Taking care of disease in day-care centre

Namrata, a two year old cute baby girl has suddenly experienced abdominal pain, several episodes of passing loose stool, indigestion and anorexia. Her mother was worried and brought her to me to consult about her problem. The mother is a service holder and does not have any reliable helping hand at home while she is in office. So, she drops her child in a day-care centre on the way to her office in the morning and picks her up again on her way back from office to home. Namrata has been in the day-care centre since last eighteen months and she did not suffer any major illness since then.
I examined her and advised routine examination of stool to explore the cause. The report revealed that child was having infection in her gut with a parasite named Giardia.
Parasitic infestation is quite common in Bangladesh, specially in children below five years of age. Along with Giardia, some of the common parasites infect at this age are round warm, hook warm, pin warm. Giardia is one of the chief causes of diarrhoea and is transmitted through contaminated water, food, fruit, salad etc. It can survive the normal amounts of chlorine used to purify community water supplies and can live for more than 2 months in cold water. Children in day care settings who stay in close contact and share food are at risk for Giardia exposure. Namrata was such a typical case.
The parasite attaches itself to the lining of the gut, where it sabotages the body's absorption of food components like fats and carbohydrates from digested foods.
Most of them cause diarrhoea, indigestion, malabsorption, anaemia due to loss of blood from the gut by parasite, abdominal pain, weight loss, skin rash, occasionally pneumonia, rarely may cause appendicitis.
Lab examination of fresh stool confirmed the diagnosis. Specific anti-parasitic drug resolves the problem. But re-infestation is also very common. So, in order to prevent catching Giardia, we have to teach children on how to maintain a good personal hygiene. Also, we have to ensure safe food for them. Handwashing with soap and clean water before taking any food and after using comfort room is important. Hot cooked food are safer, fruits are to be taken after proper washing and it is better to avoid salad if not very fresh.
Trimming of nails twice a week is definitely a good practice preventing intestinal problems. Regular deworming at least twice a year is an important preventive measure. Now a days, deworming is done in all schools through school health clinic. Make sure your child is not left out. Take care of your kids.

The writer is a Paediatrician working in Community Based Medical College (CBMC) Hospital, Mymensingh.
E-mail: mmukkhan@gmail.com