Kosek, Bern, and Guerrent (2003) estimates a global median incidence of Diarrhoea to be 3.2 episodes Merson (1982) and by Bern et al. (1992) as well as to those reported in the first edition of Disease Control Priorities in Developing Countries (Jamison et al. 1993). Yet every child in Bangladesh suffers an average of three to five diarrhoeal attacks in each year, which is a major contributor to malnutrition. According to the statistical survey, around 125,000 children under five die each year from diarrhoeal disease; that is, 342 children per day (IPRSP 2002). Bangladesh, has been experiencing a rapid increase in population over the past two decades. People migrate to Dhaka and the most migrants work in marginal employment at very low wages and live in squatter and slum settlements with few basic services that are porne to develope Diarrhoea.


CAUSES OF DIARRHOEA

A hundred or more different diseases can be associated with Diarrhoea. Fortunately, the most of the severe causes are rare and the most common form is the one that affects the most of us for a few days each year. It is due to a simple infection, usually caused by a virus, called Rota virus.
 




Bacterial infections can cause more serious cases of Diarrhoea as a result of having contaminated food or drinks (food poisoning). Common bacteria are campylobacter, salmonellae and shigella organisms; less common are Escherichia coli (E coli), yersinial, listerial and cryptosporidial bacteria. These can cause fairly severe Diarrhoea with vomiting, abdominal cramping and fever.

 

Non Inflammatory Diarrhoea                                  Inflammatory Diarrhoea  
Viral
       
Rotavirus
       Norwalk virus
       Norwalk-like virus
       Astrovirus
       Adenovirus

Protozoal
      Giardia lamblia
      Cryptosporidium

Bacterial
     1.
Preformed enterotoxin production
         Enterotoxigenic E coli (ETEC)
         Vibrio cholerae
     2. Enterotoxin production                   Staphylococcus aureus
         Bacillus cereus
         Clostridium perfringens
Protozoal
Entamoaeba histolytica

Bacterial
1. Cytotoxin production       Enterohemorrhagic
    E coli 01S7: HS (EHEC)
    Vibrio parahaemolyticus
    Clostridium difficile
2. Mucosal invasion
    Shigella
    Campylobacter jejuni
    Salmonella
    Enteroinvasive E coli (EIEC)
    Aeromonas, Plesiomonas
    Yersinia enterocolitica, Chlamydia
    Neisseria gonorrhoeae
    Listeria monocytogenes

Table - 1 : Organisms responsible for Acute infectious Diarrhoea

       CAUSES OF CHRONIC DIARRHOEA

        Osmotic Diarrhoea

  1. Medications: antacids, lactulose, sorbitol
2. Disaccharidase deficiency: lactose intolerance
3. Factitious Diarrhoea: magnesium (antacids, laxatives)
 

       Secretory Diarrhoea

1. Hormonally mediated : Carcinoid, medullary       carcinoma of thyroid (calcitonin), Zollinger-Ellison     syndrome
2. Factitious Diarrhoea (laxative abuse);     phenolphthalein, cascara, Senna
3. Villous adenoma
4. Bile salt malabsorption (ileal resection; Crohn's ileitis;     post cholecystectomy)
5. Medications
 

       Inflammatory conditions

1. Ulcerative colitis
2. Crohn's disease
3. Microscopic colitis
4. Malignancy: lymphoma, adenocarcinoma (with      obstruction and pseudo Diarrhoea)
5. Radiation enteritis
 

       Malabsorption syndromes

1. Small bowel mucosal disorders: Cellae sprue, tropical     sprue, Whipple's disease, eosinophilic gastroenteritis,     small bowel resection (short bowel syndrome). Crohn's     disease
2. Lymphatic obstruction: Lymphoma, carcinoid,     infectious (tuberculosis), Kaposi's sarcoma,     sarcoidosis, retroperitoneal fibrosis
3.Pancreatic disease: Chronic pancreatitis, pancreatic    carcinoma
4.Bacterial overgrowth: Motility disorders (diabetes,    vagotomy), scleroderma, fistulas, small intestinal    diverticula

       Motility disorders

1. Post-surgical: Vagotomy, partial gastrectomy, blind     loop with bacterial overgrowth
2. Systemic disorders: Scleroderma, diabetes mellitus,
    hyperthyroidism
3.Irritable bowel syndrome (IBS)

       Chronic Infections

1. Parasites: Giardia lamblia, Entamoeba histolytica
2. AIDS-related:
    Viral: Cytomegalo virus, HIV Infection
    Bacterial: Clostridium difficile, Mycobacterium avium
    Protozoal: Microsporida (Enteroeyloloan bieneusl),          cryptosporidium, Isospora belli

 
1816-1826 : First Cholera pandemic:                        The pandemic began in                         Bengal, and then spread                         across India by 1820.

1829-1851 : Second Cholera                        pandemic reached                        Europe, London and                        Paris in 1832

1961-1970s : Seventh Cholera                          pandemic began in                          Indonesia, called El Tor                          after the strain, and                          reached Bangladesh in                          1963
 
1816-1826 : First Cholera pandemic:                        The pandemic began in                         Bengal, and then spread                         across India by 1820.

1829-1851 : Second Cholera                        pandemic reached                        Europe, London and                        Paris in 1832

1961-1970s : Seventh Cholera                          pandemic began in                          Indonesia, called El Tor                          after the strain, and                          reached Bangladesh in                          1963
 
1816-1826 : First Cholera pandemic:                        The pandemic began in                         Bengal, and then spread                         across India by 1820.

1829-1851 : Second Cholera                        pandemic reached                        Europe, London and                        Paris in 1832

1961-1970s : Seventh Cholera                          pandemic began in                          Indonesia, called El Tor                          after the strain, and                          reached Bangladesh in                          1963
 
1816-1826 : First Cholera pandemic:                        The pandemic began in                         Bengal, and then spread                         across India by 1820.

1829-1851 : Second Cholera                        pandemic reached                        Europe, London and                        Paris in 1832

1961-1970s : Seventh Cholera                          pandemic began in                          Indonesia, called El Tor                          after the strain, and                          reached Bangladesh in                          1963