NTA Level 4 • Semester 1 • PST04102

Identification of Patients with Cholera

Disease Control and Prevention • Source Session/Topic 23

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Session 23: Identification of Patients with Cholera

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause of Cholera

• Describe Mode of Transmission of Cholera

• Describe major Signs and Symptoms of Cholera

• Explain Treatment of Common Cholera

• Explain Prevention and Control of Cholera

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Cholera (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes cholera? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition

• Cholera is acute diarrheal infection of the intestine caused by vibrio

cholerae

• The infection is often mild or without symptoms, but sometimes can be

severe and fatal

STEP 3: Mode of Transmission of Cholera (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|How is cholera transmitted? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Transmission is through faecal –oral route but almost all cholera

infections are water- borne (see figure 1).

o Vibrio cholera can live in water for 2 weeks and prefer salty water

o Vibrio may survive for longer period and multiply in shellfish

The reservoir of infection is formed mainly by carriers excrete vibrio in

small numbers posing danger to the community

[pic]

STEP 4: Signs and Symptoms of Cholera (10 minutes)

|Activity: Brainstorming (15 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the signs and symptoms of cholera? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• The incubation period is 2-3 days

• The clinical presentation of cholera is caused by water and

electrolyte loss and develop in 3 stages described below:

First stage (last for 3-12 hours)

• Characterized by passage of profuse watery stool

• The stool comprises of clear fluid with flakes of mucous (rice water

appearance)

• vomiting

• Severe cramps in the abdomen and limbs develop from loss of

electrolytes

Second stage:

• There is collapse from dehydration

• The body becomes cold, the skin dry and inelastic

• The blood pressure is low and the pulse is rapid and feeble

• Urine production stops and the patient may die of shock

Third stage:

• Stage of recovery, either spontaneously or with treatment

• Diarrhoea decreases

• Patient is able to take fluids and general condition improves

STEP 5: Treatment of Cholera (10 minutes)

• Patients should be hospitalised

Rehydration

• Cholera is cured by appropriate and timely rehydration

o Patients of all ages who are strong enough to drink will take a lot of

glucose/electrolyte solution needed for rehydration and maintenance

• It is essential to use oral rehydration solution (ORS) or appropriate

intravenous (IV) fluids to replace the necessary electrolytes.

• Patients in shock or who are too weak to drink require intravenous

fluids until they can take in oral fluids.

Antimicrobials

• Antimicrobial agents have been shown to shorten the period of

diarrhoea and the amount of fluid loss

o Tetracycline or doxycycline are the drugs of choice

o Erythromycin is an effective alternative both in children and adults

o Cotrimoxazole is also another alternative

• Strict isolation is not necessary as only vomitus and stool are

infectious

• Patients are treated on ‘Cholera bed’ (beds with central hole) through

which the continuous stool can pass into a bucket and fluid loss be

measured

[pic]

STEP 6: Prevention and Control of Cholera (30minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of cholera? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Prvention and control measures

• Improve quality of public water supply by chlorination in large scale

• Encourage individuals to boil drinking water

• Milk products should be pasteurized

• Avoid eating half cooked food

• Leftovers should be protected against contamination by flies

• Markets and food premises should be free from contamination

• Improvement of sanitation facilities e.g. proper excreta and refuse

disposal

• Give health education to public on how cholera is spread, clinical

features, preventive measures, ways of making water safer (e.g. by

boiling), proper food handling, sanitation and hand washing

• The vomitus and stool should be properly deposited in pit latrine or a

septic tank system

• Hospital equipment should be cleaned with disinfectant such as 5%

lysol

STEP 6: Key Points (5 minutes)

• Cholera is acute intestinal disease caused by vibrio cholerae

• Patients present with profuse watery diarrhoea, vomiting and rapid

dehydration

• The disease is spread by faecal-oral route

• Rehydration can prevent death

• Cholera can be prevented by improving sanitation, water supply, refuse

dispersal and personal hygiene

STEP 7: Evaluation (5 minutes)

• What causes cholera?

• How does cholera spread?

• What are signs and symptoms of cholera?

• What is the treatment of cholera?

• What are the preventive and control measures of cholera?

STEP 8: Assignment (5 hours)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on control measures in the outbreak of cholera |

|in their area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J,& Manschot, P (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

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