a method of disinfecting water using only sunlight and plastic polyethylene bottles.
     • The polyethylene bottles are bottles that are currently used to sell mineral water or soft drinks.
     • SODIS is a free and effective method for decentralized usually applied at the household level.
     Steps of implementing SODIS:
     • Collect several colorless, transparent polyethylene water bottles with few surface scratches.
     • Remove the labels on the bottle and wash the bottles before use.
     • Fill the bottles with water from the source.
     • To improve oxygen saturation, fill the bottles to three quarters, shake it for 20 seconds with the cap on, then fill it completely and recap.
     • Very cloudy water with turbidity higher than 30 NTU must be filtered prior to exposure to the sunlight.
     • Expose the filled bottles to the sun for a minimum of 6 hours on a sunny day.
     • If it is a cloudy day expose it for 2 days.
     • Bottles will heat faster and to higher temperatures if they are placed on a sloped sun-facing corrugated metal roof as compared to thatched roofs.
     • Now the water is clean and it can be consumed directly from the bottle or poured into clean drinking cups.
     • Consider the following when using SODIS:
     • The bottles must not hold more than 3 liters.
     • Do not use old bottles with too many scratches on it.
     • SODIS does not work satisfactorily during lengthy periods of rain, cloud cover.
  5. Slow sand filtration:
     • The aim of slow sand filtration (SSF) is to reduce bacteria, turbidity and organic levels
     • The process percolates untreated water slowly through a bed of porous sand, with the filtered water coming out the other side.
     • When properly constructed, the filter consists of a bed of fine sand, a layer of gravel, a system of under drains to collect the filtered water on the other side, and a flow regulator to regulate the flow.
     • SSF is relatively inexpensive to build and is useful in small scale water supply systems
     • Removal efficiency for harmful organisms is not guaranteed in the SSF process. Therefore, treatment or boiling before consumption is recommended.
  6. Biological Filtration (Bio-sand Filter):
     • The aim of a bio-sand filter is to make water suitable for households and is smaller version of the slow sand filter which is adapted for intermittent use.
     • Key characteristics of a bio-sand filter include:
     • Inlet reservoir zone – where water is poured into filter
     • Stand water zone – this water keeps the sand wet while letting oxygen pass to the bio-layer.
     • Biological zone – develops at the top 5-10cm of the sand surface.
     • The filtration sand removes pathogens, suspended particles and other contaminants.
     • In the slow sand filters, a biological layer of micro-organisms develops at the top 1-2cm of the sand surface.
     • Non – biological zone – contains virtually no living micro-organisms due to the lack of nutrients and oxygen.
     • Gravel zone – holds the sand in place and protects the outlet tube form clogging
     • The filter container can be made of concrete or plastic and is filled with layers of specially selected and prepared sand and gravel. The filtration process involves the poring of contaminated water into the reservoir on an intermittent basis.
     • The water slowly passes through the diffuser and percolates down through the bio-layer, sand and gravel. Then the treated water flows from the outlet tube and ready for consumption

Can AWD Patient use drugs used to stop vomiting and diarrheal drugs?

• The best treatment of acute watery diarrhea is to replace the lost fluid and electrolytes
• The fluid with toxins must be removed from the intestine with an immediate replacement
• Do not use the following drugs in patients with AWD:
  • Anti-emetics (drugs used to stop vomiting)
  • Anti-diarrheal (drugs used to stop diarrhea)

source: Ministry of Health(www.moh.gov.et)