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.

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.

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.

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.

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.

Feeding:

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.

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).

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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

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.

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

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.

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

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.

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

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

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.

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

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

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.

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.

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.

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.

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.

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

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

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

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.

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.

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.

- 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.

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.

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.

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

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).

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.

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.

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.

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

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.

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.

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.

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.

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.

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

- 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.

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.

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.

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.

Yes, MoniMix is available in all pharmacies.

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.

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.

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.

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.

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.

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.

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.

- 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.