Infection Prevention | Political economics

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Hygiene and sanitation play a key role in preventing gastrointestinal infections. The most common gastrointestinal illnesses seen in health services are indigestion, upper abdominal pain and diarrhea.

Adults usually complain of heartburn, acid, upper abdominal pain during meals or on an empty stomach, and bloating. Patients may also complain of nausea, vomiting, and regurgitation. When investigated for stool H.pylori bacteria, many of them test positive. Survey of their eating habits reveals that a majority use tap water or direct groundwater supply. Street food consumption also seems to be a frequent culprit. We all know that food and drink are handled with bare hands, and many vendors don’t even bother to cover the food. Poor hygiene contributes to the spread of H.pylori in the community.

A meta-analysis shows that the prevalence of H. pylori is 44.3% worldwide. H.pylori the infection causes gastric and duodenal ulcers. H. pylori are found in 90-95% of people with duodenal ulcers and 50-70% of people with gastric ulcers. Infection contributes to long-term gastric cancer.

In 1994, WHO and the International Agency for Research on Cancer (IARC) classified Helicobacter pylori as a Class 1 human carcinogen due to its prevalence associated with gastric carcinoma. Hygiene and food handling and using safe water for drinking can help prevent acquiring this infection.

Poor hygiene in children makes them susceptible to contracting worms, viruses and bacterial infections leading to diarrhoea. Rotavirus and Escherichia coli are the two most common causative agents of moderate to severe diarrhea in low-income countries. Diarrhea is the second leading cause of infant morbidity and mortality. A 2017 WHO report indicates that diarrhea kills many children under five every year. The main reasons for getting these infections are improper hand washing after using the toilet and not showering regularly, especially after being exposed to dirt and sucking on objects and thumbs in children. Bottle-feeding also transmits bacteria and can be a source of infection in infants and toddlers.

Diarrhea can last for days and leave the body without the water and salts necessary for survival. In the past, for most people, severe dehydration and fluid loss were the leading causes of death from diarrhea. Today, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhea-associated deaths. In addition, each episode deprives the child of the nutrition necessary for growth. As a result, diarrhea is one of the leading causes of malnutrition in children under five, and malnourished children are more likely to fall ill again from diarrhoea.

Diarrhea is the second leading cause of infant morbidity and mortality. A 2017 WHO report indicates that diarrhea kills many children under five every year. The main reasons for getting these infections are improper hand washing after using the toilet and not showering regularly, especially after being exposed to dirt and sucking on objects and thumbs in children. Bottle-feeding also transmits bacteria and can be a source of infection in infants and toddlers.

Maternal literacy plays an important role here. An educated mother can well understand the importance of hygiene, proper nutrition for her child, and recognition of signs of illness. Through education and awareness, many diseases can be prevented. This can be done through counseling sessions in maternity wards, print media, social media and television. Mothers should avoid bottle-feeding, regularly trim their children’s nails, give them daily showers and provide them with clean water and food. Mothers need to know when to take the child to the doctor. Urgency to drink fluids, sunken eyes and lethargy are warning signs of dehydration that need to be treated quickly. Exclusive breastfeeding for the first six months of life and rotavirus vaccination for babies can help prevent diarrhea.

Adults also transmit infections like typhoid and cholera due to improper food handling. Long, dirty fingernails harbor bacteria; cooking and serving with unwashed hands spreads infections at home and in the community outside. Using a hat while cooking and gloves when needed can help prevent the spread of infection. Flies and mosquitoes carry bacteria and viruses and are a source of infection transmission by contaminating food. Polluted air also carries dust and germs. Therefore, it is important to cover food and drink appropriately.

Meat and poultry should be refrigerated and thoroughly cooked. Dairy products and unpasteurized juices should not be consumed. Vegetables and fruits should be washed well before eating. Many parasitic infections are likely to be contracted by contact with soil contaminated with human or animal faeces. These include giardiasis, cryptosporidiosis and toxoplasmosis. Swimmers are also prone to contracting gastrointestinal infections as faecal contamination from swimming pools can be harmful.

Drinking water can contain various impurities – physical, biological and chemical. The most dangerous contaminants are biological in nature. These cause human health problems, often resulting in death. Poor treatment facilities lead to the spread of waterborne diseases. Worldwide, 780 million people lack access to improved drinking water and 2.5 billion lack access to improved sanitation. In Pakistan, the drinking water system and the sewage pipes work in parallel, which causes leaks and the mixing leads to deterioration of the water quality. In most cities of Pakistan, the groundwater supply contains various pathogens including numerous viral, bacterial and protozoan agents causing 2.5 million deaths annually from endemic diarrheal disease. Water contaminated with human or animal faeces, such as sewage, septic tanks and latrines, is of particular concern. Tap water is not drinkable. Drinking water must be made safe by chlorination, boiling, using membrane filters or alternative standard methods. It is the responsibility of educated members of the community to educate their contacts. Hand hygiene and the practice of drinking water should be encouraged at home, at school and in the workplace.

Travelers can get diarrhea if they are not careful with the food and drink they take. It is advisable to use bottled water for drinking and cleaning teeth and to avoid ice and raw foods. Meat and eggs should be thoroughly cooked before eating. Salads should be avoided as they are a rich source of bacterial growth. Travelers should also avoid contact with people with gastrointestinal infections as a precaution.


The writer is the Senior Registrar, Family Medicine, Baqai Medical University


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