DISEASES
ASSOCIATED WITH LOW
STANDARDS OF
PERSONAL AND PUBLIC
HYGIENE
1.
Low standards of
hygiene, both personal and public, are responsible for a vast amount of disease
everywhere in the world and particularly in the topics where poor living
conditions are so common. In the diseases considered here, man is either the
sole (satu-satunya) or principle host
of the parasites. And transmission results from the contamination of the
environment by his excreta or body discharge (kotoran). Theses diseases include such important infections as
cholera, anclystomiasis, schistosomiasis, the enteric fevers and dysentery, and
also many other less striking infections which are responsible for a great deal
of ill-health, disability and even mortality, especially among children. In
some diseases unhygienic food habits play as great or even a greater part in
transmission then insanitary disposal of human excreta.
2.
These infections
present a particularly difficult problem of control – the control of man
himself. Their prevalence can be reduced (dikurangi)
by the provision (pengadaan) and use
of such sanitary facilities as hygienic systems of excreta disposal (pembuangan) and supply of water,
preferably to each home, an adequate (cukup)
quantity being probably more important than quality. The elimination of faecal
contamination of the surface of the soil, of flies and of snails in the
schistomiasis areas, will reduce transmissions, and this will be further
lowered by the provision of sufficient (mencukupi)
living space in houses and improved food hygiene. These measures demand the
active co-operation of the people themselves, which only can be about by a
process of education over a long period of time. Elimination of these diseases
will ultimately depend on raising economic and social standards.
3.
These infections
can be divided into four groups: (A) viral, bacterial and protozoal diseases
resulting from ingestion of water or food which has been contaminated directly
or indirectly with infected human faeces or urine; (B) worm infections in which
transmission follows ingestion of either the egg or larval forms of the
parasite; (C) worm infections resulting from penetration of the skin by
immature stages of the parasites; (D) bacterial diseases due to the consumption
of foodstuffs infected from human or animal sources and commonly reffered to as
food poisoning (keracunan). In this
reading selection, one of the diseases from group A, Cholera, will be
discussed.
4.
The diseases of
the four groups are limited to man and are maintained in the human community by
insanitary living habits. The causative organism leaves the human body in the
excreta and the new host is parasitized by ingestion on infected faeces
conveyed to its mouth in a number of ways, the most common vehicles of
transmission being contaminated hands, food, and water. The epidemiological
patterns of these diseases are thus broadly similar.
5.
CHOLERA. This is
an acute specific infection of the alimentary tract (system pencernaan) caused by Vibrio Cholerae and characterized by sudden onset, toxaemia,
vomiting and frequent copious water evacuations from the bowel (buang air besar), resulting in
rapid (cepat) and extreme dehydration. In children fluid is often kept in
paralysed ileus and little may be evacuated (cholera sicca).
6.
THE PARASITE.
Vibrio Cholerae, or ‘commas bacillus’, is a minute, motile curved (melengkung) organism, flagellated, and
gram-negative on staining. It is identified by culture, serological methods,
and phage typing. The E1 Tor biotype, the principal organism, as isolated the
present epidemic, produces infections clinically and epidemiologically
indistinguishable from that of the type
strain. It is, however, resistant to group IV cholera phage, is less affected
by environmental conditions, and may give rise to a chronic carrier state. The
type strains rarely persist in the intestine for as long as three weeks.
7.
EPIDEMIOLOGY.
Man is the only reservoir of infection and is thus solely responsible for its
maintenance in a community. The disease persists in endemic areas where
sporadic cases of cholera occur almost continually throughout the year,
associated with a low mortality possibly as a result of immunity acquired (terdapat) by repeated mild infections.
8.
DIAGNOSIS.
Cholera is a serious disease that spreads (menyebar)
rapidly, and preventive action must be taken upon clinical diagnosis. This may
be easy during an epidemic, but sporadic, atypical (tidak teratur; tidak khas), and mild cases may be difficult to
recognize. A clinical diagnosis can be confirmed by direct examination of a
stool (kotoran) specimen in a dark
ground preaparation. If organism showing the typical motility of vibrios are
seen, a specimen can be prepared to
which is added specific anti-serum; the cessation of motility in 3-5 minutes
confirms the identity of the organism.
9.
CONTROL. Early
detection, isolation and treatment of cases, suspected cases and their
contacts, and the control of the contaminated environment are the basic measure
of prevention.
Immediately after the
disease is suspected, the patient should be isolated in a treatment centre
where the diagnosis can be confirmed within minutes by the dark ground,
agglutinating (yang melekatkan) serum
technique. Treatment should be started at once by replacing fluid and
electrolytes. With this should be given eight oral doses of 500 mg of
tertracycline which will reduce diarrhoe and eliminate (menghilangkan) the vibrios. This treatment will shorten the
duration of the convalescent carrier state, reduce transmission, and speed of
the flow of patients through the centre.
10. QUESTION LEADING TO DISCUSSION
1. What is responsible for a vas amount of disease in
the topics?
2. What diseases are caused by contamination of the
environment by man’s excretions?
3. What is the most important factor in controlling
such diseases?
4. Explain what cholera and how the infection is
transferred to man!
5. Name some characteristics of cholera.
6. What is the ileus?
7. In the past how did cholera spread from endemic
centers in Asia to the rest of the world?
8. How can an explosive epidemic of cholera occur?
9. What is the basic measure of the prevention of
cholera?
10. What is the preliminary treatment as soon as a
patient is diagnosed as having cholera?
11. How do you think food hygiene can be improved?
12. Do you know where the endemic centers of cholera are
in Jakarta/your city?
13. What measures are usually taken when cholera appears
to be endemic in a certain area?
14. State briefly how raising economic and social
standards will help prevention of
cholera?
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