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Kiingereza hadi Kiswahili: Communicable Diseases General field: Kimatibabu Detailed field: Matibabu: Utunzaji Afya
Matini asilia - Kiingereza 33. Bacterial and Viral Faeco-Oral Diseases
Study Session 33 Bacterial and Viral Faeco-Oral Diseases 4
Introduction 4
Learning Outcomes for Study Session 33 4
33.1 Cholera 4
33.1.1 Infectious agents and occurrence of cholera 5
33.1.2 Cholera epidemics 5
Question 6
Answer 6
33.1.3 Symptoms and signs of cholera 6
Question 8
Answer 8
Question 8
Answer 8
33.2 Shigellosis (or bacillary dysentery) 8
33.2.1 Infectious agents and occurrence of shigellosis 9
33.2.2 Symptoms and signs of shigellosis 9
33.3 Rotavirus infection and other viral diarrhoeal diseases 9
33.4 Modes of transmission of diarrhoeal diseases 10
Question 10
Answer 10
33.5 Diagnosis, treatment and control of bacterial and viral diarrhoeal diseases 12
33.5.1 Diagnosis of diarrhoeal diseases 12
33.5.2 Treatment of bacterial and viral diarrhoeal diseases 13
33.6 Prevention and control of bacterial and viral diarrhoeal diseases 15
33.6.1 Controlling epidemics of diarrhoeal diseases 15
Question 15
Answer 15
Question 16
Answer 17
33.6.2 Epidemic control measures for cholera 17
33.6.3 Epidemic control measures for shigellosis 18
Question 18
Answer 18
33.6 Typhoid fever 19
Question 20
Answer 20
Summary of Study Session 33 22
Self-Assessment Questions (SAQs) for Study Session 33 22
SAQ 33.1 (tests Learning Outcomes 33.1, 31.2, 31.3 and 33.4) 23
Answer 23
SAQ 33.2 (tests Learning Outcomes 31.1, 33.4 and 33.5) 23
Answer 23
SAQ 33.3 (tests Learning Outcomes 33.2, 33.3 and 33.4) 24
Answer 24
SAQ 33.4 (tests Learning Outcomes 33.1, 33.2, 33.2, 33.4 and 33.5) 24
Answer 25
Study Session 33 Bacterial and Viral Faeco-Oral Diseases
Introduction
In the previous study session you learnt about the general features of faeco-oral diseases. With that introduction in mind, we will now discuss the common faeco-oral diseases caused by bacteria and viruses. In Study Session 34, you will learn about faeco-oral diseases caused by protozoa and intestinal worms. The conditions covered in this study session are divided into two groups: bacterial and viral faeco-oral diseases characterised by diarrhoea, and those characterised by high fever.
We begin with three diarrhoeal diseases: cholera, shigellosis and rotavirus infections. In each case, you will learn about their specific infectious agents, occurrence, modes of transmission, symptoms and signs. Then we remind you of the common features of the diagnosis and treatment, prevention and control of diarrhoeal diseases, which you already studied in general terms in Study Session 32. Finally, we describe the febrile illness, typhoid fever, which is also transmitted by the faeco-oral route. The focus of discussion in this study session will be on aspects that will be especially important to you in your daily work as a Health Extension Practitioner.
Learning Outcomes for Study Session 33
When you have studied this session, you should be able to:
33.1 Define and use correctly all of the key words printed in bold.
(SAQs 33.1, 33.2 and 33.4)
33.2 Describe the most common types of bacterial and viral faeco-oral diseases, their causative infectious agents and their occurrence in the population. (SAQs 33.1 and 33.3)
33.3 Describe the main modes of transmission of each of the bacterial and viral faeco-oral diseases, and the age groups that are most susceptible to them. (SAQs 33.3 and 33.4)
33.4 Explain how you would diagnose and treat cases of bacterial and viral faeco-oral diseases, and when and why you would refer them to a higher-level health facility. (SAQs 33.2 and 33.4)
33.5 Describe how you would apply prevention and control measures against bacterial and viral faeco-oral diseases, and what actions you would take to prevent epidemics of cholera or shigellosis. (SAQs 33.2 and 33.4)
33.1 Cholera
We begin by discussing cholera – its infectious agent, occurrence, symptoms and signs. Knowing about the nature of cholera will help you to diagnose, treat, prevent and control this disease, as described in Sections 33.5 and 33.6, together with measures against all the other bacterial and viral diarrhoeal diseases.
33.1.1 Infectious agents and occurrence of cholera
What comes to your mind when hear the word cholera? It is an acute diarrhoeal disease that affects the intestines and can kill vulnerable patients within a few hours if they are not treated quickly. The WHO estimates that there are 3 to 5 million cases of cholera every year around the world, and between 100,000 to 120,000 deaths. It can affect people in all age-groups. Cholera is caused by the bacteria named Vibrio cholerae (Figure 33.1), which occur naturally in the environment in shallow water around coasts, particularly where rivers flow into the sea. However, people infected by cholera bacteria can rapidly spread the organisms anywhere in a country, particularly where faeces leak into waste water collections.
Figure 33.1 Vibrio cholerae bacteria magnified thousands of times.
(Photo: Wikimedia Commons)
33.1.2 Cholera epidemics
Cholera can spread very easily from person to person, because even a few bacteria are enough to cause the disease if the person is already vulnerable, e.g. due to malnutrition or other infections. Although about 75% of people infected with the bacteria do not develop any symptoms, they can still pass on the infection in their faeces for up to two weeks, so epidemics can develop very quickly.
Question
Do you remember the definition of an epidemic? (Think back to Study Session 1 in Part 1 of this Module.)
Answer
An epidemic is defined as a sudden rise in the number of cases of a condition, which go on increasing for weeks or months before being brought under control; sometimes the numbers affected in an epidemic can continue rising for years (e.g. HIV/AIDS).
End of answer
There have been epidemics of cholera in Ethiopia; in 1970, several thousand deaths occurred in the eastern, central and southern regions of the country. Conditions leading to epidemics include the consumption of unsafe water, poor hygiene, poor sanitation and crowded living conditions. Cholera often follows after natural disasters involving flooding, and when large numbers of refugees live in camps (Figure 33.2). Consideration of these factors is important for the prevention and control of epidemics of cholera. In Section 35.2 of this study session, we mention the actions that should be taken to prevent a single case from leading to an epidemic. The details of epidemic investigations and management more generally are the subject of Study Session 42.
Figure 33.2 Cholera can spread quickly and cause epidemics in refugee camps, like this one in the Democratic Republic of the Congo.
(Photo: Ahu2, Wikimedia Commons)
33.1.3 Symptoms and signs of cholera
Knowledge of the typical symptoms and signs of cholera will help you to suspect cases and undertake further epidemic investigation measures. Cholera usually manifests after an incubation period of one to five days (i.e. the time between the bacteria entering the person’s body and the first symptoms appearing), but it can begin within a few hours after the infection. In about 80% of cases, the disease presents with relatively mild symptoms, but about 20% develop acute watery diarrhoea with severe sudden onset. The stools are painless and voluminous, with the appearance of water in which rice has been boiled (rice-water stools are a characteristic sign of cholera). The patient also experiences nausea, vomiting (Figure 33.3), fever and rapid progression to experiencing extreme weakness and shock. In such cases, death may occur within hours after the start of the illness.
Figure 33.3 Profuse vomiting and rice-water stools are characteristic symptoms of cholera.
Shock in cholera results from rapid dehydration and loss of essential salts in the voluminous diarrhoea and vomit. You learned about shock as a result of haemorrhage during and after childbirth in the Modules on Labour and Delivery Care and Postnatal Care. The signs are the same in shock due to severe dehydration caused by cholera.
Question
What are the typical signs of shock in an adult patient?
Answer
The typical signs of shock are systolic blood pressure dropping below
90 mmHg and/or diastolic blood pressure dropping below 60 mmHg, with a rapid pulse rate above 100 beats per minute. A person in shock will often appear confused and may lose consciousness. You must act quickly to save their life.
End of answer
If you see a person with the characteristic symptoms and signs of cholera, you must manage the patient immediately and begin effective control measures in the community (as described below in Sections 33.4 and 33.5). The risk of a cholera epidemic developing from a single case is high, so you must also undertake epidemic investigation and management procedures, which will be described for all epidemic conditions in Study Session 42.
Question
Suppose you were called to see an adult with acute watery diarrhoea and profuse vomiting of two days’ duration. What other evidence would suggest a diagnosis of cholera in this person?
Answer
In addition to the rapid onset and progression of the illness, the following symptoms and signs would support the diagnosis of cholera:
• Painless diarrhoea and rice-water appearance of his stool
• Fever
• Extreme weakness
• Shock (low blood pressure and rapid pulse rate)
• Similar cases in the household or nearby.
End of answer
33.2 Shigellosis (or bacillary dysentery)
The word dysentery refers to diarrhoea containing blood and mucus. There are two main types of dysentery, caused by different infectious agents. The one that we are going to describe here is bacillary dysentery, or shigellosis. The other type is amoebic dysentery, which is discussed in Study Session 34. However, in this section we will mention some of the main differences between the two types of dysentery, to help you diagnose them correctly.
33.2.1 Infectious agents and occurrence of shigellosis
The infectious agents causing shigellosis are different species of Shigella bacteria. Although these bacteria may cause mild cases of acute watery diarrhoea, dysentery is the real threat in shigellosis. The bacteria infect and destroy cells lining the patient’s large intestine (colon), causing ulcers and bleeding, which results in the characteristic appearance of blood and mucus in the stool.
As you may recall from Study Session 1 of this Module, dysentery is common in Ethiopia, ranking among the top ten causes of outpatient visits (refer to Table 1.1). Although Shigella infection can occur at any age, it is rare in infants less than six months of age and most common in children aged two to three years. This age-distribution is unlike amoebic dysentery, which is rare in children less than five years of age. Two-thirds of the cases of shigellosis and most of the deaths are in children below ten years, and (like all diarrhoeal diseases) the effects are most severe in malnourished children.
Shigella bacteria can be easily transmitted from person to person and rapidly cause epidemics, particularly under conditions of overcrowding, where personal hygiene is poor, such as in prisons, institutions for children, and refugee camps. Small doses of the infectious agent – as few as ten organisms – are enough to transmit the infection, which means it can be transmitted easily to close contacts. Another reason for the rapid spread is that after recovery, infected individuals can transmit the bacteria in their faeces for up to four weeks after the illness. By contrast, epidemics of amoebic dysentery rarely occur. Therefore, if an epidemic of dysentery occurs in your community, you should suspect the most likely cause is bacillary dysentery due to Shigella bacteria.
33.2.2 Symptoms and signs of shigellosis
Symptoms of shigellosis usually appear after an incubation period of one to three days. The diarrhoea may be watery and of a large volume initially, but then changing into frequent, small-volume episodes of bloody and mucoid (mucus-containing) diarrhoea. The onset of the disease is sudden, with fever, abdominal pains, straining during defaecation and an irresistible urge to defaecate, but only small quantities of blood and mucus come out, without any formed solid stools. The person may complain of abdominal cramps and pain in the rectum, and is often too ill to leave their bed. Dehydration can progress quickly and may lead to shock and death if not rapidly treated.
33.3 Rotavirus infection and other viral diarrhoeal diseases
In this section, we will briefly mention the viruses that cause diarrhoeal diseases. The most prevalent infectious agents in this category are the rotaviruses. The WHO estimates that about 40% of all cases of severe infant diarrhoea worldwide, and at least 500,000 deaths in childhood from diarrhoeal diseases, are due to rotavirus infections – making these viruses the single biggest cause of diarrhoeal deaths. Most cases occur between the ages of three months and two years. Other viruses responsible for diarrhoeal diseases include the noroviruses.
The main manifestations of viral diarrhoeal diseases include acute, very watery diarrhoea, nausea and projectile vomiting, often (but not always) with fever and abdominal pain. Vomiting is called ‘projectile’ when the person cannot control the rapid emergence of vomit, which is projected forwards from the mouth with great force. Dehydration can occur rapidly in children and is the most common cause of death.
Individuals at highest risk from viral diarrhoeal diseases are malnourished children, weanlings and bottle-fed infants. To help prevent rotavirus infections, encourage exclusive breastfeeding under the age of six months; if the mother cannot breastfeed, or after weaning, encourage feeding with a very clean cup and spoon instead of a bottle. If bottles have to be used, show the parents how to wash the bottles and teats frequently and very thoroughly with clean warm water and soap.
33.4 Modes of transmission of diarrhoeal diseases
All three types of diarrhoeal diseases discussed so far are transmitted directly or indirectly by faeco-oral routes, as already described in detail in Study Session 32.
Question
Briefly distinguish between direct and indirect modes of faeco-oral transmission of infectious agents.
Answer
Direct transmission occurs through contact between hands contaminated with faeces and the person’s mouth; indirect modes of transmission are through ingestion of contaminated food or water, contact with infected soil, utensils, etc., and transmission by flies that have crawled on faeces (Figure 33.4).
Figure 33.4 Flies are a major source of indirect transmission of diarrhoeal diseases.
(Photo: CDC Image Library, image 5452)
End of answer
The main modes of transmission for cholera, shigellosis and viral diarrhoeal diseases are summarised in Table 33.1 and Figure 33.5.
Table 33.1 Main modes of transmission for bacterial and viral diarrhoeal diseases.
Diarrhoeal disease Main modes of transmission
Cholera Contaminated water or food (summarised in Figure 33.5)
Shigellosis (bacillary dysentery) Person-to-person contact, e.g. while caring for a sick person, or via contaminated water or food
Viral diarrhoeal diseases Contaminated water or food, particularly when feeding infants with milk or other nutritious fluids in a contaminated bottle
Figure 33.5 The main modes of transmission for most diarrhoeal diseases are by ingestion of contaminated food and water. (Source: adapted from AMREF, 2007, Communicable Diseases Distance Education Programme, Unit 11)
33.5 Diagnosis, treatment and control of bacterial and viral diarrhoeal diseases
You have already learned the general features of the diagnosis and treatment of diarrhoeal diseases in Study Session 32, so the discussion below will remind you of the main points in your role as a Health Extension Practitioner.
33.5.1 Diagnosis of diarrhoeal diseases
Accurate diagnosis of a specific type of diarrhoeal disease is only possible with laboratory identification of the infectious agents, mainly from stool samples. This can be essential in determining the type of treatment if antibiotics are required, and can also help to target prevention and control measures most effectively. However, laboratory diagnosis of the infectious agent takes time and is not needed for the treatment of most cases of acute watery diarrhoea among children. You can begin treating most children immediately on the basis of your clinical diagnosis, i.e. your knowledge of the characteristic symptoms and signs of acute watery diarrhoea described earlier in this study session, without the need for identifying the specific infectious agent.
Laboratory diagnosis is required for:
• children with dysentery (which could be bacillary or amoebic)
• all adults with severe diarrhoea, however caused.
Even in cases where laboratory diagnosis is required, you should not wait for the results of the investigation before starting rehydration as described below (Section 34.4.2) and referring the patient to the nearest health centre or hospital. Explain to the adult patient or caregiver (if the patient is a child) that referral is needed for further diagnosis, because treatment varies depending on the specific cause of the disease. Ensure that the patient seeks treatment urgently, as the disease could worsen rapidly and lead to serious outcomes.
Although you can’t be sure of the diagnosis yourself, if you suspect dysentery or cholera, ask whether anyone else in the patient’s household, or their neighbours, have a similar illness. This helps you to identify and report suspected cases, which is essential to prevent an epidemic from spreading.
33.5.2 Treatment of bacterial and viral diarrhoeal diseases
As you already know, for all patients with diarrhoea (watery or bloody), the core measure in treatment of all cases is rapid and adequate rehydration – fluid replacement. This is usually achieved by the patient drinking plenty of fluids, but in the most severe cases the fluid has to be given intravenously (directly into a vein). Rehydration should be started as soon as possible and continued for as long as the diarrhoea persists. The best fluid to prevent or treat dehydration is a solution of oral rehydration salts (ORS) – a simple mixture of sugar and salts in the correct proportions mixed with boiled and cooled water (Figure 33.6).
Figure 33.6 A man with cholera is helped to drink oral rehydration salts. (Photo: CDC Image Library, image 5301)
In addition to rehydration, other interventions might also be necessary depending on the type of disease and the age of the patient. For children with diarrhoea, the measures that you should undertake during treatment were summarised in Box 32.1 in the previous study session. However, before you can treat a child with diarrhoea correctly, you first need to learn how to assess and classify the danger signs and the level of dehydration; this is taught in detail in the Module on the Integrated Management of Newborn and Childhood Illness (IMNCI) in this curriculum.
A patient in shock due to severe diarrhoeal disease will die without adequate and rapid rehydration.
For adults with severe diarrhoea, assess if the patient is able to take fluids orally. If they are too weak or nauseous to take fluids orally, or they are showing signs of shock, refer them immediately to the nearest health centre or hospital. Advise the patient or caregiver that immediate treatment is necessary to save the patient’s life.
If the patient is able to take fluids orally, give ORS and tell them to drink 200–400 ml of ORS after each loose stool. Advise the patient to drink other fluids as much as possible and to continue eating. Adults with severe diarrhoea due to bacteria may also need an antibiotic treatment appropriate for the specific disease, after first determining the type of bacteria from laboratory examination of a stool sample. This is one reason why adults with severe diarrhoea are given ORS and referred to a higher health facility.
33.6 Prevention and control of bacterial and viral diarrhoeal diseases
Prevention and control measures for all diarrhoeal diseases, whatever the infectious organism, aim at interrupting faeco-oral transmission from contaminated hands, water, food and other sources. Look back at Study Session 32 to remind yourself of the key points to emphasise when you educate people in your community on how to protect themselves and their children from developing diarrhoeal diseases. Figure 33.7 illustrates some important strategies that everyone should know.
Figure 33.7 Poster showing actions to reduce the transmission of diarrhoeal diseases: (top right) build a latrine with a water container for handwashing; (bottom left) give an affected child ORS to drink and take him to a health facility; (bottom right) bury faeces in a safe place.
(Photo: Ali Wyllie)
33.6.1 Controlling epidemics of diarrhoeal diseases
What else should you do if there is an outbreak of a diarrhoeal disease, which threatens to spread in the community?
Question
Which bacterial or viral diarrhoeal diseases are most often associated with epidemics? Do you remember two reasons why?
Answer
Cholera and shigellosis (bacillary dysentery) can rapidly spread and cause an epidemic. The two main reasons are that very small numbers of bacteria (fewer than ten) can result in the illness if they get into a susceptible person, and people who have recovered from the illness can go on shedding the bacteria in their faeces for weeks afterwards.
End of answer
Suspected cases of cholera or shigellosis (bacillary dysentery) should be immediately reported to the woreda Health Office.
Whenever you suspect there may be a single case of cholera or shigellosis in your community, you must take swift action to investigate and report it, and apply measures to control the source of infection before it can spread. Epidemic investigation techniques will be discussed in detail in Study Session 42, so here we will briefly summarise the main points.
Question
Why do you think it is important to report suspected cases of cholera or shigellosis to the woreda (District) Health Office?
Answer
You cannot prevent an epidemic from developing on your own. Reporting suspected cases enables the woreda Health Office and other higher bodies to start epidemic investigation and laboratory diagnosis as soon as possible, and collaborate with you in taking action to control the outbreak before it spreads.
End of answer
You should try to identify everyone who has been in close contact with the source patient (i.e. the first case in your community) by asking the patient, the family and neighbours about what the patient has been doing recently and who he or she has seen. It is particularly important to locate everyone who has been eating the same food or drinking water from the same place as the patient. Give these individuals advice to seek early treatment if the illness starts and to report it immediately.
33.6.2 Epidemic control measures for cholera
In addition to the points described above, you should take action to prevent the spread of cholera bacteria in water, food or on the hands of people who have been caring for patients.
• Ensure that everyone in contact with the patient knows that they must be especially careful to wash their hands very thoroughly with soap and water after touching the patient, as well as at all the usual times (after defaecation, before preparing food or eating, etc.)
• Make sure that faeces or vomit from the patient cannot contaminate sources of drinking water, for example, when washing the patient’s soiled clothes, bedding or drinking cups. Do not wash any articles that may be carrying cholera bacteria in streams, pools or water containers that people use to collect drinking water (Figure 33.8). Infected water is one of the main transmission modes for cholera bacteria. In a cholera epidemic, everyone in the community must use protected water sources for drinking, and either boil the water or disinfect it by adding chlorine.
• Disinfection of clothes contaminated with faeces and vomit, and articles used by patients, is essential; they should be boiled or scrubbed with a disinfectant solution such as chlorine bleach.
• Interruption of foodborne transmission includes cooking food thoroughly before eating, preventing contamination of food by flies and avoiding eating raw vegetables and fruits.
Figure 33.8 Clothes from someone with cholera should not be washed in water that people use for bathing or drinking. (Photo: Basiro Davey)
33.6.3 Epidemic control measures for shigellosis
Shigella bacteria are particularly likely to be passed directly from one person to another, for example when shaking hands, so people who are caring for a patient with bacillary dysentery are at high risk of infection. Educate carers that a very small number of organisms can cause infection and that strict hygiene precautions are needed when handling the faeces of patients. In addition, patients and carers should understand that anyone with a Shigella infection should not prepare food for others to eat, or care for a young child or a sick person, until a month after recovery. This is because the bacteria continue to be shed from the person in their faeces for several weeks, and can easily be transmitted to vulnerable contacts.
Question
What measures would be most important in preventing transmission of shigellosis?
Answer
The measures to be given priority include:
• frequent and very thorough handwashing with soap and water (Figure 33.9)
Figure 33.9 Handwashing with soap and water is the single most important measure to control a shigellosis epidemic. (Photo: Basiro Davey)
• avoiding direct contact with faeces if possible, and disposing of faeces safely
• disinfection of clothing and articles contaminated with faeces.
End of answer
33.6 Typhoid fever
In the final section of this study session, we turn to typhoid fever – a bacterial faeco-oral disease caused by Salmonella typhi bacteria, which is classified as a febrile illness (not a diarrhoeal disease). The incubation period is usually one to two weeks. Although typhoid fever can cause diarrhoea in children, it is rare in children of less than five years of age. In adults, diarrhoea may be present in the early stage of the illness, but this quickly turns to constipation. The main distinguishing feature is a very high fever (39oC to 40oC), with headache, lethargy, loss of appetite, and sometimes rose-coloured spots on the chest. If you are trained to palpate the abdomen, you may be able to feel an enlarged liver and spleen.
Typhoid fever is a major health problem in poor communities and is endemic (always present at a relatively constant rate) in Ethiopia. The WHO estimates that there are about 17 million cases worldwide every year. Transmission of typhoid fever can occur by the direct faeco-oral route, but it is mainly transmitted indirectly through contaminated water and food.
Question
What other febrile diseases have you learned about so far in this Module, i.e. with high fever as one of their main manifestations?
Answer
Malaria and meningococcal meningitis are febrile diseases. (In Study Session 36, you will learn about two more: louse-borne relapsing fever and typhus.)
End of answer
You can suspect a case of typhoid fever based on your clinical diagnosis, but because the symptoms of typhoid fever are similar to that of malaria, you should first use the malaria rapid diagnostic test (RDT) if you are in an area where malaria is endemic (Figure 33.10). Even after ruling out malaria, you can’t be sure of the diagnosis of typhoid fever, because meningitis and relapsing fever can also present with similar symptoms and signs. Therefore, if you suspect typhoid fever, refer the patient to the nearest higher level health facility for laboratory diagnosis and specialist treatment.
Figure 33.10 Malaria Rapid Diagnostic Test (RDT) kit. The technique for conducting the test was described in Study Session 8 of this Module. (Photo: Ali Wyllie)
As with other faeco-oral diseases, your role in the prevention and control of typhoid fever is giving health education to your community on measures that aim to interrupt faeco-oral transmission. In the next study session, we will focus on faeco-oral diseases caused by single-celled parasites and helminths (worms).
Summary of Study Session 33
In Study Session 33, you have learned that:
1. Common faeco-orally transmitted diseases caused by bacteria and viruses include cholera, shigellosis (bacillary dysentery), viral diarrhoeal diseases (rotavirus infection is the most prevalent), and typhoid fever.
2. Cholera is a bacterial disease, which manifests with painless, acute watery diarrhoea that resembles rice-water, and profuse vomiting.
3. Shigellosis or bacillary dysentery is an acute diarrhoeal disease characterised by blood and mucus in the stool, with urgency and straining during defaecation.
4. Viral diarrhoeal diseases are the commonest type of diarrhoeal disease, particularly in children. Their manifestation is mainly acute watery diarrhoea.
5. The transmission of cholera bacteria and rotaviruses is mainly via contaminated water and food, whereas shigellosis is mainly spread via person-to-person contact.
6. Cholera and shigellosis are prone to epidemics, because small numbers of bacteria can cause the illness, and bacteria continue to be shed for some time after the patient recovers.
7. Epidemic control measures include swift case reporting, identification of contacts of the source patient, frequent thorough handwashing with soap and water, safe disposal of faeces, and disinfection or boiling of clothes, bedding and utensils used by the patient.
8. You can treat most cases of children with acute water diarrhoea at Health Post level, without the need for laboratory diagnosis of the causative infectious agent. However, adults with severe diarrhoea and children with dysentery should be referred urgently after starting rehydration with oral rehydration salts (ORS).
9. Typhoid fever is a febrile illness, characterised by high continuous fever, with constipation (rather than diarrhoea) in most adult patients. The disease is spread faeco-orally via infected water and contaminated food. If you suspect typhoid fever, you should refer the patient quickly.
Self-Assessment Questions (SAQs) for Study Session 33
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. One question also tests some of the Learning Outcomes of Study Session 32. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
SAQ 33.1 (tests Learning Outcomes 33.1, 31.2, 31.3 and 33.4)
Which of the following statements is false? In each case, state why it is incorrect.
A Typhoid fever is transmitted mainly indirectly by contaminated food or water.
B The characteristic manifestations of cholera include bloody diarrhoea.
C Shigellosis is transmitted mainly by direct person-to-person contact.
D Diarrhoeal diseases can lead to severe dehydration and shock.
E Viruses are the commonest cause of diarrhoea in children.
F Typhoid fever is a common cause of diarrhoea in adults.
Answer
A is true. Typhoid fever is transmitted mainly indirectly, via contaminated food or water.
B is false. The characteristic manifestations of cholera are voluminous rice-water diarrhoea and vomiting – but not bloody diarrhoea.
C is true. Shigellosis is transmitted mainly by direct person-to-person contact.
D is true. Diarrhoeal diseases can lead to severe dehydration and shock.
E is true. Viruses are the commonest cause of diarrhoea in children.
F is false. Typhoid fever usually presents with constipation rather than diarrhoea in adults. The main symptom is continuous high fever.
End of answer
SAQ 33.2 (tests Learning Outcomes 31.1, 33.4 and 33.5)
If you see an adult patient with bloody diarrhoea, what actions should you take:
1. To treat the patient?
2. To prevent the disease from spreading?
Answer
1. In an adult patient with bloody diarrhoea, you should start immediate rehydration with ORS, and refer him/her to a higher health facility for laboratory diagnosis of the causative infectious agent and specific treatment.
2. You should report the suspected case to the woreda Health Office and request assistance in preventing an epidemic. Ask the patient’s family members and neighbours about the presence of other individuals with a similar illness, and advise all contacts of the patient to apply thorough hygiene measures, including handwashing with soap and water. Make sure they control the spread of the infectious agents by boiling or disinfecting clothes, bedding or utensils used by the patient; these articles must not be washed in water sources used for bathing or drinking.
End of answer
SAQ 33.3 (tests Learning Outcomes 33.2, 33.3 and 33.4)
Complete the missing details from Table 33.3 below.
Table 33.3 Incubation periods and most affected age-groups for common bacterial and viral faeco-oral diseases.
Disease Incubation period Age group for most cases
Cholera
Shigellosis
Rotavirus infection
Typhoid fever
Answer
The completed version of Table 33.3 appears below.
Table 33.3 Incubation periods and most affected age-groups for common bacterial and viral faeco-oral diseases
Disease Incubation period Age group for most cases
Cholera 2 hours to 5 days All ages can be affected
Shigellosis 1 to 3 days 2 to 3 years
Rotavirus infection 2 to 3 days Under 5 years
Typhoid fever 1 to 2 weeks Over 5 years
End of answer
SAQ 33.4 (tests Learning Outcomes 33.1, 33.2, 33.2, 33.4 and 33.5)
1. Rotaviruses are endemic in all developing countries and the major cause of diarrhoeal diseases in young children. What does endemic mean?
2. How are bacterial and viral diarrhoeal diseases transmitted?
3. A nine-month-old baby has had three episodes of watery diarrhoea in the last three days. The mother says the child is still partly breastfed, and is eating and drinking normally. It does not appear to be dehydrated. What actions should you take and what should you advise the mother?
Answer
1. Endemic means that rotaviruses and the diarrhoeal diseases they cause are ‘always present’ in the country at an approximately steady rate.
2. Bacterial and viral diarrhoeal diseases are transmitted directly by hands contaminated with faeces that make contact with the mouth, and indirectly in contaminated food, water, soil and utensils (e.g. bottles used to feed milk to infants), and by flies that have crawled over faeces.
3. The mother tells you that the infant is still breastfeeding, eating and drinking normally. As long as it is not dehydrated, there is no need to give ORS immediately. But the mother should be advised to go on breastfeeding as much as the child will drink, and feed other nourishing food and drinks with a very clean cup and spoon. She should wash her hands frequently and thoroughly with soap, particularly after changing the infant’s nappy (diaper) or cleaning its bottom. Tell her she must bring the child back to see you immediately, or take it to the nearest health centre or hospital, if its diarrhoea persists or gets worse.
End of answer
Tafsiri - Kiswahili 33. Magonjwa yanayosababishwa na Bakteria na Virusi na Kusambazwa kutoka kwa Kinyesi hadi Kinywani
Kipindi cha 33 cha Somo Magonjwa yanayosababishwa na Bakteria na Virusi na Kusambazwa kutoka kwa Kinyesi hadi Kinywani 4
Utangulizi 4
Malengo ya Somo la Kipindi cha 33 4
33.1 Kipindupindu 5
33.1.1 Viini ambukizi na kutokea kwa kipindupindu 5
33.1.2 Janga la kipindupindu 6
Swali 6
Jibu 6
33.1.3 Dalili na ishara za kipindupindu 7
Swali 8
Jibu 8
Swali 9
Jibu 9
33.2 Shigelosi (au maambukizi ya basila ya kuhara damu) 9
33.2.1 Viini ambukizi na kutokea kwa shigelosi 9
33.2.2 Dalili na ishara za shigelosi 10
33.3 Maambukizi ya virusi vya rota na magonjwa mengine ya kuharisha yanayosababishwa na virusi 10
33.4 Mbinu za usambazaji wa magonjwa ya kuharisha 11
Swali 11
Jibu 11
33.5 Utambuzi, matibabu na udhibiti wa magonjwa ya kuharisha yanayosababishwa na bakteria na virusi 13
33.5.1 Utambuzi wa magonjwa ya kuharisha 13
33.5.2 Matibabu ya magonjwa ya kuharisha yanayosababishwa na bakteria na virusi 14
33.6 Kuzuia na kudhibiti magonjwa ya kuharisha yanayosababishwa na bakteria na virusi 16
33.6.1 Udhibiti wa majanga ya magonjwa ya kuharisha 16
Swali 17
Jibu 17
Swali 18
Jibu 18
33.6.2 Hatua za kudhibiti janga la kipindupindu 18
33.6.3 Hatua za udhibiti wa janga la shigelosi 19
Swali 19
Jibu 19
33.6 Homa ya matumbo 20
Swali 21
Jibu 21
Muhtasari wa Kipindi cha 33 23
Maswali ya Kujitathmini ya Kipindi cha 33 24
Swali la Kujitathmini 33.1 (linatathmini Malengo ya Somo 33.1, 31.2, 31.3 na 33.4) 24
Jibu 24
Swali la Kujitathmini 33.2 (linatathmini Malengo ya Somo 31.1, 33.4 na 33.5) 25
Jibu 25
Swali la Kujitathmini 33.3 (linatathmini Malengo ya Somo 33.2, 33.3 na 33.4) 25
Jibu 25
Swali la Kujitathmini 33.4 (linatathmini Malengo ya Somo 33.1, 33.2, 33.2 na 33.5) 26
Jibu 26
Kipindi cha 33 cha Somo Magonjwa yanayosababishwa na Bakteria na Virusi na Kusambazwa kutoka kwa Kinyesi hadi Kinywani
Utangulizi
Katika kipindi kilichotangulia, ulijifunza kuhusu sifa za kijumla za magonjwa yanayosambazwa kutoka kwa kinyesi hadi kinywani. Ukizingatia utangulizi huo, tutajadiliana kuhusu magonjwa ambayo mara nyingi husambazwa kutoka kwa kinyesi na kinywa yanayosababishwa na bakteria na virusi. Katika Kipindi cha 34, utajifunza kuhusu magonjwa yanayosambazwa kutoka kwa kinyesi hadi kinywa na yanayosababishwa na protozoa na minyoo ya utumbo. Hali zilizozungumziwa katika kipindi hiki zimegawanywa katika vikundi viwili: magonjwa yanayosababishwa na bakteria na virusi na kusambazwa kutoka kwa kinyesi hadi kinywa, ambayo dalili yake ni kuharisha, na yale ambayo dalili yake ni homa kali.
Tutaanza kwa kuzungumzia magonjwa ya kuharisha matatu: kipundupindu, shigelosi na maambukizi ya virusi vya rota. Katika kila kauli, tutajifunza kuhusu viini ambukizi, jinsi magonjwa haya yanavyotokea, jinsi yanavyosambazwa, dalili na ishara zake. Kisha tutakukumbusha kuhusu sifa zinazodhihirika mara nyingi katika utambuzi na matibabu na jinsi ya kuzuia na kudhibiti magonjwa ya kuharisha kama ulivyojifunza kwa ujumla katika Kipindi cha 32. Hatimaye, tutaelezea kuhusu magonjwa yenye homa, homa ya matumbo inayosambazwa kutoka kwa kinyesi na kinywa. Lengo la mjadala wa kipindi hiki litakuwa kuhusu maswala muhimu kwa kazi yako kama Mhudumu wa Afya.
Malengo ya Somo la Kipindi cha 33
Baada ya kuhitimisha somo hili, unatarajiwa kuweza:
33.1 Kufasili na kutumia kwa usahihi maneno yote muhimu yaliyoandikwa kwa herufi nzito.
(Maswali ya Kujitathmini 33.1, 33.2 na 33.4)
33.2 Kueleza aina kuu zaidi za magonjwa yanayosababishwa na bakteria na virusi na kusambazwa kutoka kwa kinyesi hadi kinywani, viini ambukizi na visababishi, na jinsi yanavyotokea katika umma. (Maswali ya Kujitathmini 33.1 na 33.3)
33.3 Kueleza mbinu kuu za usambazaji ya kila ugonjwa, na vikundi vilivyo katika hatari ya kuambukizwa. (Maswali ya Kujitathmini 33.3 na 33.4)
33.4 Kufafanua jinsi ya kutambua na kutibu visa vya magonjwa haya na wakati na sababu za kuwapa wagonjwa rufaa hadi kituo cha afya cha juu zaidi. (Maswali ya Kujitathmini 33.2 na 33.4)
33.5 Kueleza jinsi yakufuata hatua za kuzuia na kudhibiti magonjwa haya na hatua za kuzuia mzuko wa kipindupindu na shigelosi. (Maswali ya Kujitathmini 33.2 na 33.4)
33.1 Kipindupindu
Tutaanza kwa kujadili kipindupindu - kiini ambukizi, kutokea kwake, dalili na ishara zake. Ufahamu kuhusu kipindupindu utakusaidia kutambua, kutibu, kuzuia na kudhibiti ugonjwa huu kama ilivyoelezwa katika vitengo vya 33.5 na 33.6 pamoja na hatua za kuchukua dhidi ya magonjwa mengine ya kuharisha yanayosababishwa na bakteria na virusi.
33.1.1 Viini ambukizi na kutokea kwa kipindupindu
Unawaza nini unaposikia neno kipindupindu? Huu ni ugonjwa mkali wa kuharisha unaodhuru matumbo, na unaweza kuua wagonjwa wenye uhatarisho baada ya saa chache ikiwa hawatatibiwa kwa haraka. Shirika la Afya Ulimwenguni linakadiria kuwa kuna visa milioni 3 hadi 5 vya kipindupindu kila mwaka duniani kote, na kati ya vifo 100,000 na 120,000. Ugonjwa huu unaweza kudhuru watu katika umri wowote. Kipindupindu husababishwa na bakteria inayoitwa Vibrio cholerae (Picha 33.1) ambayo huwepo kiasilia katika pwani zenye maji madogo, hasa sehemu ambapo mito huingia baharini. Hata hivyo, watu wenye kipindupindu wanaweza kueneza maambukizi kwa haraka sana, hasa katika sehemu ambapo kinyesi huingia kwenye mkusanyiko wa majitaka.
Picha 33.1 Bakteria ya Vibrio cholerae iliyokuzwa mara nyingi.
(Picha: Wikimedia Commons)
33.1.2 Janga la kipindupindu
Kipindupindu kinaweza kuenezwa kutoka kwa mtu hadi mwingine kwa urahisi sana, kwani bakteria chache zinatosha kusababisha ugonjwa huu ikiwa mtu ana uhatarisho wa kuambukizwa; kwa mfano kutokana na utapiamlo au maambukizi mengine. Ingawa takriban 75% ya watu walioambukizwa bakteria hii hawaonyeshi dalili zozote, bado wanaweza kuwaambukiza wengine kupitia kinyesi chao kwa hadi wiki mbili, hivyo majanga yanaweza kutokea haraka sana.
Swali
Je, unakumbuka ufasili wa janga? (Rejelea Kipindi cha 1 katika sehemu ya 1 ya Moduli hii.)
Jibu
Janga hufasiliwa kama ongezeko la ghafla la idadi ya visa vya hali fulani, ambalo huzidi kuongezeka kwa wiki au miezi kadhaa kabla ya kudhibitiwa; wakati mwingine, idadi ya walioambukizwa inaweza kuendelea kuongezeka kwa miaka mingi (kwa mfano VVU/UKIMWI).
Mwisho wa jibu
Kumekuwa na majanga ya kipindupindu Kusini mwa Sahara: katika miaka ya 1970, maelfu ya vifo vilitokea katika maeneo mengi barani Afrika. Hali zinazosababisha majanga hujumuisha matumizi ya maji machafu, hali duni ya usafi wa kibinafsi na wa kimazingira, na kuishi katika maeneo yenye watu wengi kupita kiasi. Mara nyingi, kipindupindu hutokea baada ya maafa ya kiasilia yanayohusisha mafuriko, na idadi kubwa ya wakimbizi wanaoishi kambini (Picha 33.2). Ni muhimu kutilia maanani maswala haya katika kuzuia na kudhibiti majanga ya kipindupindu. Katika Kitengo cha 35.2 cha somo hili, tutataja hatua za kuchukua ili kuzuia kisa kimoja cha ugonjwa huu kuenea hadi kuwa janga. Habari za kina kuhusu uchunguzi na udhibiti wa janga zimejadiliwa kwa kijumla zaidi katika Kipindi cha 42.
Picha 33.2 Kipindupindu kinaweza kusambaa kwa haraka na kusababisha janga katika kambi za wakimbizi, kama ilivyo katika Jamhuri ya Kidemokrasia ya Kongo.
(Picha: Ahu2, Wikimedia Commons)
33.1.3 Dalili na ishara za kipindupindu
Ufahamu kuhusu dalili na ishara za kawaida za kipindupindu utakusaidia kutambua visa, hivyo kuchukua hatua zaidi za kuchunguza janga. Kwa kawaida, kipindupindu hudhihirika baada ya muda wa kupevuka wa siku moja hadi tano (wakati kati ya kuingia kwa bakteria mwilini hadi kutokea kwa dalili za kwanza), lakini kinaweza kuanza saa chache baada ya kuambukizwa. Katika takriban 80% ya visa, ugonjwa huu huonyesha dalili hafifu, huku 20% wakianza kuharisha vikali kinyesi majimaji. Kinyesi hiki huwa kingi na kisichokuwa na maumivu, na hufanana na maji yaliyochemshiwa wali (kinyesi cha maji ya wali ni ishara bayana ya kipindupindu). Mgonjwa wa kipindupindu pia huhisi kichefuchefu, kutapika (Mchoro 33.3), homa na kuendelea kwa haraka hadi kuwa mdhaifu zaidi na kupata mshtuko. Katika visa kama hivi, kifo kinaweza kutokea saa chache baada ya ugonjwa kuanza.
Mchoro 33.3 Kutapika kwingi na kinyesi cha maji ya wali ni dalili za kipindupindu.
Mshtuko katika kipindupindu hutokana na kupoteza maji na chumvi muhimu kwa haraka kupitia kuharisha na kutapika. Ulijifunza kuhusu mshtuko unaosababishwa na kuvuja damu katika na baada ya kuzaa katika Moduli ya Utunzaji wa Leba na Kuzaa na Utunzaji wa baada ya Kuzaa. Ishara zake huwa sawa na za mshtuko unaosababishwa na kupoteza maji mengi kutokana na kipindupindu.
Swali
Ishara za kawaida za mshtuko kwa mtu mzima aliye mgonjwa ni zipi?
Jibu
Ishara za kawaida za mshtuko ni shinikizo la damu la kisistoli linaloshuka chini ya
90 mmHg na/au shinikizo la damu ya kidiastoli linaloshuka hadi chini ya 60 mmHg, na mpigo wa moyo wa kasi, wa zaidi ya midundo 100 kwa dakika. Mtu aliye na mshtuko mara nyingi huonekana kuchanganyikiwa na anaweza kupoteza ufahamu. Unapaswa kuchukua hatua kwa haraka ili kuokoa maisha.
Mwisho wa jibu
Unapomtambua mtu mwenye dalili na ishara bayana za kipindupindu, unapaswa kumhudumia mgonjwa huyo haraka iwezekanavyo kisha uanze hatua mwafaka za udhibiti katika jamii (kama inavyoelezwa katika kitengo cha 33.4 na 33.5). Kuna hatari kuu ya kipindupindu kuwa janga kutokana na kisa kimoja, hivyo unapaswa pia kufuata taratibu za uchunguzi na udhibiti wa janga. Hatua hizi zimeelezwa katika kipindi cha 42, huku zikigusia hali zote za majanga.
Swali
Tuseme umeitwa kumhudumia mtu mzima aliye na hali kali ya kuharisha majimaji na kutapika sana kwa siku mbili. Je, ni ushahidi upi mwingine utakaoonyesha kwamba mtu hiyu ana kipindupindu?
Jibu
Kando na kutokea ghafla na kuendelea kwa ugonjwa, dalili na ishara zifuatazo zinaweza kusaidia kutambua kipindupindu:
• Kuharisha kusiko na maumivu na kinyesi cha maji ya wali
• Homa
• Udhaifu uliokithiri
• Mshtuko (shinikizo la chini la damu na mpigo wa kasi wa moyo)
• Visa kama hivi nyumbani humo au karibu na humo.
Mwisho wa jibu
33.2 Shigelosi (au maambukizi ya basila ya kuhara damu)
Kuhara damu ni kuhara kinyesi kilicho na damu na kamasi. Kuna aina mbili kuu za kuhara damu zinazosababishwa na viini ambukizi tofauti. Viini tutakavyoangazia hapa ni maambukizi ya basila ya kuhara damu au shigelosisi. Aina ile nyingine ni kuhara damu kutokana na amiba, kama ilivyojadiliwa katika Kipindi cha 34. Hata hivyo, katika kitengo hiki tutataja baadhi ya tofauti kuu za aina hizi mbili ili uweze kuzitambua vyema.
33.2.1 Viini ambukizi na kutokea kwa shigelosi
Viini ambukizi vinavyosababisha shigelosi ni spishi tofauti za bakteria ya Shigella. Ingawa bakteria hizi zinaweza kusababisha hali ya ghafla na hafifu ya kuharisha kwenye majimaji, kuharisha damu ndilo tishio kuu katika shigelosi. Bakteria huambukiza na kuharibu seli zinazofunika utumbo mkubwa (koloni) na kusababisha vidonda na kuvuja damu, hivyo kuwepo kwa damu na kamasi katika kinyesi.
Kama unavyoweza kukumbuka kutoka Kipindi cha 1 cha Moduli hii, kuhara damu hutokea sana Afrika, hii ikiwa mojawapo ya sababu kumi kuu za ziara za wagonjwa wasiolazwa (rejelea Jedwali la 1.1). Ingawa maambukizi ya Shigella yanaweza kutokea katika umri wowote, ni nadra kuupata katika watoto wachanga wa chini ya miezi sita, bali hupatikana mara nyingi katika watoto wa umri wa miaka miwili hadi mitatu. Hii ni kinyume na hali ya kuhara damu kutokana na amiba, ambayo ni nadra katika watoto wa chini ya umri wa miaka mitano. Thuluthi mbili ya visa vya shigelosi na idadi kubwa ya vifo huwa vya watoto wa chini ya miaka kumi na (sawa na magonjwa mengine ya kuharisha) athari zake huwa kali zaidi katika watoto wenye utapiamlo.
Bakteria ya Shigella inaweza kusambazwa kutoka kwa mtu mmoja hadi mwingine kwa urahisi, hivyo kusababisha majanga kwa haraka, hasa katika hali za msongamano wa watu, hali duni ya usafi wa kibinafsi; kama vile katika jela, taasisi za watoto na kambi za wakimbizi. Kiwango kidogo cha viini ambukizi - hata viumbehai kumi - vinatosha kusambaza maambukizi, hivyo ugonjwa huu unaweza kusambazwa kwa urahisi kwa watu walio karibu. Sababu nyingine ya kusambaa haraka kwa ugonjwa huu ni kuwa, hata baada ya kupona, mtu aliyeambukizwa anaweza kusambaza bakteria hii kutoka kwa kinyesi kwa hadi wiki nne baada ya ugonjwa. Kinyume na haya, majanga ya kuhara damu kutokana na amiba huwa nadra. Kwa hivyo, iwapo janga la kuhara damu litatokea katika jamii yako, hali hii mara nyingi itakuwa imesababishwa na kuhara damu kwa basila kutokana na bakteria ya Shigella.
33.2.2 Dalili na ishara za shigelosi
Dalili za shigelosi mara nyingi hutokea baada ya muda wa kupevuka wa siku moja hadi tatu. Mwanzoni, kuhara kunaweza kuwa majimaji na kwa kiasi kikubwa, kisha kubadilika na kuanza kutokea katika vipindi vingi na viwango vidogo vya kuhara damu na kamasi (damu yenye kamasi). Mwanzo wa ugonjwa huu huwa wa ghafla, ukiambatana na homa, maumivu ya tumbo, ugumu wa kunya na hamu kubwa isiyozuilika ya kunya, ambapo viwango vidogo tu vya damu na kamasi ndivyo hutoka, bila kinyesi kigumu. Mgonjwa anaweza kukumbwa na mikakamo ya tumbo na maumivu ya rektamu, na mara nyingi huwa dhaifu sana kiasi kwamba hawezi kutoka kitandani. Kupoteza maji mwilini ni hali inayoweza kuendelea kwa haraka na kusababisha mshtuko na kifo isipotibiwa haraka.
33.3 Maambukizi ya virusi vya rota na magonjwa mengine ya kuharisha yanayosababishwa na virusi
Katika kitengo hiki, tutataja kwa muhtasari virusi vinavyosababisha magonjwa ya kuharisha. Viini ambukizi vikuu zaidi katika kikundi hiki ni virusi vya rota. Shirika la Afya Ulimwenguni linakadiria kuwa takriban 40% ya visa vyote vikali vya kuharisha katika watoto kote wachanga duniani, na karibu vifo 500,000 vya utotoni kutokana na magonjwa ya kuharisha hutokana na maambukizi ya virusi vya rota - kwa hivyo virusi hivi ndivyo kisababishi kikuu zaidi cha vifo kutokana na kuharisha. Visa vingi hutokea kati ya umri wa miezi mitatu hadi miaka miwili. Virusi vingine vinavyosababisha magonjwa ya kuharisha hujumuisha virusi vya noro.
Dalili kuu za magonjwa ya kuharisha yanayotokana na virusi ni pamoja na hali kali ya kuharisha kinyesi majimaji sana, kichefuchefu na matapishi yanayorushwa mbali; hali ambazo mara nyingi (lakini sio kila mara) huambatana na homa na maumivu ya tumbo. Matapishi hujulikana kama ya 'kurushwa mbali' iwapo mtu hawezi kuyadhibiti yasitoke haraka, bali hurushwa kwa nguvu kutoka mdomoni. Kupoteza maji kunaweza kutokea haraka katika watoto hivyo hali hii ndiyo kisababishi kikuu cha vifo.
Watu walio katika hatari kuu zaidi ya magonjwa ya kuharisha yanayotokana na virusi ni watoto wenye utapiamlo, walioachishwa kunyonya na wanaolishwa kwa chupa. Ili kusaidia kuzuia maambukizi ya virusi vya rota, himiza kuwa watoto wa chini ya umri wa miezi sita wanyonyeshwe bila kulishwa. Ikiwa mama hataweza kunyonyesha, au baada ya kumwachisha mtoto kunyonya, himiza kuwa mtoto alishwe kwa kikombe na kijiko safi sana badala ya chupa. Ikiwa chupa itatumika, waonyeshe wazazi jinsi ya kusafisha chupa na chuchu mara nyingi na vyema, kwa maji safi yenye uvuguvugu na sabuni.
33.4 Njia za usambazaji wa magonjwa ya kuharisha
Aina zote tatu za magonjwa ya kuharisha yaliyojadiliwa hapa husambazwa moja kwa moja au kwa njia isiyo ya moja kwa moja kutoka katika kinyesi hadi kinywani kama ilivyoelezwa katika Kipindi cha 32.
Swali
Kwa muhtasari, tofautisha kati ya mbinu za moja kwa moja za kusambazwa kwa viini ambukizi na njia zisizo za moja kwa moja.
Jibu
Maambukizi ya moja kwa moja hutokea iwapo mikono iliyogusa kinyesi itagusa kinywa; mbinu zisizo za moja kwa moja ni kupitia kutumia chakula au maji machafu, kugusa udongo, vyombo, au vifaa vingine vilivyoambukizwa, na maambukizi kupitia nzi waliogusa kinyesi (Picha 33.4).
Picha 33.4 Nzi ni asili kuu ya maambukizi yasiyo ya moja kwa moja ya magonjwa ya kuharisha.
(Picha: CDC Image Library, image 5452)
Mwisho wa jibu
Njia kuu za maambukizi ya kipindupindu, shigelosi na magonjwa ya kuharisha yanayotokana na virusi zimeelezwa kwa muhtasari katika Jedwali 33.1 na Mchoro 33.5.
Jedwali 33.1 Njia kuu za maambukizi ya magonjwa ya kuharisha yanayotokana na bakteria na virusi.
Ugonjwa wa kuharisha Njia kuu za usambazaji
Kipindupindu Maji au chakula kilichochafuliwa (muhtasari upo katika Mchoro wa 33.5)
Shigelosi (maambukizi ya basila ya kuhara damu) Mgusano wa moja kwa moja, kwa mfano wakati wa kumtunza mgonjwa au kupitia chakula au maji machafu
Magonjwa ya kuharisha yanayosababishwa na virusi Chakula au maji machafu hasa wakati wa kumnywesha mtoto maziwa au viowevu vingine vilivyo katika chupa chafu
Mchoro 33.5 Mbinu kuu za maambukizi ya magonjwa mengi ya kuharisha ni kupitia chakula au maji machafu. (Asili: Makala hii imekopwa kutoka AMREF, 2007, Communicable Diseases Distance Education Programme, Unit 11), Kitengo cha 11)
33.5 Utambuzi, matibabu na udhibiti wa magonjwa ya kuharisha yanayosababishwa na bakteria na virusi
Umejifunza kuhusu sifa za kijumla za utambuzi na matibabu ya magonjwa ya kuharisha katika Kipindi cha 32, hivyo mjadala unaofuata utakukumbusha vidokezo vikuu vya jukumu lako kama Mhudumu wa Afya wa Jamii.
33.5.1 Utambuzi wa magonjwa ya kuharisha
Utambuzi sahihi wa aina mahususi za ugonjwa wa kuharisha unawezekana tu iwapo utambuzi viini wa kimaabara utafanywa, hasa kutoka kwa sampuli za kinyesi. Hatua hii inaweza kuwa muhimu katika kuamua aina ya matibabu ikiwa antibiotiki zitahitajika, na pia inaweza kusaidia kuzingatia hatua za kuzuia na kudhibiti kwa njia mwafaka zaidi. Hata hivyo, utambuzi wa kimaabara wa viini ambukizi huchukua muda mrefu na hauhitajiki katika matibabu ya visa vingi vikali vya kuharisha kinyesi majimaji katika watoto. Unaweza kuanza kuwatibu watoto wengi upesi kulingana na utambuzi wa kimatibabu, yaani, ufahamu wa dalili na ishara maalum za hali kali ya kuharisha kinyesi majimaji kama ilivyoelezwa katika kipindi hiki, bila kuhitaji kutambua kiini mahususi cha maambukizi.
Utambuzi wa kimaabara huhitajika kwa:
• watoto wenye kuhara damu (hali inayoweza kusababishwa na basila au amiba)
• watu wote wazima walio na hali mbaya ya kuharisha, bila kuzingatia kisababishi.
Hata katika visa vinavyohitaji utambuzi wa kimaabara, mhudumu hapaswi kungoja matokeo ya uchunguzi kabla ya kuanzisha matibabu ya kuongeza maji, kama inavyoelezwa hapa chini (Kitengo cha 34.4.2) na kumpa mgonjwa rufaa hadi kwenye kituo cha afya au hospitali. Mweleze mgonjwa au mtunzaji (ikiwa mgonjwa ni mchanga) kwamba rufaa itahitajika ili kufanya utambuzi zaidi kwani matibabu hutofautiana kulingana na kisababishi cha ugonjwa. Hakikisha kuwa mgonjwa anatafuta matibabu kwa dharura kwani ugonjwa unaweza kuwa mbaya zaidi na kwa haraka hivyo kupelekea madhara hatari.
Ingawa huwezi kuwa na uhakika wa utambuzi, ukikisia uwepo wa kuhara damu au kipindupindu, unafaa kuuliza kama kuna mtu mwingine nyumbani mwa mgonjwa au majirani ambaye ana ugonjwa sawa. Hatua hii husaidia kutambua na kuripoti visa vinavyokisiwa, na ni muhimu katika kuzuia janga kuenea.
33.5.2 Matibabu ya magonjwa ya kuharisha yanayosababishwa na bakteria na virusi
Kama unavyofahamu, katika wagonjwa wote wanaohara (majimaji au damu), hatua kuu ya matibabu ya visa hivi vyote ni kuongeza maji mwilini kwa haraka na kwa wingi. Hatua hii hufikiwa mgonjwa anapokunywa viowevu vingi, lakini katika maradhi makali zaidi, viowevu hivi huongezwa kupitia mishipa (moja kwa moja mishipani). Mgonjwa anafaa kuanza kuongezwa maji mwilini haraka iwezekanavyo na kuendelezwa hadi hali ya kuhara ikome. Kiowevu mwafaka cha kuzuia au kutibu hali ya kupoteza maji mwilini ni mchanganyiko wa kinywaji cha kuongeza maji mwilini - mchanganyiko wa viwango sahihi vya sukari na chumvi katika maji yaliyochemshwa na kupozwa (Picha 33.6).
Picha 33.6 Mwanaume aliye na kipindupindu akisaidiwa kunywa kinywaji cha kuongeza maji mwilini. (Picha: CDC Image Library, image 5301)
Kando na kuongeza maji mwilini, mikakati mingine pia inaweza kuhitajika kulingana na aina ya ugonjwa na umri wa mgonjwa. Kwa watoto wanaohara, hatua za kuchukua wakati wa matibabu zimeelezwa kwa muhtasari katika Kisanduku 32.1 katika kipindi kilichopita. Hata hivyo, kabla ya kumtibu vyema mtoto anayehara, unapaswa kwanza kujifunza jinsi ya kukadiria na kuainisha ishara za hatari na kiasi cha maji yaliyopotea; mambo haya yanafunzwa kwa kina katika Moduli ya Udhibiti wa Maradhi ya Watoto wachanga na ya Utotoni katika mtaala huu.
Mgonjwa aliye na mshtuko kufuatia ugonjwa wa kuhara anaweza kufa asipoongezwa maji mengi kwa haraka.
Kwa mtu mzima aliye na hali kali ya kuhara, mhudumu anafaa kubaini kama mgonjwa ataweza kunywa viowevu. Ikiwa ni mdhaifu sana, ana kichefuchefu au ishara za mshtuko, mgonjwa anafaa kupewa rufaa hadi kituo cha afya au hospitali haraka iwezekanavyo. Mshauri mgonjwa au mtunzaji kuwa matibabu ya haraka yanahitajika ili kuokoa maisha.
Ikiwa mgonjwa anaweza kunywa viowevu, basi mpe kinywaji cha kuongeza maji mwilini kisha umweleze anywe mililita 200 hadi 400 za kinywaji hiki kila baada ya kuhara. Mshauri mgonjwa anywe viowevu vingine kwa wingi na aendelee kula. Mtu mzima aliye na hali kali ya kuhara kutokana na bakteria anaweza kuhitaji matibabu ya antibiotiki mwafaka baada ya kutambua aina ya bakteria kutokana na uchunguzi wa maabarani wa sampuli ya kinyesi. Hii ndiyo sababu moja ya mtu kama huyu kupewa kinywaji cha kuongeza maji mwilini kisha kupewa rufaa hadi kituo cha juu cha afya.
33.6 Kuzuia na kudhibiti magonjwa ya kuharisha yanayosababishwa na bakteria na virusi
Hatua za kuzuia na kudhibiti magonjwa yote ya kuharisha, bila kuzingatia kiumbehai kilichosababisha maambukizi haya, hulenga kukatiza maambukizi kutoka katika kinyesi hadi kinywani kutokana na mikono chafu, maji, chakula na asili zingine. Rejelea Kipindi cha 32 ili kujikumbusha mambo muhimu ya kusisitiza unapoelimisha jamii kuhusu jinsi ya kujikinga na kukinga watoto dhidi ya magonjwa ya kuharisha. Picha 33.7 inaonyesha mikakati muhimu ambayo watu wote wanapaswa kujua.
Picha 33.7 Bango linaloonyesha hatua za kupunguza usambazaji wa magonjwa ya kuharisha: (juu kushoto) jenga choo kilicho na kifaa cha maji cha kunawia mikono; (chini kushoto) mpe mtoto mgonjwa kinywaji cha kuongeza maji mwilini kisha umpeleke katika kituo cha afya; (chini kulia) zika kinyesi katika eneo salama.
(Picha: Ali Wyllie)
33.6.1 Udhibiti wa majanga ya magonjwa ya kuharisha
Ni hatua zipi zingine unazopaswa kuchukua ikiwa kuna janga la ugonjwa wa kuharisha unaotishia kusambaa katika jamii?
Swali
Ni magonjwa yapi ya kuharisha yanayosababishwa na bakteria au virusi yanayohusishwa na majanga mara nyingi? Je, unazikumbuka sababu mbili za ukweli huu?
Jibu
Kipindupindu na shigelosi (maambukizi ya basila ya kuhara damu) inaweza kuenea kwa haraka hivyo kusababisha janga. Sababu mbili kuu ni kuwa idadi ndogo ya bakteria (chini ya kumi) inaweza kupelekea ugonjwa huu zinapomwingia mtu aliye na uhatarisho wa kuambukizwa, na watu waliopona ugonjwa huu huzidi kutoa bakteria hizi katika kinyesi chao kwa wiki kadhaa.
Mwisho wa jibu
Visa vinavyokisiwa kuwa vya kipindupindu au shigelosi (maambukizi ya basila ya kuhara damu) vinapaswa kuripotiwa mara moja katika Ofisi ya Afya ya wilaya
Unapokisia kisa kimoja cha kipindupindu au shigelosi katika jamii, unapaswa kuchukua hatua ya kufanya uchunguzi haraka iwezekanavyo, kupiga ripoti na kuanzisha mikakati ya kudhibiti asili ya maambukizi kabla ya kuenea. Mbinu za kuchunguza janga zitajadiliwa kwa kina katika Kipindi cha 42, hivyo hapa tutafanya muhtasari wa mambo makuu.
Swali
Je, unafikiri ni muhimu kuripoti visa vinavyokisiwa kuwa vya kipindupindu au shigelosi katika Ofisi ya Afya ya wilaya?
Jibu
Mtu mmoja pekee hawezi kuzuia janga kutokea. Kuripoti visa vinavyokisiwa husaidia Ofisi ya Afya ya wilaya na taasisi zingine za juu kuanzisha uchunguzi wa janga na utambuzi wa maabaranini haraka iwezekanavyo, hivyo kuungana nawe katika kuchukua hatua za udhibiti wa janga kabla ya kuenea.
Mwisho wa jibu
Unapaswa kujaribu kutambua watu wote waliokuwa na uhusiano wa karibu na mgonjwa asili (kisa cha kwanza katika jamii) kwa kumwuliza mgonjwa, familia na majirani kuhusu mambo ambayo mgonjwa amekuwa akifanya hivi karibuni na watu waliokuwa naye wakati huo. Ni muhimu kumtambua kila mtu aliyeshiriki chakula au maji na mgonjwa. Washauri watu hawa kutafuta matibabu ya mapema ikiwa ugonjwa utaanza, na pia kuripoti mara moja.
33.6.2 Hatua za kudhibiti janga la kipindupindu
Kando na mambo yaliyoelezwa hapo awali, unapaswa kuchukua hatua ya kuzuia kuenea kwa bakteria ya kipindupindu katika maji, chakula au mikono ya watu wanaowatunza wagonjwa.
• Hakikisha kuwa kila mtu aliye na uhusiano wa karibu na mgonjwa anafahamu kuwa anapaswa kunawa mikono vyema kwa sabuni na maji baada ya kumgusa mgonjwa, na pia wakati mwingine wowote (baada ya kuenda haja, kabla ya kutayarisha au kula chakula na kadhalika.)
• Hakikisha kuwa kinyesi au matapishi ya mgonjwa hayachafui asili ya maji ya kunywa; kwa mfano, wakati wa kusafisha nguo, matandiko au vikombe vilivyochafuliwa na mgonjwa. Usioshe vifaa vyovyote ambavyo huenda vikawa na bakteria ya kipindupindu kwenye mito, vidimbwi au vifaa vya maji vinavyotumika kuchotea maji ya kunywa (Picha 33.8). Maji yaliyoambukizwa ni njia moja kuu ya kusambaza bakteria ya kipindupindu. Janga la kipindupindu linapotokea, kila mtu katika jamii anapaswa kuteka maji salama ya kunywa, na wayachemshe au kuyatibu kwa klorini..
• Ni muhimu kutibu nguo zilizochafuliwa kwa kinyesi au matapishi, na pia vifaa vinavyotumika na mgonjwa; vifaa hivi vinapaswa kuchemshwa au kusuguliwa kwa mchanganyiko wa dawa ya klorini.
• Kukatiza usambazaji kupitia vyakula hujumuisha kupika chakula vyema kabla ya kula, kuzuia nzi kuchafua chakula, na kutokula mboga na matunda mabichi.
•
Picha 33.8 Nguo za mtu mwenye kipindupindu hazifai kuoshwa kwa maji wanayotumia watu wengine kuogea au kunywa. (Picha: Basiro Davey)
33.6.3 Hatua za udhibiti wa janga la shigelosi
Bakteria za Shigella zinaweza kusambazwa moja kwa moja kutoka kwa mtu mmoja hadi mwingine, kwa mfano kupitia kusalimiana. Kwa hivyo watunzaji wa wagonjwa wako katika hatari kuu ya kuambukizwa. Waelimishe watunzaji kuwa idadi ndogo sana ya viumbehai inaweza kusababisha maambukizi na kuwa hali ya juu ya usafi huhitajika wakati wa kushughulikia kinyesi cha mgonjwa. Isitoshe, wagonjwa na watunzaji wanapaswa kuelewa kuwa mtu yeyote mwenye maambukizi ya Shigella hapaswi kuwatayarishia wengine chakula, kumtunza mtoto mdogo au mtu mgonjwa hadi mwezi mmoja baada ya kupona. Hii ni kwa sababu bakteria hii huendelea kutolewa na mgonjwa kupitia kinyesi kwa wiki kadhaa na inaweza kumwambukiza mtu yeyote aliye na hatari ya kuambukizwa.
Swali
Ni hatua zipi muhimu zaidi za kuzuia kuambikizwa shigelosi?
Jibu
Hatua hizi hujumuisha:
• kunawa mikono vyema na mara nyingi kwa sabuni na maji (Picha 33.9)
Picha 33.9 Kunawa mikono kwa sabuni na maji ni hatua muhimu zaidi ya kudhibiti janga la shigelosi. (Picha: Basiro Davey)
• kuepuka kugusa kinyesi moja kwa moja, ikiwezekana, na kukitupa kwa njia salama
• kutibu nguo na vifaa vilivyochafuliwa na kinyesi.
Mwisho wa jibu
33.7 Homa ya matumbo
Katika kitengo cha mwisho cha kipindi hiki, tutaangazia homa ya matumbo- ugonjwa wa bakteria kutoka kwa kinyesi hadi kinywani unaosababishwa na bakteria ya Salmonella typhi . Ugonjwa huu huainishwa kama ugonjwa wenye homa (wala sio ugonjwa wa kuharisha). Muda wa kupevuka kwa kawaida huwa wiki moja hadi mbili. Ingawa homa ya matumbo inaweza kusababisha kuhara kwa watoto, hali hii huwa nadra kwa watoto wa chini ya umri wa miaka mitano. Watu wazima wanaweza kuhara katika awamu za kwanza za ugonjwa huu, lakini hali hii hubadilika haraka na kuwa uyabisi. Tofauti kuu huwa ni homa ya juu sana (nyusi 39 hadi 40), inayoambatana na maumivu ya kichwa, ulegevu, kupoteza hamu ya kula na mara nyingine madoa ya rangi nyekundu na nyeupe kifuani. Ikiwa umefunzwa kutomasa fumbatio, unaweza kuhisi ini na wengu uliofura.
Homa ya matumbo ni tatizo kuu la afya katika jamii maskini na ni ugonjwa ulioenea (huwepo kila mara kwa viwango visivyobadilika sana) barani Afrika. Shirika la Afya Ulimwenguni linakadiria kuwa kuna takriban visa milioni 17 duniani kote kila mwaka. Homa ya matumbo inaweza kusambazwa moja kwa moja kutoka katika kinyesi hadi kinywani, ingawa mara nyingi husambazwa kwa njia isiyo ya moja kwa moja; kupitia chakula na maji machafu.
Swali
Je, ni magonjwa yapi mengine yenye homa uliyojifunza hadi sasa katika moduli hii, yaani magonjwa ambayo homa ni mojawapo ya dalili kuu?
Jibu
Malaria na meninjitisi ya meningokokasi ni magonjwa yenye homa. (Katika Kipindi cha 36, utajifunza kuhusu magonjwa mengine mawili: tifosi na homa ya kurejea inayosambazwa na chawa.)
Mwisho wa jibu
Unaweza kutambua kisa cha homa ya matumbo kwa msingi wa utambuzi wa kimatibabu, lakini kwa sababu dalili za homa ya matumbo hufanana na za malaria, unapaswa kwanza kutumia kipimo cha utambuzi wa haraka wa malaria ikiwa uko katika eneo ambalo malaria hutokea mara nyingi (Picha 33.10). Hata baada ya kuondoa uwezekano wa malaria, hauwezi kuwa na uhakika wa homa ya matumbo, kwani meninjitisi na homa inayorejea inaweza kuwa dalili na ishara sawa. Hivyo basi, ikiwa unakisia homa ya matumbo, mpe mgonjwa rufaa hadi kituo cha juu cha afya kilicho karibu ili afanyiwe utambuzi wa maabarani na matibabu maalum.
Picha 33.10 Kifaa cha Kupima Utambuzi wa Haraka wa Malaria. Mbinu ya kupima ilielezwa katika Kipindi cha 8 katika Moduli hii. (Picha: Ali Wyllie)
Sawa na magonjwa mengine yanaosambazwa kutoka kwa kinyesi hadi kinywani, jukumu lako katika kuzuia na kudhibiti homa ya matumbo ni kuielimisha jamii kuhusu hatua zinazolenga kukatiza maambukizi kutoka kwa kinyesi hadi kinywani. Katika kipindi kinachofuata tutaangazia magonjwa yanayosambazwa kutoka kwa kinyesi hadi kinywani ambayo husababishwa na heliminti (minyoo) na vimelea vya seli moja.
Muhtasari wa Kipindi cha 33
Katika Kipindi cha 33, umejifunza kwamba:
1. Magonjwa makuu yanayosambazwa kutoka kwa kinyesi hadi kinywani ambayo husababishwa na bakteria na virusi hujumuisha kipindupindu, shigelosi (maambukizi ya basila ya kuhara damu), magonjwa ya kuharisha yanayosababishwa na virusi (maambukizi ya virusi vya rota ndiyo makuu zaidi) na homa ya matumbo.
2. Kipindupindu ni ugonjwa unaosababishwa na bakteria, ambao dalili yake ni kutapika kwingi na hali kali ya kuharisha kinyesi majimaji kinachofanana na maji ya wali.
3. Shigelosi au maambukizi ya basila ya kuhara damu ni ugonjwa mkali wa kuharisha kinyesi chenye damu na kamasi, huku mgonjwa akihisi haja ya upesi na kukumbwa na ugumu wakati wa kunya.
4. Magonjwa ya kuharisha yanayosababishwa na virusi ndiyo aina ya magonjwa ya kuharisha yanayopatikana kwa wingi, hasa katika watoto. Ugonjwa huu hudhihirika kwa hali kali ya kuharisha kinyesi majimaji.
5. Usambazaji wa bakteria ya kipindupindu na virusi vya rota huwa hasa kupitia chakula na maji machafu, huku shigelosi ikienezwa kupitia watu kugusana moja kwa moja.
6. Kipindupindu na shigelosi huwa na uwezekano mkuu wa kuwa janga kwa sababu idadi ndogo ya bakteria inaweza kusababisha magonjwa, na bakteria hizi huendelea kutoka kwa mgonjwa hata baada ya kupona.
7. Hatua za kudhibiti janga hujumuisha kuripoti kwa haraka, kuwatambua watu wenye uhusiano wa moja kwa moja na mgonjwa asili, kunawa mikono vyema na mara nyingi kwa sabuni na maji, kutumia vyoo vyema na kutibu au kuchemsha nguo, matandiko na vyombo vilivyotumika na mgonjwa.
8. Unaweza kutibu visa vingi vya watoto wanaoharisha majimaji vikali katika kituo cha afya bila kuhitaji utambuzi wa maabaranini wa kiini kinachosababisha maambukizi. Hata hivyo, watu wazima wanaoharisha vikali na watoto wanaohara damu wanapaswa kupewa rufaa haraka baada ya kuanzishiwa viowevu vya kuongeza maji mwilini.
9. Homa ya matumbo ni ugonjwa wenye homa unaodhihirika kwa homa ya hali ya juu inayodumu, ukiambatana na uyabisi (badala ya kuhara) katika idadi kubwa ya watu wazima. Ugonjwa huu huenezwa kutoka kwa kinyesi hadi kinywani kupitia maji na chakula kichafu. Ikiwa unakisia homa ya matumbo, unapaswa kumpa mgonjwa huyo rufaa haraka iwezekanavyo.
Maswali ya Kujitathmini ya Kipindi cha 33
Kwa vile umekamilisha kipindi hiki, jibu maswali yafuatayo ili kubaini jinsi ulivyotimiza Malengo ya Somo la kipindi hiki kwa kujibu maswali yafuatayo. Swali moja pia linatathmini baadhi ya Malengo ya Somo la Kipindi cha 32. Andika majibu yako katika shajara ya masomo na uyajadili na Mkufunzi wako katika Mkutano Saidizi wa Somo unaofuata. Unaweza kudhibitisha majibu yako ukiyalinganisha na vidokezo ulivyoandika katika Maswali ya Kujitathmini mwishoni mwa Moduli hii.
Swali la Kujitathmini 33.1 (linatathmini Malengo ya Somo 33.1, 31.2, 31.3 na 33.4)
Ni elezo lipi si kweli? Katika kila kauli, eleza kwa nini sio sahihi.
A Homa ya matumbo mara nyingi husambazwa kwa njia isiyo ya moja kwa moja kupitia chakula na maji machafu.
B Dalili bayana za kipindupindu hujumuisha kuharisha kwenye damu.
C Shigelosi mara nyingi husambazwa kwa kugusana moja kwa moja na mgonjwa.
D Magonjwa ya kuharisha yanaweza kupelekea mshtuko na kuishiwa na maji mwilini.
E Virusi ndivyo kisababishi kikuu cha kuhara katika watoto.
F Homa ya matumbo ni kisababishi kikuu cha kuhara katika watu wazima.
Jibu
A ni kweli. Homa ya matumbo mara nyingi husambazwa kwa njia isiyo ya moja kwa moja, yaani kupitia chakula na maji machafu.
B si kweli. Dalili bayana ya kipindupindu ni kutapika na kuhara kinyesi kingi kinachofanana na maji ya wali - lakini sio kuhara kinyesi chenye damu.
C ni kweli. Shigelosi mara nyingi husambazwa kwa kugusana moja kwa moja na mgonjwa.
D ni kweli. Magonjwa ya kuharisha yanaweza kusababisha mshtuko na kuishiwa na maji mwilini.
E ni kweli. Virusi ni kisababishi kikuu cha kuhara katika watoto.
F si kweli.Homa ya matumbo hudhihirika kwa uyabisi badala ya kuhara katika watu wazima. Dalili kuu huwa homa ya hali ya juu inayodumu.
Mwisho wa jibu
Swali la Kujitathmini 33.2 (linatathmini Malengo ya Somo 31.1, 33.4 na 33.5)
Je, ni hatua gani utakazochukua ukimtambua mtu mzima anayehara damu:
1. Utamtibu mgonjwa?
2. Utazuia ugonjwa kuenea?
Jibu
1. Unapaswa kuanzisha viowevu vya kuongeza maji mwilini kwa mtu mzima anayehara damu na kumpa rufaa hadi kituo cha hali ya juu cha afya ili kufanyiwa utambuzi wa maabaranini wa viini ambukizi na kupewa matibabu maalum.
2. Unapaswa kuripoti kisa kinachokisiwa katika Ofisi ya Afya ya wilaya kisha uombe usaidizi wa kuzuia janga. Uliza jamaa na majirani wa mgonjwa kama kuna watu wengine wenye ugonjwa sawa, kisha uwashauri wote wenye uhusiano wa karibu na mgonjwa kuchukua hatua bora za usafi, ikijumuisha kunawa mikono kwa sabuni na maji. Hakikisha kuwa wanadhibiti kuenea kwa viini ambukizi kwa kuchemsha au kutibu nguo, matandiko au vyombo vilivyotumiwa na mgonjwa; vifaa hivi visioshewe katika asili ya maji yanayotumika kuogea na kunywea.
Mwisho wa jibu
Swali la Kujitathmini 33.3 (linatathmini Malengo ya Somo 33.2, 33.3 na 33.4)
Jaza mapengo yaliyoachwa katika Jedwali 33.3.
Jedwali 33.3 Muda wa kupevuka na vikundi vya umri vinavyoathiriwa zaidi na magonjwa makuu ya bakteria na virusi yanayosambazwa kutoka kwa kinyesi hadi kinywani.
Ugonjwa Muda wa kupevuka Kikundi cha umri kinachoathiriwa
Kipindupindu
Shigelosi
Maambukizi ya virusi vya rota
Homa ya matumbo
Jibu
Toleo lililojazwa la Jedwali 33.3.
Jedwali 33.3 Muda wa kupevuka na vikundi vya umri vinavyoathiriwa zaidi na magonjwa makuu ya bakteria na virusi ya kinyesi na kinywa.
Ugonjwa Muda wa kupevuka Kikundi cha umri kinachoathiriwa
Kipindupindu Saa 2 hadi siku 5 Umri wowote unaweza kuathiriwa
Shigelosi Siku 1 hadi 3 Miaka 2 hadi 3
Maambukizi ya virusi vya rota Siku 2 hadi 3 Chini ya miaka 5
Homa ya matumbo Wiki 1 hadi 2 Zaidi ya miaka 5
Mwisho wa jibu
Swali la Kujitathmini 33.4 (linatathmini Malengo ya Somo 33.1, 33.2, 33.2 na 33.5)
1. Virusi vya rota vina uwezo wa kuenea katika nchi zinazostawi, na ni visababishi vikuu vya magonjwa ya kuharisha katika watoto wachanga. Je, uwezo wa kuenea humaanisha nini?
2. Magonjwa ya kuharisha yanayosababishwa na bakteria na virusi husambazwa vipi?
3. Mtoto mwenye umri wa miezi tisa ameharisha kinyesi majimaji mara tatu katika siku tatu zilizopita. Mama anasema kuwa mtoto huyu angali ananyonya lakini pia anakula na kunywa kama kawaida. Mtoto huyu haonekani kupoteza maji mengi mwilini. Ni hatua gani utakayochukua, na utamshauri mama kufanya aje?
Jibu
1. Uwezo wa kuenea humaanisha kuwa virusi vya rota na magonjwa ya kuharisha yanayosababishwa na virusi hivi 'huwepo kila mara' barani Afrika kwa takriban kiwango kisichobadilika.
2. Magonjwa ya kuharisha yanayosababishwa na bakteria na virusi husambazwa moja kwa moja kwa mikono iliyochafuliwa kwa kinyesi kisha mikono hii kugusa kinywa; na kwa njia isiyo ya moja kwa moja katika chakula kilichochafuliwa, maji, mchanga na vyombo (kwa mfano chupa za kulisha watoto wachanga) na nzi waliogusa kinyesi.
3. Mama anakufahamisha kuwa mtoto bado ananyonya, kula na kunywa kama kawaida. Ikiwa mtoto hajaishiwa na maji mwilini, hakuna haja ya kumpa kinywaji cha kuongeza maji mwilini mara moja. Hata hivyo, mama anapaswa kushauriwa kuendelea kumnyonyesha mtoto kadri awezavyo, kunywa na kula vyakula vingine vya kuhuisha na kutumia kikombe na kijiko safi kabisa. Mama anapaswa kunawa mikono vyema na mara nyingi kwa sabuni, hasa baada ya kumbadilisha mtoto nepi au kumwosha matako. Mfahamishe mama kumleta mtoto kwako upesi, au kumpeleka hospitalini au katika kituo cha afya kilicho karibu, ikiwa ataendelea kuhara au kuzidiwa.
Mwisho wa jibu
Kiingereza hadi Kinyarwanda: Chidren's Books General field: Sanaa/Fasihi Detailed field: Elimu/Mafunzo
Matini asilia - Kiingereza English
Ice cream
I am Kriekie.
I am Kierie.
When were you last at the beach?
What did you do there?
Do you enjoy playing in the sand or do you find the bugs in the sand creepy?
What do you need to rub on your skin to avoid getting sunburnt?
What do you need to wear on your head when you go into the sun?
Do you enjoy eating ice cream when you are at the beach?
Tell your classmates what happened to Kierie’s
ice cream.
What did Kriekie do?
What would you have done in the same situation?
Kierie, Kriekie and Mommy Frog go to the beach.
The ice cream van arrives.
Kierie and Kriekie each buy an ice cream
Find out what happens to Kierie’s ice cream.
Tafsiri - Kinyarwanda Kinyarwanda
Aiskrimu
Nitwa Kriekie.
Nitwa kierie.
Uheruka ryari ku nkengero z’ikiyaga?
Wakozeyo iki?
Mukunda gukinira ku nkengero z’ikiyaga cyangwa mubona iminyorogoto yo mu mucanga iteye ubwoba.
Niki musabwa kwisiga kugira ngo murinde uruhu rwanya kwangizwa n’izuba?
Niki musabwa kwambara mu mutwe mugihe mugiye ku izuba?
Ese mukunda kurya aiskrimu mugihe muri ku nkengero z’ikiyaga.
Bwira bagenzi bawe ibyabaye kuri aiskrimu ya Kierie.
Kriekie yakoze iki?
Wowe uba warakoze iki muri icyo gihe?
Aiskrimu
Kierie, Kriekie na mama gikeri bagiye ku nkengero z’ikiyaga imodoka itwaye asikrimu irahagera.
Kierie na Kriekie buriwese agura aiskrimu.
Shaka ibyabaye kuri aiskrimu ya Kierie.
Kiingereza hadi Kiswahili: iFixit General field: Teknolojia/Uhandisi Detailed field: Mekaniki/Uhandisi wa Kiufundi
Matini asilia - Kiingereza Replacing Bush Pump Above Grade
English Swahili
Replacing Bush Pump Above Grade Kubadili Mfereji wa Juu wa Pampu ya Mkono wa Kidhibiti Vipimo
Riser Pipe Mfereji inuzi
INTRODUCTION UTANGULIZI
This guide will walk you through the procedure to remove the above grade riser pipe. Mwongozo huu utakuelekeza katika utaratibu wa kuondoa mfereji inuzi wa vipimo vya juu.
You can then replace it with a new one, or perform any necessary repairs on it. Unaweza kutia mfereji mpya, au kuukarabati ifaavyo.
Step 1 — Head and Handle Hatua ya 1 - Kichwa na Mkono
Test pump performance by pumping 40 strokes. Tathmini utendakazi wa pampu kwa kuipiga mara 40.
An effective pump should return at least 10 liters. Pampu bora inafaa kutoa angalau lita 10.
Step 2 Hatua ya 2
Remove the two pins connecting the handle to the slider. Ondoa pini mbili zinazounganisha mkono na kitelezi.
Step 3 Hatua ya 3
Pull the two lever arms away from the slider. Vuta nyenzo zote mbili mbali na kitelezi.
Step 4 Hatua ya 4
Lift the two pins attaching the pump frame to the head and handle up, off of the pump frame. Inua pini zote mbili zinazoshikisha fremu ya pampu kwenye kichwa na mkono, hadi ziachishwe kwenye fremu ya pampu.
Step 5 Hatua ya 5
Throughout this step, make sure you support the handle and head with at least three hands. Katika hatua yote hii, hakikisha kuwa mkono na kichwa kimeshikwa kwa angalau mikono mitatu.
Slide the bearing rod out of the head. Ondoa ufito himili kutoka kichwani.
Inspect the bearing rod and head for any wear or tear. Chunguza ufito himili na kichwa kuhakikisha kuwa havijachakaa.
Step 6 Hatua ya 6
Remove the head and handle, and place them on a clean surface to prevent contamination Ondoa kichwa na mkono kisha uviweke kwenye mahali sifa ili kuvizuia visichafuke.
Step 7 — Riser Main Slider Hatua ya 7 - Kitelezi cha Kiinuzi Kikuu
Firmly lift the riser main slider with two hands. Inua kwa udhabiti kitelezi cha kiinuzi kikuu kwa mikono miwili.
Use caution not to drop the riser main, as this can damage the pump cylinder. Jitahadhari dhidi ya kuangusha kiinuzi kikuu usije kuharibu mtungi wa pampu.
Step 8 Hatua ya 8
Use a pipe wrench to fully loosen the above grade riser pipe. Tumia spana ya mrefereji ili kufungua mfereji inuzi wa vipimo vya juu.
Step 9 Hatua ya 9
Lift the slider and riser main pipe. Inua kitelezi na mrefeji wa kiinuzi kikuu.
Place a pump rod clamp around the rod, and tighten it securely against the pump rod. Tia klempu ya ufito ikiuzingira ufito kisha uikaze salama dhidi ya ufito wenyewe.
Carefully lower the riser main and slider to allow it to rest on the rod clamp. Kishushe kiinuzi kikuu na kitelezi kwa utaratibu ili kuviwezesha kuegemea juu ya klempu ya ufito.
Step 10 Hatua ya 10
Loosen and remove both the pump rod jam nut and pump rod nut on the top of the slider. Fungua na uondoe nati ya kukwamisha ufito na nati ya pampu juu ya kitelezi.
To reassemble your device, follow these instructions in reverse order. Ili kuunganisha kifaa chako tena, fuata maagizo haya kwa utaratibu wa kinyume.
Step 11 Hatua ya 11
Remove the riser main slider, and inspect it for wear and tear. Ondoa kitelezi cha kiinuzi kikuu, kisha ukichunguze kama kimechakaa.
Set the slider in a sanitary place to prevent contamination. Kiweke kitelezi katika mahali safi kukizuia kisichafuke.
Step 12 — Above Grade Riser Pipe Hatua ya 12 - Mfereji Inuzi wa Vipimo vya Juu
Remove the above grade riser pipe. Ondoa mfereji inuzi wa vipimo vya juu.
Firmly screw a T-handle onto the pump rod. Ufungilie mkono wa umbo la T kwa udhabiti kwenye ufito wa pampu.
If you are replacing the above ground riser main, leave the T-handle attached until you are ready to install the replacement part. Iwapo unabadili kiinuzi kikuu cha juu ya ardhi, uwache mkono wa umbo la T ukiwa umepandikizwa hadi uwe tayari kutia sehemu unayobadilisha.
To reassemble your device, follow these instructions in reverse order. Ili kuunganisha chombo tena, fuata maagizo haya ukianzia mwisho.
Tafsiri - Kiswahili Replacing Bush Pump Above Grade
English Swahili
Replacing Bush Pump Above Grade Kubadili Mfereji wa Juu wa Pampu ya Mkono wa Kidhibiti Vipimo
Riser Pipe Mfereji inuzi
INTRODUCTION UTANGULIZI
This guide will walk you through the procedure to remove the above grade riser pipe. Mwongozo huu utakuelekeza katika utaratibu wa kuondoa mfereji inuzi wa vipimo vya juu.
You can then replace it with a new one, or perform any necessary repairs on it. Unaweza kutia mfereji mpya, au kuukarabati ifaavyo.
Step 1 — Head and Handle Hatua ya 1 - Kichwa na Mkono
Test pump performance by pumping 40 strokes. Tathmini utendakazi wa pampu kwa kuipiga mara 40.
An effective pump should return at least 10 liters. Pampu bora inafaa kutoa angalau lita 10.
Step 2 Hatua ya 2
Remove the two pins connecting the handle to the slider. Ondoa pini mbili zinazounganisha mkono na kitelezi.
Step 3 Hatua ya 3
Pull the two lever arms away from the slider. Vuta nyenzo zote mbili mbali na kitelezi.
Step 4 Hatua ya 4
Lift the two pins attaching the pump frame to the head and handle up, off of the pump frame. Inua pini zote mbili zinazoshikisha fremu ya pampu kwenye kichwa na mkono, hadi ziachishwe kwenye fremu ya pampu.
Step 5 Hatua ya 5
Throughout this step, make sure you support the handle and head with at least three hands. Katika hatua yote hii, hakikisha kuwa mkono na kichwa kimeshikwa kwa angalau mikono mitatu.
Slide the bearing rod out of the head. Ondoa ufito himili kutoka kichwani.
Inspect the bearing rod and head for any wear or tear. Chunguza ufito himili na kichwa kuhakikisha kuwa havijachakaa.
Step 6 Hatua ya 6
Remove the head and handle, and place them on a clean surface to prevent contamination Ondoa kichwa na mkono kisha uviweke kwenye mahali sifa ili kuvizuia visichafuke.
Step 7 — Riser Main Slider Hatua ya 7 - Kitelezi cha Kiinuzi Kikuu
Firmly lift the riser main slider with two hands. Inua kwa udhabiti kitelezi cha kiinuzi kikuu kwa mikono miwili.
Use caution not to drop the riser main, as this can damage the pump cylinder. Jitahadhari dhidi ya kuangusha kiinuzi kikuu usije kuharibu mtungi wa pampu.
Step 8 Hatua ya 8
Use a pipe wrench to fully loosen the above grade riser pipe. Tumia spana ya mrefereji ili kufungua mfereji inuzi wa vipimo vya juu.
Step 9 Hatua ya 9
Lift the slider and riser main pipe. Inua kitelezi na mrefeji wa kiinuzi kikuu.
Place a pump rod clamp around the rod, and tighten it securely against the pump rod. Tia klempu ya ufito ikiuzingira ufito kisha uikaze salama dhidi ya ufito wenyewe.
Carefully lower the riser main and slider to allow it to rest on the rod clamp. Kishushe kiinuzi kikuu na kitelezi kwa utaratibu ili kuviwezesha kuegemea juu ya klempu ya ufito.
Step 10 Hatua ya 10
Loosen and remove both the pump rod jam nut and pump rod nut on the top of the slider. Fungua na uondoe nati ya kukwamisha ufito na nati ya pampu juu ya kitelezi.
To reassemble your device, follow these instructions in reverse order. Ili kuunganisha kifaa chako tena, fuata maagizo haya kwa utaratibu wa kinyume.
Step 11 Hatua ya 11
Remove the riser main slider, and inspect it for wear and tear. Ondoa kitelezi cha kiinuzi kikuu, kisha ukichunguze kama kimechakaa.
Set the slider in a sanitary place to prevent contamination. Kiweke kitelezi katika mahali safi kukizuia kisichafuke.
Step 12 — Above Grade Riser Pipe Hatua ya 12 - Mfereji Inuzi wa Vipimo vya Juu
Remove the above grade riser pipe. Ondoa mfereji inuzi wa vipimo vya juu.
Firmly screw a T-handle onto the pump rod. Ufungilie mkono wa umbo la T kwa udhabiti kwenye ufito wa pampu.
If you are replacing the above ground riser main, leave the T-handle attached until you are ready to install the replacement part. Iwapo unabadili kiinuzi kikuu cha juu ya ardhi, uwache mkono wa umbo la T ukiwa umepandikizwa hadi uwe tayari kutia sehemu unayobadilisha.
To reassemble your device, follow these instructions in reverse order. Ili kuunganisha chombo tena, fuata maagizo haya ukianzia mwisho.
Kiingereza hadi Kiswahili: Online Profile General field: Basi/Kifedha Detailed field: Matangazo/Uhusiano wa Umma
Matini asilia - Kiingereza Cannot load more emails?
Retrieval settings for mailbox
NetEase
QQ
See?
Sina
Experience it now
Please select contacts to @
Permission Request
Failed to delete personal information of the account
Click to grant permission
Attachment auto-download failed
Click to grant permission
Tafsiri - Kiswahili Je, huwezi kupakia barua pepe zaidi?
Mipangilio ya urejeshaji ya kikasha pokezi
NetEase
QQ
Unaona?
Sina
Itumie sasa
Tafadhali chagua anwani za @
Ombi la Ruhusa
Imeshindwa kufuta maelezo ya kibinafsi ya akaunti hii
Bofya ili upeane ruhusa
Kiambatishi hakikupakuliwa moja kwa moja
Bofya ili upeane ruhusa
More
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Elimu ya Tafsiri
Master's degree - University of Nairobi
Tajiriba
Miaka ya tajiriba ya tafsiri: 14. Umesajiliwa katika ProZ.com: Sep 2013.
Kiingereza hadi Kiswahili (University of Nairobi) Kiingereza hadi Kiswahili (Translators Without Borders) Kiingereza hadi Kiswahili (Kenya National Examinations Council)
Adobe Acrobat, Adobe Illustrator, Adobe Photoshop, memoQ, Microsoft 365, Microsoft Excel, Microsoft Word, Multicorpora, Pagemaker, Passolo, Powerpoint, Smartling, Trados Studio, Wordfast
Professional objectives
Meet new translation company clients
Build or grow a translation team
Learn more about additional services I can provide my clients
Meet new end/direct clients
Screen new clients (risk management)
Network with other language professionals
Find trusted individuals to outsource work to
Get help with terminology and resources
Learn more about translation / improve my skills
Get help on technical issues / improve my technical skills
Learn more about the business side of freelancing
Find a mentor
Stay up to date on what is happening in the language industry
Help or teach others with what I have learned over the years
Transition from freelancer to agency owner
Buy or learn new work-related software
Improve my productivity
Bio
Hello!
I hold a Masters in Translation Studies from the University of Nairobi. I am a Freelance English-Swahili
translator/editor who also volunteers for Translators without Borders.
I have been translating for 12 years now specializing in
Medical, IT, Media, Legal and Education.
I have translated for notable clients such as Google, Uber, Netflix, DSTV, Amazon, Coca Cola, Sony,
Microsoft, the State of Oregon, Wikipedia, Open University UK, EAST University Kenya, Kenya Medical
Training College, Translators Without Borders, World Readers and Ushahidi among
others.
I provide high-quality translations, stay in touch with the
client for any project updates, ask questions when necessary and offer very
competitive rates. I aim at making translation read naturally, easily and fluidly.
I am open for localization and translation projects to enable you to speak to your audience in Swahili speaking Eastern Africa in their mother tongue.
Best,
Matthias
Mtumiaji huyu ametozwa alama za KudoZ kwa kusaidia watafsiri wengine na istilahi za kiwango cha WATAALAMU Bofya jumla ya(za) alama ili kuona tafsiri za istilahi zilizotolewa
Jumla ya alama zilizotozwa: 4 (Kiwango cha WATAALAMU wote)
