Frequently Asked Question

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What is Diarrhoea?
Diarrhoea is the passage of loose or watery stools, usually at least three times in a 24-hour period. However, it is the consistency of the stools rather than the number that is most important.
What are the types of diarrhoea ?

Four clinical types of diarrhoea can be recognized:

Acute watery diarrhoea (including cholera): This lasts several hours or days, the main danger is dehydration, weight loss also occurs if feeding is not continued.

Acute bloody diarrhoea: This is also called dysentery, the main dangers are intestinal damage, sepsis and malnutrition; other complications, including dehydration, may also occur.

Persistent diarrhoea: This lasts 14 days or longer, the main danger is malnutrition and serious non-intestinal infection; dehydration may also occur.

Diarrhoea with severe malnutrition: the main dangers are severe systemic infection, dehydration, heart failure and vitamin and mineral deficiency.

What is dehydration?

During diarrhoea there is an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in the liquid stool. Water and electrolytes are also lost through vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced adequately and a deficit of water and electrolytes develops.

The volume of fluid lost through the stools in 24 hours can vary from 5 ml/kg (near normal) to 200 ml/kg, or more. The concentrations and amounts of electrolytes lost also vary. The total body sodium deficit in young children with severe dehydration due to diarrhoea is usually about 70-110 millimoles per litre of water deficit. Potassium and chloride losses are in a similar range. Deficits of this magnitude can occur with acute diarrhoea of any aetiology.

Why is diarrhoea dangerous?

Two main dangers of diarrhoea are death and malnutrition. Death from acute diarrhoea is most often caused by loss of a large amount of water and salt from the body. This loss is called dehydration. Dysentery is another important cause of death related to diarrhoea. Diarrhoea is worse in children with malnutrition. Diarrhoea can cause malnutrition and can make it worse because:

- Nutrients are lost from the body in diarrhoea,
- It may develop loss of appetite
- Mothers may not feed children during diarrhoea, or even for some days after the diarrhoea is better.

To reduce this malnutrition, additional foods should be given to children as soon as dehydration has been corrected.


How diarrhoea causes dehydration?

The body normally takes in the water and salts it needs (input) through drinks and food. It normally loses water and salts (output) through stool, urine and sweat.

When the bowel is healthy, water and salts pass from the bowel into the blood. When there is diarrhoea, the bowel does not work normally. Less water and salts pass into the blood, and more pass from the blood into the bowel. Thus, more than the normal amount of water and salts are passed to the stool.

This larger than normal loss of water and salts from the body results in dehydration. It occurs when the output of water and salts is greater than the input. The more diarrhoea stools a child passes, the more water and salts he/she loses. Dehydration can also be caused by a lot of vomiting, which often accompanies diarrhoea.

What are the most important parts of treatment of diarrhea for children?

The most important parts of treatment of diarrhoea are:
- Prevent dehydration from occurring if possible
- Treat dehydration quickly if it does occur
- Give zinc supplements for 10/14 days, depending on the availability of supplies and national policy to reduce the severity of the episode and to reduce the incidence of diarrhoea episodes in the following 2 to 3 months, and
- Feed the child.

Prevention of dehydration:

In the home, dehydration can usually be prevented by drinking more fluids as soon as the diarrhoea starts. To do this, give the recommended home fluids or give available food-based fluids, such as gruel, soup or rice-water. Also increase the frequency of breastfeeding, or give milk feeds prepared with twice the usual amount of water. The types of fluid or solutions used in your area for preventing dehydration in the home will depend on:

- local traditions for treatment of diarrhoea,
- availability of a suitable food-based solution,
- availability of salt and sugar,
- access of people to health services, and
- availability of oral rehydration salts (ORS)

Treatment of dehydration:

If dehydration occurs, the child should be brought to a community health worker or health centre for treatment. The best treatment for dehydration is oral therapy with a solution made with ORS. This treatment for children is also good for adults with diarrhoea. For treating dehydration, ORS should always be used, if possible.

Zinc supplementation:

It has been shown that zinc supplements given during an episode of diarrhoea reduce the duration and severity of the episode, and lower the incidence of diarrhoea in the following 2–3 months. For these reasons, all patients with diarrhoea should be given zinc supplements as soon as possible after the diarrhoea has started.


The child should be offered small amounts of nutritious, easily digestible food frequently. If the child is breastfed, try to increase the frequency and duration of feeds. Feeding during the diarrhoea episode provides nutrients the child needs to be strong and grow, and prevents weight loss during diarrhoea. Fluids given to the child do not replace the need for food. After the diarrhoea has stopped, an extra meal each day for a week will help the child regain weight loss during the illness.

An important development has been the discovery that dehydration from acute diarrhoea of any etiology and at any age, except when it is severe, can be safely and effectively treated by the simple method of oral rehydration using a single fluid. Glucose and several salts in a mixture known as Oral Rehydration Salts (ORS) are dissolved in water to form ORS solution. After 20 years of research, an improved ORS solution has been developed.

What is ORT (Oral Rehydration Therapy)?

ORT is the giving of fluid by mouth to prevent and/or correct the dehydration that is a result of diarrhoea. As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started with Oral Rehydration Salts (ORS).

How does ORT work?

ORT does not stop the diarrhoea, but it replaces the lost fluids and essential salts thus preventing or treating dehydration and reducing the danger. The glucose contained in ORS solution enables the intestine to absorb the fluid and the salts more efficiently

Can the solution be made with dirty water?

The benefits of fluid replacement in diarrhoea far outweigh the risks of using contaminated water to make oral rehydration solution. In situations where it is difficult to boil water, mothers are advised to use the cleanest water possible.

Can ORS be used for everyone?

ORS is safe and can be used to treat anyone suffering from diarrhoea, without having to make a detailed diagnosis before the solution is given. Adult need rehydration treatment as much as children, although children must always be treated immediately because they become dehydrated more quickly.

What should be done if the child vomits?

Mothers must be taught to persist in giving ORS solution, even though this requires time and patience. They should give regular, small sips of fluid. Giving ORT reduces nausea and vomiting and restores the appetite through correction of acidosis and potassium losses.

Should feeding continue at the same time as ORT?

Once the diarrhoea episode has passed, the child should be given more food than usual to make up for losses during diarrhoea. Breastfeeding is particularly beneficial because breast milk is easily digestible. It also contains protective substances which help to overcome the infection causing the diarrhoea.

What sort of foods are good during diarrhoea?

High energy foods such as fats, yogurt and cereals are quite well absorbed during diarrhoea. Small, frequent feeds of energy-rich local foods familiar to the child should be given.

- Foods high in potassium are important to restore the body's essential stores depleted during diarrhoea. Such foods include lentils, bananas, mangoes, pineapples, pawpaw, coconut milk and citrus fruits.
-It is very important to continue feeding a person with diarrhoea. Give soft, easy-to-digest foods, like khichuri, watery dal, curd, bananas etc.
-You should also give plenty of other fluids, like lebu pani, lassi, coconut water etc. If the baby is being breast-fed, continue to give her mother's milk.
- Give an extra meal a day, after the diarrhoea stops, to help the body get strong again.

Certain foods should be avoided during diarrhoea, for example those containing a lot of fibre such as coarse fruits and vegetables, whole grain cereals and spicy foods.

Is it necessary to use drugs as well as ORT?

In most cases, no. The diarrhoea will get all right by itself in a day or two. If there is any blood or mucous in the stools, any fever or vomiting, you must see the doctor immediately. Don't take any medicines yourself, It is important to follow the doctor's advice.

ORT on its own is usually enough to rehydrate the child. Unnecessary antibiotic therapy upsets the normal bacteriological balance of the intestine.

Why is prepacked ORS referred to as "complete formula" and why is a home-prepared solution not as effective for treatment? Are they not both basically sugar, salt and water anyway?

No. They are not the same thing at all. The complete formula ORS contains potassium and a base - either bicarbonate or citrate - which corrects acidosis which small infants in particular suffer when they are dehydrated. If a child is rehydrated with a solution containing no potassium, each successive attack of diarrhoea leaves the child more and more depleted of potassium - this results in fatigue, apathy and muscular weakness and finally such a child may die.

Can potassium be made good by feeding potassium rich foods like bananas?

Fortunately to some extent yes. However, mothers need to be taught and motivated how to modify a child's normal diet to include these foods for several weeks after an attack of diarrhoea or more or less permanently in fact in order to have much of an effect.

Apart from ORT, are there any other important aspects to the management of diarrhoea?

Firstly , prevention including the following measures should be taken:

- breastfeeding
- environmental sanitation
- personal hygiene
- clean drinking water
- clean preparation and storage of food
- insect and fly control

Secondly, maintaining or increasing food and fluid intake during and after an attack of diarrhoea should be ensured.

What is zinc and where does it come from?

Zinc is classified as an essential mineral. It is essential to over 180 biologic functions. Many foods rich in trace minerals contain zinc, with the highest amounts in meat products. Lesser amounts are found in milk, spinach, nuts, oats, rice and beans.

Who needs it and what are the symptoms of deficiency?

Many experts say that zinc deficiency is widespread. People living in poverty with diets low in zinc, especially children below five years of age, need zinc the most. Deficiencies result in poor wound healing because of zinc's role in cellular repair. Zinc deficiency also leads to slower growth. Most importantly, children with low levels of zinc are at increased risk for infection, severe infections and death.

What conditions or problems is Zinc used for?

Zinc is prescribed to treat and prevent diarrhoea for children < 5 years of age.

Can I give zinc and ORS at the same time?

Yes, zinc and ORS can be given at the same time when a child has diarrhoea. Zinc is given once a day. Give the zinc at a time of day that is easy for you to remember and repeat every day for 10-14 days. ORS needs to be given throughout the day only as long as your child has loose or watery stools, but zinc should be given for the entire 10 to 14 days.

Between zinc and ORS which one should be given first?

During diarrhoea ORS should be given first and followed by zinc. If it is the first time the child has received zinc, it is best to wait 30 minutes after the ORS is given.

Should a child with severe dehydration be given zinc?

Usually children with severe dehydration are given intravenous fluids first. After the intravenous fluid is no longer needed and the child is not vomiting, ORS and zinc should be started.

Can zinc be given by mixing it with juice, ORS, breast milk or any other liquids?

The zinc tablet is meant to be dissolved in water, breast milk, or ORS.. Other fluids are not recommended.

Should I give less ORS since I am giving zinc?

No, you should continue to give plenty of ORS, as recommended, even though you are giving zinc. ORS will help to replace fluids lost during diarrhoea. Zinc will speed up recovery but does not replace fluids.

At what stage of the diarrhoeal episode should zinc be administered?

The earlier that zinc is administered, the sooner the child will benefit. However, it can be started at any time during the illness.

Why is zinc treatment recommended after the diarrhoea episode has stopped?

Zinc treatment is recommended for the complete dosing regimen of 10 to 14 days because zinc not only decreases the number of days with diarrhoea and the severity of diarrhoea, it helps the child fight off new episodes of diarrhoea and pneumonia for the next 3 months following a full treatment.

Why is a range of 10 to 14 days given in the recommendation? Is 14 days better than 10 days?

Studies have included 10 or 14 days of treatment. Both have been proven to be equally effective.

Should a child be given another course of zinc treatment if he/she experiences a second episode of diarrhoea?

Yes, all episodes of diarrhoea should be treated with zinc. Even if a child has recently completed a full course of zinc treatment, it is still safe to give a second course. Children with persistant, repeated episodes of diarrhoea should be taken to a clinic or hospital.

How does zinc work in diarrhoea?

It is clear that zinc is vital for a wide range of biological functions. In diarrhoea we have come to know that zinc helps in the following ways:

- It boosts the immune system
- It helps in healing the intestinal lining
- It improves absorption of fluids

Does the zinc dose vary according to the weight of the child?

The zinc treatment is given according to age, not weight. Irrespective of the child's weight, the recommended dose of zinc for children 6 months to 5 years is 20 mg zinc once daily for 10 consecutive days. Children 2 to 6 months are prescribed 10 mg/day.

Can the zinc tablet be taken by chewing?

Yes, it can be chewed. Chewing is not the recommended mode of delivery, but is acceptable.

What should be done if the child misses a zinc dose?

Give the zinc tablet the next day and continue for the full course of 10 days.

Can zinc be given to infants and newborns?

The current recommendation is to provide zinc treatment to all children < 5 years of age. However, diarrhoea among newborns is rare and may be a sign of sepsis or severe disease so care should be sought.

Can zinc be given to adults?

Zinc can be given to anybody, but WHO/UNICEF recommendations are limited to children under five years of age.

Are all zinc tablets or syrups acceptable to buy?

No. Parents should be advised to only purchase zinc products that you know to be safe and of high quality.

Should a mother continue to breastfeed or provide other foods while treating their child for diarrhoea?

Yes, children should continue to be fed. Allow the child to take as much as they want. If vomiting occurs, the smaller, more frequent feeds are recommended.

Can zinc be given with other medications?

Yes, zinc can be given with other medications. However, if a child is receiving iron supplement, it is recommended this be stopped while on the zinc treatment because the iron will decrease the effect of zinc.

If a child is receiving multivitamins, should zinc be given on top of that?

Yes, multivitamins without iron can be continued. If the multivitamin contains iron, it should be stopped until the 10-14 days of zinc is finished.

If a child is being treated for anemia with iron what should be recommended?

During the 10-day period of zinc treatment, the child should stop taking the iron supplements. If the child is being treated for severe anemia, he/she should be seen by a doctor (or nurse where no doctor is available) before deciding to continue or stop iron supplementation.

If a child is already eating zinc fortified food as a regular part of their diet, is there a risk of zinc overdose if they also start the zinc treatment?

Zinc fortified foods contain low amounts of zinc in line with recommended daily requirements. Adding the zinc treatment is safe and highly recommended. There is no risk of overdosing.

If after three days or more of zinc treatment a child is not improving, what should be done?

Do not stop the zinc. The child should be taken to a local clinic or a community health worker for further assessment.

Why a Dispersible Tablet and not Syrup?

Zinc tablets are preferred over syrup for the following reasons: -
- Easier distribution and storage
- Lower cost
- Easier for caretakers to administer properly as well as count the number of days given
-Longer shelf-life

What are the ingredients of the zinc tablet?

The ingredients in zinc tablet include zinc sulphate, glucose and flavoring.

Are there any side effects of zinc?

At the dose being provided in the zinc tablet, there is a small increased chance of transient nausea or vomiting. If the child is vomiting, we recommend settling the child first before administering zinc.

What if my child takes more than one tablet?

You should keep the tablets away from all children in the home to prevent this from happening. If more than one tablet is taken, wait until the next day a resume to course of one tablet per day until the blister pack is finished.

Can zinc be given if a child is vomiting?

When a child is vomiting with diarrhoea, wait for the child to settle before giving zinc. If the child vomits repeatedly withhold zinc for that day and start from the next day.

What are Combined Oral Contraceptives (COC) and who can use them?
Combined Oral Contraceptives (COC) are oral pills taken by women to protect themselves from getting pregnant. COCs are manufactured to contain very small quantities of the hormones estrogen and progestin in synthetic formulation. In addition to preventing pregnancies, COCs are also prescribed by doctors/health providers to treat Acne, extreme menstrual cramps, and some other female related illnesses. There are many low dose brands of COC available in the market such as Femicon, Femipill, and N
What are some of the benefits of using COCs, if any?
As a contraceptive method, COCs are safe and easy to use method. They are also easily reversible, that is after stopping a woman can quickly get pregnant. In addition to being an effective method for preventing pregnancy, COCs also protects women against cancer of the Uterus and Ovary. It helps reduce Iron deficiency Anemia, menstrual cramps, other menstrual bleeding problems and excess hair on face or body. It may also help protect against Ovarian Cysts.
When can a woman start the COCs?
Women can start using combined oral contraceptives any time she wants if it is reasonably certain that she is not pregnant. Therefore menstruating women, can start using COCs anytime within the first five days of her menstrual bleeding. For women who may not be in their menstrual cycle such as if they want to switch immediately from a non hormonal method like IUD or condoms or from a progestin only method, they can start COCs immediately after stopping the previous method if she certain she i
How are COCs used?
A woman needs to take one pill every day until the pack is empty. When she finishes the pack, she should take the first pill from the next pack on the very next day. A woman should link pill-taking with some activity such as brushing her teeth or at bed time. Taking pills at the same time each day helps to remember them. It may also help reduce some side effects. Before starting its use, one must read through the instructions given in each COC packet.
Are there any side effects of these pills?
A woman may face some side effects after starting the use of pills such as changes in the menstrual pattern, headache, dizziness, nausea, breast tenderness, weight change, mood changes etc. However in vast majority of the cases these side effects or discomforts go away within two or three months of regular use.
What if a woman forgets to take pills?
If a woman misses a hormonal pill (that is not the dark ones containing iron in a packet ) she should take the missed hormonal pill as soon as she remembers and should continue taking the other pills as usual, one each day.
What if she has missed 2 pills? Or Started new pack 1 or 2 days late?
She should take a hormonal pill as soon as she remembers and should continue taking the other pills as usual, one each day. There would be little or no risk of pregnancy.
What if a woman has missed 3 or more pills in the first or second week? Or started the new pack 3 or more days late?
She should take a hormonal pill as soon as she remembers and ask her husband to use a condom or avoid sex for the next 7 days. And if she had sex in the past 5 days, she should consider taking an emergency pill.
What if she has Vomiting?
If a woman taking the pill vomits within 2 hours after taking a pill, she should take another pill from her pack as soon as possible, and then keep taking the pills as usual.
There are some other common misconceptions regarding pill. For example:
• Pills build up in a woman’s body and therefore a woman needs a break after taking the pill continuously for a few years. Correct Answer is No. She can take the pill as long as she wants without a break. • Woman only needs to take the pill if she has had sex that day. Correct Answer is No. She must take the pill everyday whether or not she has had sex that day • Taking the pill for long makes a woman infertile. Correct Answer is No. Pills do not cause infertility no matter how long it is use
What are emergency contraceptive pills and what is it used for?
Emergency contraceptive pills prevent pregnancy when taken within 72 hours (3 days) of having unprotected sex. They consist of synthetic progestin hormones. There is no estrogen. A sexual act may be unprotected meaning it could lead to pregnancy for various reasons such as breakage or slippage of condoms, missing of pills, rape or incest, failure of the man to withdraw his penis before ejaculation if not using a condom, and others. There are a number ECPs sold through pharmacies such as Norix b
Why are ECPs becoming so popular?
ECPs provide couples with a second chance at preventing pregnancy if they are not ready and therefore protect them from seeking out abortion which may be highly risky and costly as an option to eliminate pregnancy.
How are ECPs used?
There are two different packaging of ECPs available in the market: A higher dose single tablet version and a milder two tablet version such as SMCs Norix. The single dose must be taken within 72 hours of unprotected sex. In the case of the two tablets, the first tablet must be taken within 72 hours of unprotected sex and the second tablet after 12 hours of taking the first tablet. Monthly menstruation may start a few days earlier or later than the usual date. If the next monthly periods are mo
Are there side effects with ECPs?
Although there are no long term side effects, some women may face initial discomforts after taking ECPs such as nausea and vomiting, headache, dizziness, abdominal pain, vaginal bleeding etc. These are very temporary and not harmful.
It is important to remember that-
• ECPs do not protect from HIV/AIDs or STIs • ECPs are not recommended as a regular use of contraception • Breast feeding women should breastfeed her child immediately before taking ECP and wait for a few hours each time after taking the table before starting to breastfeed again.
What are Progestin only pills or POP?
Progestin only Pills or POPs as they are commonly known are contraceptive pills containing progestin hormone only. Unlike COCs they do not contain the estrogen hormone and therefore can be used safely by estrogen contraindicated women.
What are the advantages of POP?
The most significant advantage of POP is the fact that they can be used by lactating women at least 6 weeks after child birth. In addition, it can also be used safely by women who want to delay their first child and those who cannot take estrogen because of various health reasons.
How are POPs used?
Like any other pill it should be started within 7 days of the menstrual cycle to ensure that the woman is not pregnant. Breast feeding mother can start the pill anytime after 6 weeks of child birth if her period has not returned. One pill must be taken at the same time every day. Because of a single hormone and very low dose, it is important to maintain regular timing to ensure maximum efficacy. Making a habit to take the pill before bedtime helps to maintain regularity and timing. If a woman mi
Are there any side effects of POP?
Most common side effects are changes in the monthly menstrual bleeding patterns like spotting and irregular and scanty bleeding. Other common side effects include headaches, nausea, dizziness mood changes and breast tenderness. These minor discomforts usually subside with regular use and there is no need to worry.
What are condoms?
Condoms are a method used by males to prevent pregnancies. They are placed in the penis during intercourse so that the male sperm do not enter into the female reproductive system during ejaculation. Many different condom brands are available in the market such as Raja, Hero, Panther, Sensation and U&Me that are marketed by SMC.
What are the advantages of condoms?
Condoms are safe, easy to use and can be used both as a protection from unwanted pregnancies as well as sexually transmitted infections (STIs) including HIV. There are almost no side effects to using condoms. It is also easily reversible. That is when discontinued, a woman can get pregnant without any delay.
Are condoms an effective method? I heard sometimes they rupture?
If used properly every time, condoms are very effective in preventing pregnancies and Sexually Transmitted Diseases (STI). However if not properly used consistently, condoms may rupture or slip. This may cause pregnancy or the user may contract STI. To ensure effective use, certain guidelines must be followed consistently which includes using a new condom for each act of the sex. Instructions for proper usage are given on each pack. In case of rupture or leakage during use, the user should
What are contraceptive Injections?
Contraceptive injections are progestin only compositions that once taken can protect a woman from having an unwanted pregnancy for up to three months. There are three types of contraceptive Injections: DMPA commonly known as Depo Provera is effective for 3 months; NETEN commonly known as Norigest is effective for two months and Mesigyna which has one month efficacy period. In Bangladesh, Only DMPA or Depot Provera is widely available both through the public sector and the private sector dist
What are the advantages of injections?
Contraceptive Injections (DMPA) has many advantages. Being a progestin only method, it can be safely used by lactating mothers and also by estrogen contra indicated women. It can be used immediately after delivery and within 7days after miscarriage or abortion. Since it provides long term protection (one administration protects for three months) it ensures privacy for a woman. The injections protects against the cancers common in women and iron deficiency anemia.
Where are injections available?
Contraceptive injectable DMPA are widely available through government clinics, hospitals, FP centers at little or no cost. In the private sector, SMC provides its own branded SOMAJECT injections at very affordable cost through the SMC Blue Star providers who have received special training on the method. There are over 4,500 Blue Star providers located in the different upazillas of the country.
How are contraceptive injections used?
A woman planning to use DMPA injections for the first time should first visit a nearest government health facility or Blue Star provider or an NGO preferably during the first five days of her menstrual cycle, where a health provider must rule out if she is currently pregnant or not and then screen her to ensure that she is eligible to take contraceptive injectables. The injection is given deep intramuscularly either in the hip or upper arm using a disposable syringe. Rubbing the injected area i
Are there any side effects of contraceptive injections?
Many women face some side effects that initially may be discomforting but are not harmful to the health. Use of DMPA usually changes the monthly menstrual cycle of a woman. During the first 3 months there may be irregular or prolonged bleeding. Over time menstruation may become very scanty and at one point may even stop, a condition known as Amenorrhea. Many women enjoy Amenorrhea since they don’t have to worry about managing their monthly cycles. Some worry a lot thinking that they may have b
What is Iron?
Iron is an essential micronutrient for the body. It is a component of body systems that are involved in the utilization of oxygen. It forms part of hemoglobin, the red pigment in blood, which allows oxygen to be carried from the lungs to the tissues.
What are the main Functions of Iron?

- Iron transports and stores oxygen in human body.
- Supports proper physical and mental growth of children.
- Aids in energy production and cell diffusion in human body.
- Helps the immune and central nervous systems.

What do you mean by Iron Absorption?

Iron absorption refers to the amount of dietary iron one obtains from the food s/he eats. Healthy adults absorb about 15% of the iron in their diet.

Vitamin C helps the body to absorb iron. The actual amount of iron a body absorbs depends on the amount of iron already stored in the body. When the body has low amounts of iron stored, it will absorb more iron from the foods eaten. When the body has a large amount of iron stored, the amount of iron it absorbs will decrease.

What is Iron Deficiency Anemia (IDA) ?

Iron Deficiency Anemia is a common condition that occurs when there is not enough iron in the body. It is the most common type of anemia. A lack of iron in the body can come from not eating enough foods that contain iron, bleeding, or not absorbing enough iron from food that is eaten.

The term anemia is used for a group of conditions in which the number of red blood cells in the blood is lower than normal, or the red blood cells do not have enough hemoglobin. Hemoglobin — an iron-rich protein that gives the red color to blood — carries the oxygen from the lungs to the rest of the body.

Children need to absorb an average of 1 mg per day of iron to keep up with the needs of their growing bodies. Since children only absorb about 10% of the iron they eat, most children need to ingest 8-10 mg of iron per day. Breast-fed babies need less, because iron is absorbed 3 times better when it is in breast milk.

A common time for iron deficiency is between 6 and 24 months of age. The adolescent growth spurt is another high-risk period.

What are the causes of IDA?

A person can have low iron levels mainly for four reasons:

- Not getting enough iron in the diet.
- Not being able to absorb the iron in the diet.
- Blood loss, either from disease or injury
- Parasitic infections, malaria, worm.

Iron deficiency anemia also can develop when the body needs higher levels of iron, such as during pregnancy and lactation period

What are the Symptoms of IDA?

Following are the most common symptoms of iron deficiency anemia. However, each individual may experience symptoms differently. Symptoms may include:

- Feeling tired and weak.
- Decreased work and school performance.
- Slow cognitive and psychosocial development during childhood.
- Difficulty maintaining body temperature.
- Abnormal paleness or lack of color of the skin.
- Irritability.
- Decreased immune function, which increases susceptibility to infection.
- Increased heart rate (tachycardia).
- Sore or swollen tongue.
- Enlarged spleen.
- A desire to eat peculiar substances such as dirt or ice (a condition called pica).

What are the consequences of IDA?

Iron Deficiency Anemia has serious health consequences, which are:

- Impaired physical growth.
- Impaired brain development and cognitive performance.
- Decreased concentration and attention.
- Impaired learning capacity and memory functions.
- Decreased resistance to diseases.
- Increased morbidity and mortality from infections.

What is prevention and treatment strategies of IDA?

Special care and attention should be given to children from birth to age 5. This is the most critical period for physical and mental development of human child. This is also the most critical age for children to be affected by Iron Deficiency Anemia. Children with IDA should be treated with Iron Supplementation (i.e. MoniMix) along with iron-riched foods.

What are the approaches to prevent IDA efforts should be targeted to ?

1. Food-based approaches

Dietary Improvement: Food-based approaches represent the most desirable and sustainable method of preventing micronutrient malnutrition. Food Fortification: Food fortification is the process by which nutrient is added to commonly eaten foods to improve the quality of the diet.

2. Iron supplementation:

Treating iron deficiency anemia with iron supplementation is a common practice especially in the developing countries. Iron supplementation is quite often prescribed/recommended by medical professionals for children most of who suffer from anemia.

What is the composition of MoniMix?

MoniMix contains a number of vitamins and minerals including Iron, Zinc, Folic Acid, Vitamin A and Vitamin C.

Can MoniMix be used in fluid drinks like milk or juice?

MoniMix can be used in any food products, but because the iron is coated with lipid (to mask the metallic taste), it will float to the top of liquids and tend to stick to the side of the cup or glass. So, to avoid the wastage, it is better to mix MoniMix with solid food.

Can MoniMix be provided to non-anemic infants without producing any toxicity?

Yes. The amount of micronutrients in the MoniMix sachets is high enough to meet the needs of infants with micronutrient deficiencies (e.g. iron deficiency anemia) but not too high for those who do not have deficiencies.

Can MoniMix be used in older children, adolescents, adults and pregnant women?

Yes, they can be safely used for any age group, although they were developed for infants and young children. Infants and young children cannot safely ingest tablets or pills. Syrups and drops have been used for many years, but compliance has been documented to be poor (for iron). For other age groups, there are more choices for supplementation, including the use of fortified foods, pills and capsules. Nevertheless, MoniMix can be used in these other age groups without fear of toxicity. To date, research emphasis has focused on infants and children under aged 5 years, however there are other ongoing research involving pregnant women.

Though literature says MoniMix will not change the taste or color of the food into which it is added, why in some cases there has been a change in the taste and color of the food?

In order to mask the strong metallic taste of the iron, the iron in the MoniMix is coated or encapsulated with a thin coat of a soy lipid. The melting temperature for the lipid is around 60°C. If MoniMix are added to food that is hotter than 60°C, the lipid coating around the iron will melt and the food will be exposed to the iron. The result will be that the iron can change the color of the food and will have a taste that may not be liked by children. To prevent changes in the taste and the color of food to which MoniMix is added, it is recommended that MoniMix be added to the food after it is cooled to a temperature below 60°C.

For whom MoniMix should be used?

MoniMix is most suited for all children from the age of 6 months to 24 months. It is also suitable for children under the age of 5 years. A single sachet of MoniMix provides the daily dose of 12.5mg Iron recommended by WHO for infants of 6-24 months.

When should MoniMix be started?

Infants should be exclusively breastfed until 6 months of age. MoniMix should be given once complementary foods are started.

How long MoniMix can be used?

- MoniMix is recommended one packet per day for a child.
- MoniMix is food based rather than a medical intervention, suggesting a daily dose, but unlike conventional medicine, it is not so important if a dose or two are forgotten.

For MoniMix to be efficacious, research findings suggest that a child must be given a minimum of 60 packets over a period of 60-120 days to prevent anemia for at least the next 6 months. A dose of 60 packets should be repeated at every 6 months interval.

Can MoniMix be used in infants younger than 6 months of age?

According to the WHO recommendation infants should be exclusively breastfed until 6 months of age. We do not recommend using MoniMix before 6 months of age.

Are there any side effects of MoniMix?

There are no major side effects of MoniMix. Color of stool may become dark which happens because of 'unabsorbed1 iron being excreted in the stool. Iron itself is dark in color, thus unabsorbed iron will darken as a result of the iron content of MoniMix.

Can one sachet of MoniMix be given to a child a few times?

Content of one whole sachet should be mixed with one meal to achieve the desired result. It is recommended not to split one sachet into portions and administered several times. Since many children do not like to eat too much at one meal, it is recommended that MoniMix be mixed with a small amount of food so that the child finishes the MoniMix mixed food in the first few morsel.

Is MoniMix readily available to the general public?

Yes, MoniMix is available in all pharmacies.

What is Intrauterine Devise?
Intrauterine Devise or IUD as it is commonly called is a long acting contraceptive method which is free from hormones and once inserted and settled can provide hassle free protection for up to 10 years. There are two types of IUD: Copper T which protects for 10 years and Multiload which is effective for five years. IUDs can only be given by providers especially trained on its insertion. They are available at government clinics, hospitals and FP centers, NGOs and in the private sector through g
What are the advantages of IUD?
IUD provides long term protection so they are ideal for women who do not want or are not sure about having any more children. In that sense they can be an alternative to a permanent method. IUDs are also popular among women who are breast feeding; contraindicated to the use of estrogen and progestin hormones; or who want immediate return to fertility upon removal.
When should a woman start using IUD?
A woman can start this method at any time during her menstrual cycle if she is sure that she is not pregnant at that time. If she is starting within 12 days after the start of her monthly cycle, then there is no need for a back up method. If starting more than 12 days after the start of her cycle, she can have the IUD inserted anytime it is reasonably sure she is not pregnant. IUDs are also very popular as a post partum contraceptive method and can be safely inserted within 48 hours after delive
Does IUD have any side effect?
IUDs don’t have the side effects that are so commonly associated with hormonal methods. However some women may go through irregular or heavy bleeding or abdominal cramps after its insertion but these generally go away over time and regular follow up with the provider. A woman must ensure proper hygiene of her genital area to protect from infections.
When should a woman consult or follow up with her provider after insertion?
A woman should consult her provider who inserted the IUD if she is having irregular and overdue periods, severe abdominal pain or signs of infection. She also needs to see the doctor if she feels that the IUD has shifted position, or the strings are missing or if just feeling weak following the insertion.
What are contraceptive Implants?
Contraceptive Implants are long acting progestin only preparation which can protect a woman from an unwanted pregnancy for up to 5 years. They are inserted underneath the skin of a woman desiring contraception. There is more than one type of Implants available in Bangladesh. The most widely available now are Jadelle which contains two flexible rod like implants each containing 75 Mg of synthetic levonorgestrel hormone and protects for 5 years. Implants can only be given by providers especially
What are the advantages of Implants?
Jadelle provides long term protection so they are ideal for women who want spacing intervals for between 3 and 5 years. They are popular among women who are breast feeding; contraindicated to the use of estrogen and also newly married women who want to delay their first child since return to fertility is fairly quick upon removal.
When should a woman start using Implants?
A woman can start this method at any time within seven days of her menstrual cycle without taking any back up contraceptive method. If insertion is done later than 7 days, the provider must ensure that the patient is not pregnant at the time of insertion and the woman must use a non hormonal contraceptive such as condoms for the next seven days. If a woman has had a miscarriage or abortion, she can have Implants inserted immediately.
Does IMPLANTS have any side effect?
Irregular menstrual bleedings are most common side effects of Jadelle implants. The periods may be prolonged, scanty or sometimes heavy. In some women periods may stop altogether. Bleeding irregularities however diminish with continuing use. In over 10% of the cases women have also reported vaginal discharge, pelvic pain, breast tenderness, headache, weight gain and nausea.
What are some of the other important information to know about Jadelle Implants?
• Implants should be removed immediately after the end of five years since they lose their efficacy soon afterwards. • They can also be removed any time before 5 years. However they must be removed by a trained provider. • Breast feeding mothers can use Jadelle Implant from the 6th week after child birth.
How can I keep track of my menstrual cycle?

Use a calendar to keep track of your menstrual cycle. Mark each day of your period with an X. Calculate the length of your cycle by counting the days from the first day of bleeding in one period to the first day of bleeding in the next period. In addition to noting the days of your period, it is helpful to make notes about the flow, any pain that is felt, and changes in mood or behavior.

Can menstrual irregularities lead to other health problems?

The presence of menstrual irregularities can be a sign of other health problems such as Primary ovarian insufficiency (POI), endometriosis, Polycystic ovary syndrome (PCOS), polyps, and uterine fibroids. If left untreated, menstrual irregularities can lead to other conditions. These possible conditions vary depending on the type of menstrual irregularity and include endometrial hyperplasia (thickening of the endometrium), low bone density, and iron-deficient anemia. It is important for a woman with a menstrual irregularity to speak to a health care provider to determine the cause of the irregularity and to receive appropriate treatment as necessary.

Why sanitary napkin plays an important role in female’s physical well-being?

According to studies conducted by the World Health Organization, the hygiene of female sanitary products is especially important to a woman, as the pelvis, uterus, vagina of a women’s body are all inter-connected, thus it increases the chances of bacterial infection if sanitary napkins of low hygiene standards were used during the menstruation period.

Why is it important to replace sanitary pads on a regular basis?

Menstruation flow and secretion are highly prone to growth of bacteria; therefore sanitary napkins should be replaced on a regular basis. Under normal circumstances, bacteria start to grow 15 minutes after a new napkin is used. In two hours, the napkin can be filled with bacteria. It is strongly advised that a new napkin is used every 3-4 hours during the menstruation period.

In what ways do Joya Sanitary Napkin differ from conventional choices at the market?

First of all, SMC is truly committed to manufacturing health products under stringent quality control standards and bringing better health, better value and an unprecedented level of comfort for women. Joya Sanitary Napkins are light, odourless, and can be used with assurance of no side effects. Unlike many of the brands, who have devoted their resources in doing commercials and hiring celebrities in their promotions, we have devoted all resources in our product development, in pursuit of a real quality and benefits for women.

What are the special characteristics of the packaging of Joya Sanitary Napkin?

Most customers tend to store sanitary pads in the bathroom, which is rather unhygienic. Under the moist environment, pads will be prone to growth of bacteria. We have adopted the highest standards in packaging which are comparable to those used for food packaging. This ensures that every piece of Joya Sanitary Napkin remains dry and more resistant to growth of bacteria.

What benefits shall I get from Joya Sanitary Napkin?

Joya Sanitary Napkin is scented first time in Bangladesh and hygienic. It helps to prevent bacterial multiplication, eliminates odour and promotes comfort during menstrual period.

What are the common mistakes in the use of sanitary napkins?

- Not washing hands before a napkin change: Changing napkin by dirty hands can cause a considerable quantity of microbes to be brought onto its surface.
- Storing napkins in a bathroom: In a bathroom, there is humidity. This is an ideal environment for reproduction of bacteria, which can easily get into napkins.
- Disregarding expiry date: Date expired napkins can cause health hazards.
- Not changing a napkin for a long period: After a longer period of use, bacteria increases promptly and may cause health hazards.

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