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Epidemic Control Toolkit
for community volunteers
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Acute diarrhoea

Last update: 2024-03-13

Key facts

Transmission: faecal-oral route

  • Unwashed hands
  • Food or water contaminated by waste from people or animals
  • Unwashed fruits and vegetables/food washed or prepared with contaminated water
  • Close contact with a sick person

Most vulnerable to severe consequences

  • Children under five years old
  • People, especially children, who are malnourished
  • People with weakened immune systems, especially children, pregnant women or those suffering from other health conditions (such as HIV infection) 
  • Elderly

Most vulnerable to contracting the disease

  • People living in areas with poor water, sanitation and hygiene facilities and services
  • People on the move with poor access to water, sanitation and hygiene facilities and services 


  • Abdominal cramps/stomach pain
  • Dehydration (sometimes)
  • Fever (sometimes)

Symptoms of acute diarrhoeal disease

  • Three or more loose or liquid stools over a period of 24 hours. 
  • Nausea and vomiting (sometimes)

Symptoms of bloody diarrhoea (dysentery)

  • Diarrhoea containing blood 

What can you do to prevent and control an epidemic?

Monitoring the community and identifying sick people  

  • Identify possible source or point of contamination 

Treatment and management

  • Referral of serious cases of dehydration and children exhibiting signs of malnutrition to health facilities
  • Provide oral rehydration (ORS) to those who do not show signs or symptoms of malnutrition
  • Provide zinc supplementation
  • Provide psychosocial support to the sick person and their family members

Appropriate sanitation and waste management

  • Discourage open defecation
  • Encourage use of toilets/latrines
  • Promote good hand hygiene (handwashing with soap) 
    • BEFORE: preparing food, eating, feeding a child, treating wounds or caring for sick people
    • AFTER: using the toilet or cleaning a baby; touching garbage or waste; touching or feeding animals; blowing nose, coughing or sneezing; treating wounds or caring for sick people 
  • Food and water hygiene and safety
    • Thoroughly clean and/or cook food
    • Cover and store food safely (protected from insect/animal contamination)
    • Use clean utensils and storage containers
    • Use safe, clean drinking/cooking water
    • Store water in clean, covered water container
    • Encourage exclusive breastfeeding for the first six months of life, and complementary breastfeeding until the age of two years (especially when a child is sick)
    • Provide oral rehydration (ORS) 

Social mobilization and health promotion

  • Find out the specific advice being given by health and other relevant authorities
  • Model following this advice and inform community members of current health practice advice
  • Offer support and encouragement to follow the advice 
    • Try to gain understanding about if and why health practice advice is not being followed 
    • With the advice of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices


  • Support routine or mass vaccination where available (for example, rotavirus, cholera)

Mapping and community assessment

  • Make a map of the community.
  • Mark the following information on the map:
    • How many people have fallen sick with acute diarrhoeal disease? Where?
    • How many people have died? Where? When?
    • Who and where are the vulnerable people?
    • Where are the local health facilities and services? (include traditional healers)
    • Where do people obtain their drinking water?
  • Record the following information on the back of the map:
    • When did people start to fall sick with acute diarrhoeal disease? 
    • How many people live in the affected community? How many are children under five years?
    • Are children in the community generally well-nourished?
    • Do people always have enough food?
    • Is breastfeeding common?
    • Is the water source safe? 
    • Do people know how to treat water? How do they do it?
    • What sanitation facilities are available? (put communal toilets/latrines on map). Do people use them? 
    • What handwashing facilities are available? (put communal handwashing stations on map). Do they have soap?
    • What are the community’s habits, practices and beliefs about caring for and feeding sick people? When babies and infants are sick, do women continue to breastfeed them? Consider any differences in roles and responsibilities between men and women.
    • Is a social mobilization or health promotion programme in place?
    • What are the roles, responsibilities, specific needs and priorities of women and girls, men and boys, and people with disabilities in handling, storing and treating water? Make sure you think about cultural and social traditions and perceptions, household decision-making, livelihoods such as agriculture and livestock raising etc.
    • What are the barriers people face in accessing water points and sanitation and hygiene facilities, of all gender identities, ages, disabilities and backgrounds? 
    • Which sources do people use/trust the most for information?
      • Are there rumours or misinformation about acute diarrhoea? 
    • Can people identify the signs and symptoms of dehydration?
    • Do people know how to make oral rehydration solution (ORS)? 
      • Do they have resources at hand to make it?