Okufuna obutwa mu mmere, obulwadde bw’olubuto obw’amaanyi, n’okubulwa amazzi mu mubiri ennyo¶

Obulwadde bw’olubuto n’olw’emmere bubaawo nga bakitiriya, akawuka, obuwuka obusirikitu oba obutwa obukoleddwa nga tebunnabaawo bunyiiza n’okuzimba olubuto lwo n’ebyenda byo. Wadde ng’abantu abakulu abasinga obungi abalamu bawona ssennyiga omutono ow’omu lubuto oba obutwa bw’emmere mu ssaawa 24 ku 72 nga bakozesa amazzi g’omu kamwa, okufiirwa amazzi amangi nga bayita mu kusesema okutasalako n’ekiddukano eky’amazzi kiyinza okuvaako okusannyalala kw’omusaayi, okulemererwa kw’ekibumba okw’amaanyi, obutakwatagana n’obusannyalazo obutta, oba ebizibu by’enkola ebiyinza okutta obulamu mu ssaawa ntono.

Obuwuka obumu obuva mu mmere era bufulumya obutwa obw’amaanyi mu busimu oba obutwa obusaanyaawo ekibumba ng’okulabirira awaka okwa bulijjo tekumala. Okumanya engeri y’okwawula obulwadde bw’olubuto obwa bulijjo obw’akawuka ku botulism, hemolytic uremic syndrome, oba okuggwaamu amazzi mu mubiri ennyo, engeri y’okutabulamu eddagala ettuufu erya World Health Organization (WHO) eriweebwa amazzi mu kamwa awaka, n’eddagala ki eriziyiza ekiddukano mu butuufu eriyinza okutega obutwa obutta munda mu mubiri gwo kikuuma obulamu bwo n’obulamu bw’abaana abataliiko mwasirizi n’abantu abakulu.

Kino kikole kati¶

1. Kebera oba waliwo bendera emmyufu eziteeka obulamu mu matigga era kuba ku ssimu ey’amangu bwe wabaawo. Kuba ku nnamba y’amangu mu kitundu kyo (911 mu Amerika ne Canada, 112 okwetoloola omukago gwa Bulaaya, 999 mu Bungereza, oba laba byonna ennamba z’amangu) singa omuntu oyo alaga obubonero bw’okubulwa amazzi mu mubiri ennyo oba okuwuniikirira (okutabulwa, okukoowa ennyo, okuziyira oba okuzirika ng’ayimiridde, omutima okukuba amangu emirundi egisukka mu 110 buli ddakiika, amaaso agabbira, oba obutafulumya musulo okumala essaawa 8 ku 12 mu bantu abakulu oba essaawa 6 mu baana abawere), asesema omusaayi oba ebintu ebiddugavu ebiringa kaawa omubisi, ayita mu musaayi omubisi oba ogw’amaanyi omusulo, oba okukaluba ensingo, enkyukakyuka mu kulaba kw’obusimu, oba obulumi obw’amaanyi mu kitundu mu lubuto olwa wansi olwa ddyo.
2. Wummula olubuto okumala akaseera katono ng’omaze okusesema, olwo otandike okunywa micro-sips za Oral Rehydration Solution (ORS). Tomira giraasi ennene ez’amazzi amayonjo amangu ddala ng’omaze okusesema, kuba okugolola olubuto oluzimba kiddamu okuleeta gag reflex. Linda eddakiika 15 ku 30 oluvannyuma lw’okusesema, olwo owe mililita 5 (ekijiiko kimu) ez’eddagala erizza amazzi mu kamwa buli ddakiika 2 ku 5 ng’okozesa ekijiiko, ekikopo ky’eddagala oba empiso ey’omu kamwa, mpolampola n’ogenda ng’onywa obutonotono ng’olubuto lutereera.
3. Tegeka eddagala eriweweeza ku munnyo ne ssukaali erya WHO singa obupapula bwa ORS obw’eddagala tebuliiwo. Amazzi amayonjo gokka tegadda mu kifo kya sodium ne potassium ebibula, era omubisi gw’ebibala ogutafukiddwa oba sooda owa bulijjo gusika amazzi amangi mu byenda okuyita mu puleesa y’omukka (osmotic pressure), ekiddukano ne kyeyongera. Tabula ebijiiko bya ssukaali omweru ow’omutindo 6 (mililita 30) n’ebijiiko by’omunnyo gw’oku mmeeza 0.5 (mililita 2.5) mu liita emu (ebikopo bya Amerika 4.2) eby’amazzi amayonjo agatali malungi okutuusa lwe bisaanuuse ddala.
4. Towa ddagala eriweweeza ku kiddukano eritali ku ddagala singa wabaawo omusujja omungi oba omusulo ogulimu omusaayi. Tomira ddagala erikendeeza ku kutambula nga loperamide oba bismuth subsalicylate bw’oba ​​olina omusujja ogusukka diguli 38.5 (diguli 101.3 Fahrenheit) oba omusaayi oba amasira agalabika mu musulo gwo. Okukendeeza ku sipiidi y’ebyenda kutega obuwuka obuyingira n’obutwa bwa Shiga ku bbugwe w’ekyenda, ekyongera obulabe bw’obutwa obuyitibwa megacolon n’okulemererwa kw’ekibumba.
5. Kuuma n’okussaako akabonero ku mmere gy’oteebereza mu ngeri etali ya bulabe. Bw’oba oteebereza nti emmere ey’omu dduuka entongole, ekintu ekitali kya pasteurized, ffene ow’omu nsiko, oba ekibbo ekizimba mu bipipa awaka kyaleeta obulwadde obw’amaanyi mu bantu abawera, ssimu emmere esigadde mu kaveera akawandiikiddwa obulungi munda mu firiigi (togiteeka mu firiigi okuggyako ng’olagiddwa) olwo abakebera ebyobulamu by’abantu oba abasawo b’obutwa basobole okugezesa ekituufu obuwuka obuleeta endwadde oba obutwa.
6. Yawulamu ebifo ebirimu obucaafu n’eddagala lya chlorine bleach, so si mwenge. Singa norovirus oba ekiddukano ekisiigibwa kisaasaana mu maka go, eddagala erirongoosa mu ngalo eririmu omwenge n’ebisiimuula ebitta obuwuka ebya standard quaternary ammonium tebijja kutta kisusunku kya kawuka. Naaba bulungi mu ngalo ne ssabbuuni n’amazzi agabuguma okumala sekondi 20, yambala ggalavu ezikozesebwa omulundi gumu ng’oyoza ebisesema oba omusulo, n’okutta obuwuka ku bifo ebikalu n’eddagala lya chlorine bleach ery’awaka eryaakatabuddwa nga lirekeddwa nga libisi okumala waakiri eddakiika 5 ku 10.

Flowchart y’okusalawo mu kusengejja mu bwangu n’okuggwaamu amazzi mu mubiri¶

Kozesa omuti guno ogw’okusalawo mu bujjanjabi okuzuula oba omuntu alina okusiiyibwa okw’amaanyi n’ekiddukano asobola okuddukanyizibwa awaka ng’afuna amazzi mu kamwa oba nga yeetaaga obujjanjabi obw’amangu mu ddwaaliro.

flowchart TD
    Start["Okusesema okw’amaanyi, Ekiddukano ekiva mu mazzi, oba okuzimba olubuto"] --> NeuroCheck{"Obubonero bwonna obulaga obusimu?<br/>Okulaba emirundi ebiri, ebikowe ebigwa,<br/>okwogera obubi, obuzibu mu kumira, oba okuzirika?"}

    NeuroCheck -->|"Yee"| Call911Neuro["Kuba essimu mu by’amangu mu bwangu<br/>Okuteeberezebwa nti ofunye obulwadde bwa Botulism oba Marine Neurotoxin<br/>Kuuma omulwadde nga yeegolodde ekitundu era olondoole okussa"]
    NeuroCheck -->|"Nedda"| RedFlags{"Kebera Systemic Red Flags:<br/>Omusulo ogulimu omusaayi oba omuddugavu, okusiiyibwa mu kaawa,<br/>okutabulwa, okuzirika, olubuto olukaluba, oba obutafulumya musulo >8 hrs?"}

    RedFlags -->|"Yee, 1 oba okusingawo aliwo"| ERVisit["Genda mu kitongole ky’amangu mu ddwaaliro Kati<br/>Kyetaagisa IV Crystalloids, Electrolyte Panel,<br/>Okukula omusulo, n’okulongoosa oba okwekenneenya ekibumba"]
    RedFlags -->|"Nedda"| HighRiskCheck{"Omulwadde mwana muwere <emyezi 6,<br/>omuntu omukulu omunafu >65, olubuto,<br/>obulwadde bwa sukaali, oba abaserikale b’omubiri abakendedde?"}

    HighRiskCheck -->|"Yee"| SameDayEval["Tuukirira Omusawo oba Obujjanjabi obw’amangu Leero<br/>Tandika micro-sips za WHO ORS amangu ddala<br/>Lower threshold for IV hydration"]
    HighRiskCheck -->|"Nedda"| TrialORS["Tandika Home Oral Rehydration Protocol<br/>5 mL (1 tsp) ORS buli ddakiika 2 ku 5<br/>Weewale eddagala eriziyiza okutambula singa wabaawo omusujja"]

    TrialORS --> ToleranceCheck{"Omulwadde asobola okukuuma micro-sips wansi<br/>okumala essaawa 4 ku 6 nga teyeyongedde kwonooneka?"}
    ToleranceCheck -->|"Yee"| RecoveryDiet["Okusooka okuddamu okuliisa nga bukyali nga bwe kigumiikiriza<br/>Buli musulo oguyidde gukyuse ne 200 ku 250 mL ORS<br/>Laba obubonero bw’ekibumba bwa HUS obulwawo okumala ennaku 14"]
    ToleranceCheck -->|"Nedda, okusesema okutambula obutawona"| ERVisit

Ebiseera by’okutandika: okuzuula obuwuka obuleeta endwadde nga tuyita mu ssaawa y’okufumbiza¶

Abantu abawera bwe balwala oluvannyuma lw’okugabana emmere, abasawo ab’amangu n’abakugu mu by’obutwa basooka kutunuulira kiseera ky’okufumbiza (omuwendo gw’essaawa oba ennaku wakati w’okulya emmere eteeberezebwa n’akabonero akasooka) ku mabbali g’akabonero akasinga. Obubonero obw’amangu obutandika mu ssaawa emu ku 6 kumpi bulijjo bulaga eddagala oba obutwa bwa bakitiriya obwali bumaze okutuula mu mmere nga tonnagimira, so ng’ate okulwawo ennaku 1 ku 5 bulaga nti obuwuka, akawuka oba obuwuka obusirikitu obulamu bweyongera munda mu nkola y’ekyenda kyo.

Okukebera okubulwa amazzi mu mubiri mu bujjanjabi mu myaka gyonna¶

Okubulwa amazzi mu mubiri mu acute gastroenteritis si kumala kuwulira nnyonta; kwe kukendeera okugenda mu maaso kw’obunene bw’amazzi mu misuwa n’obusannyalazo obuli mu butoffaali (sodium, potassium, chloride, ne bicarbonate). Obuzito bwa plasma bwe bugenda bukendeera, omutima gulina okukuba amangu n’emisuwa mu lususu n’ensigo okuzibikira okukuuma puleesa okutuuka ku bwongo n’omutima.

Abasawo n’ekitongole ky’ebyobulamu mu nsi yonna bagabanya okubulwa amazzi mu mubiri mu biti bisatu ebiyinza okukolebwa: Obutaba na mazzi oba okukendeera kw’amazzi mu mubiri (okugejja kw’omubiri okutakka wansi wa bitundu 3 ku buli 100), Okubulwa amazzi mu mubiri okutono oba okw’ekigero (okugejja kw’omubiri ebitundu 3 ku 9 ku buli 100), ne Okukendeera kw’amazzi mu mubiri okw’amaanyi (okukendeera kw’obuzito bw’omubiri ebitundu 10 ku 100 oba okusingawo, ekifuula okugejja kw’omubiri okukendeera).

Engeri y’okutabula n’okugaba eddagala eriweweeza ku mazzi mu kamwa (ORS) .¶

Mu kyasa eky’amakumi abiri, okuzuula enkola ya sodium-glucose cotransport mechanism (SGLT1) mu kyenda ekitono eky’omuntu kyakyusa eddagala ery’amangu. Ne bwe kiba nti obutwa bwa kkolera, rotavirus, oba Salmonella buleetera ekitundu ky’ekyenda okuyiwa liita z’amazzi mu kyenda, obutoffaali obutambuza SGLT1 ku nsalosalo ya bbulawuzi y’ekyenda busigala nga tebukyuse ddala. Naye, puloteyina zino zisobola okunyiga sodiyamu n’amazzi okuyita mu bbugwe w’ekyenda singa glucose (ssukaali) ne sodiyamu (omunnyo) bibaawo wamu mu mugerageranyo omutuufu ogwa 1-to-1 molar ratio.

• Bw’onywa amazzi amayonjo mu bungi mu kiseera ky’okusiiyibwa okw’amaanyi n’ekiddukano, gayita bubi mu byenda ebizimba ne gakendeeza ku sodium asigadde mu musaayi gwo, ekiyinza okuleetera hyponatremia ey’akabi (okuzimba obwongo, okutabulwa, n’okukonziba).
• Bw’onywa omubisi gw’obulo ogutali gufukiddwa, cola owa bulijjo, ebyokunywa eby’emizannyo ebiwoomerera, oba caayi awoomerwa, bibaamu ssukaali mungi nnyo (high osmolality) ne sodium mutono nnyo. Ssukaali ayitiridde atayingizibwa atuula munda mu kyenda n’akola nga sipongi, n’aggya amazzi amangi n’okusingawo okuva mu musaayi gwo ne gayingira mu byenda byo (osmotic diarrhea).

1. Packets za ORS ez’ebyobusuubuzi eza WHO-formula (Okusooka okulondebwa) .¶

Buli lwe kiba kisoboka, kozesa obupapula bw’omunnyo ogw’okuzzaamu amazzi mu kamwa obupimiddwa nga tebunnabaawo okuva mu dduuka ly’eddagala (nga WHO/UNICEF Reduced Osmolarity ORS, Pedialyte, Dioralyte, Hydralyte, oba CeraLyte), nga bitabuddwamu nnyo n’obunene bwennyini obw’amazzi amayonjo agakubiddwa ku packet. Totabulangako packet ya ORS na mata, ssupu, oba omubisi gw’ebibala, era tofumba solution oluvannyuma okussaamu eminnyo (amazzi go bwe gaba geetaaga okufumba, sooka ofumbe amazzi, galeke ganyogoze ddala, n’oluvannyuma otabule mu packet).

2. Enkola entuufu ey’amangu ey’awaka eya WHO ORS¶

Bw’oba tosobola kutuuka mu dduuka ly’eddagala, teekateeka enkola eno entuufu etaasa obulamu eragiddwa ekitongole ky’ebyobulamu mu nsi yonna ne pulojekiti y’okuzza amazzi mu mubiri. Kozesa ebijiiko ebipima ebya bulijjo (si bya ffeeza eby’okulya ebitali bya bulijjo) era owoomerwa amazzi agasembayo nga tonnagawa mwana: tegalina kuwooma munnyo okusinga amaziga g’omuntu ag’obutonde.

• Amazzi amayonjo, amayonjo ag’okunywa: Liita emu (ebikopo bya Amerika nga 4.2, oba egiraasi ttaano eza mililita 200).
• Ssukaali w’oku mmeeza omweru omubisi (sucrose): ebijiiko bya caayi 6 eby’omutindo (mililita 30, oba gram 25.2).
• Omunnyo gw’oku mmeeza ogw’omutindo (sodium chloride): ekijiiko kya caayi eky’omutindo 0.5 (ekitundu kimu) (mililita 2.5, oba gram 2.9).

Tabula n’amaanyi okumala sekondi 60 okutuusa nga buli kirisitaalo y’omunnyo ne ssukaali bisaanuuse. Teeka ng’obikkiddwa mu kifo ekiyonjo era ekitundu kyonna ekitakozesezza kisuule oluvannyuma lw’essaawa 24, ng’oteekateeka ekibinja ekipya buli lunaku.

3. Enkola endala ez’amazzi g’awaka nga ssukaali taliiwo¶

• Starch-based cereal ORS (Highly effective for severe watery diarrhea): Sitaaki ezizibu mu muceere zimenya mpola ne zifuuka glucose mu byenda nga tezirinnyisa osmolality y’ekyenda, ekikendeeza ku bungi bw’omusulo ogufuluma ebitundu 30 ku buli 100 bw’ogeraageranya ne ssukaali omunyangu. Fumba giraamu 50 ku 60 (ekikopo nga 0.5) ez’obuwunga bw’omuceere omweru omukalu oba omuceere omweru omufumbe ogufumbiddwa mu liita 1.1 ez’amazzi** okumala eddakiika 5 ku 7 okutuusa lwe gukola ekikuta ekigonvu, eky’amazzi, kireke kitonnye okutuuka ku bbugumu erya bulijjo, osseemu ekijiiko kya caayi eky’omutindo 0.5 eky’omunnyo gw’oku mmeeza, era okakasizza nti obuzito obusembayo bwenkana liita emu.
• Diluted fruit juice plus salted cracker fallback (For mild cases in older children and adults): Singa omwana oba omuntu omukulu alina amazzi amatono agaana standard ORS, abanoonyereza balaze nti okufukirira ekitundu 1 eky’omubisi gw’obulo ogutaliimu biwoomerera n’ebitundu 4 eby’amazzi (1:4 dilution) oba okukyusakyusa okunywa ekyokunywa eky’ebyemizannyo ekitabuddwa (ekitundu 1 eky’okunywa eky’ebyemizannyo okutuuka ku kitundu 1 eky’amazzi) n’omunnyo ogwa bulijjo crackers ne broth bisobola okukuuma amazzi mu kiseera ky’obulwadde bw’olubuto obutono obw’akawuka. Tokozesa fallback eno ku baana abawere oba okuggwaamu amazzi mu mubiri okw’ekigero oba okw’amaanyi.

4. Ebigendererwa by’obunene mu mutendera ku mutendera n’enkola y’okulwanyisa okusiiyibwa¶

Omuntu bw’aba asesema nnyo, abazadde n’abalabirira batera okulowooza nti okuddamu amazzi mu kamwa kulemye kubanga omulwadde asuula egiraasi y’amazzi ejjudde. Mu kusengejja abaana mu bwangu, okuddamu amazzi mu kamwa kituuka ku buwanguzi ebitundu ebisukka mu 90 ku buli 100 nga kiweereddwa nga bakozesa syringe oba spoon pacing:

1. Etteeka lya mililita 5: Ng’okozesa empiso oba ekijiiko ky’eddagala ekya mililita 5 (ekijiiko kimu), fuuwa oba ekijiiko mililita 5 eza ORS ennyogovu mu mabbali g’akamwa buli luvannyuma lwa ddakiika 3. Ku sipiidi eno, omuntu anywa mililita 100 (awunsi 3.4) buli ssaawa butereevu ng’ayita mu lubuto n’olubuto olw’okungulu nga takuŋŋaanyizzaako buzito bwa mazzi gamala mu lubuto okutandika okusesema.
2. Bwe zisesema nga ziddamu amazzi: Linda eddakiika 15 ku 20 okuleka okusannyalala kw’omumwa gwa nnabaana n’olubuto okukka, olwo oddemu okutandika ku mililita 5 buli luvannyuma lwa ddakiika 5.
3. Ekiruubirirwa ky’okuddamu amazzi mu ssaawa 4 olw’okubulwa amazzi mu mubiri mu ngeri etali ya maanyi okutuuka ku kigero: Genderera okugabira nga mililita 50 ku 75 eza ORS buli kkiro y’obuzito bw’omubiri (nga 1 ounce buli pawundi) nga zisaasaanyizibwa obutasalako mu ssaawa 4 ezisooka:
4. Omwana omuwere azitowa kkiro 6 (pawundi 13): mililita 300 ku 450 (awunsi 10 ku 15) zonna awamu mu ssaawa 4.
5. Omwana omuto azitowa kkiro 12 (pawundi 26): mililita 600 ku 900 (awunsi 20 ku 30) zonna awamu mu ssaawa 4.
6. Omwana azitowa kkiro 25 (pawundi 55): Liita 1.25 ku 1.8 (awunsi 42 ku 60) zonna awamu mu ssaawa 4.
7. Omutiini oba omukulu (60+ kilograms / 132+ pounds): Liita 2.0 ku 3.5 (68 ku 118 ounces) omugatte mu ssaawa 4 ku 6.
8. Okukyusa okuddaabiriza okugenda mu maaso: Obubonero bw’ennyonta n’okubulwa amazzi mu mubiri bwe bumala okutereera, waayo mililita 60 ku 120 (awunsi 2 ku 4) eza ORS ku buli musulo oguyidde oba okusiiyibwa mu baana abato, ne miliita 200 ku 250 (ekikopo 1) oluvannyuma lwa buli musulo ogusumuluddwa mu baana abakulu n’abantu abakulu.

Ebizibu ebitta abantu okutunuulira¶

Ne bwe kiba nti okufiirwa amazzi kufugibwa, ebizibu bina eby’obujjanjabi ebiyinza okutta obulamu biyinza okuvaamu mu wiiki oba mu wiiki bbiri oluvannyuma lw’obulwadde obuva ku mmere.

1. Obulwadde bwa botulism obuva ku mmere n’abaana abawere (Descending neurotoxic paralysis) .¶

Clostridium botulinum ekola ekimu ku butwa obusinga okutta ebiramu obumanyiddwa. Okwawukanako ne Salmonella oba norovirus, botulism te kuleeta musujja era ereka omulwadde ng’ategeera mu bujjuvu era ng’alina ebirowoozo ebisongovu ate ng’egenda esalako obubonero bw’obusimu eri ebinywa eby’obwannakyewa.

• Botulism eva ku mmere y’abantu abakulu n’abaana: Weetegereze "4 Ds": Diplopia (okulaba emirundi ebiri oba okuzibu), Dysarthria (okwogera okuwunya, okugonvu), Dysphonia (eddoboozi eriwuuma oba enafu), ne Dysphagia (okukaluubirirwa okumira amazzi oba amalusu), nga kuwerekerwako okutonnya waggulu ebikowe by’amaaso (ptosis) n’amaaso agatazibikira mu kitangaala ekitangaavu. Olwo obunafu butambula wansi mu ngeri ya symmetrical okuva mu bulago n’emikono okutuuka ku diaphragm y’ekifuba n’amagulu.
• Obulwadde bw’abaana abawere (Emyaka wiiki emu okutuuka ku myezi 12): Buva ku kumira C. botulinum spores (ezisinga okumanyika okusangibwa mu omubisi gw’enjuki embisi oba ogufuuse pasteurized, awamu n’enfuufu n’ettaka) ebimera munda mu nkola y’ekyenda ky’omwana ekitakuze. Akabonero akasooka kumpi bulijjo okuziyira okupya (ennaku 3 oba okusingawo nga tolina musulo), nga kiddirirwa okukaaba okunafu, okupapajjo, okusirifu, okuyonka obubi ku bbeere oba eccupa, okubulwa okufuga omutwe ("floppy baby" hypotonia), n'okufulumya amalusu agakuŋŋaanyiziddwa.
• Ekikolebwa mu bwangu: Genda mu kitongole ky'eddwaliro eky'amangu ekikuli okumpi mu bwangu. Okuweebwa amangu eddagala lya Botulinum Antitoxin (BAT eri abantu abakulu/abaana, oba BabyBIG human botulism immune globulin eri abaana abawere) kiyimiriza okwongera okusannyalala kw’obusimu, wadde ng’enkomerero z’obusimu ezasannyalala edda zitwala wiiki okumera ebiyungo ebipya ate ng’ekyuma ekissa kiwagira okussa.

2. Obulwadde bwa Hemolytic Uremic Syndrome (HUS) n’okulemererwa kw’ekibumba¶

Abantu nga 5 ku 10 ku buli 100 (n’abaana abawera 15 ku buli 100 abali wansi w’emyaka 5) abakwatibwa Shiga toxin-producing E. coli (STEC O157:H7) oba Shigella dysenteriae zifuna Obulwadde bwa Hemolytic Uremic Syndrome (HUS). Ekyewuunyisa, HUS etera okukuba ennaku 5 ku 10 oluvannyuma lw’ekiddukano okutandika, emirundi mingi ng’ekiddukano kirabika kitereera.

Obutwa bwa Shiga buyita mu bbugwe w’ekyenda ekinene ekyonoonese ne buyingira mu musaayi ne bukwatagana butereevu n’emisuwa emitonotono munda mu nsigo. Eyo, obutwa buno busala obutoffaali obumyufu obutambula (microangiopathic hemolytic anemia), kalya obutoffaali obukola omusaayi (thrombocytopenia), era ne buziba ebisengejja ekibumba (acute renal failure).

• Obubonero obw’okulabula ku HUS: Okweyoleka okuzimba (olususu olumyufu, olw’omuzimu n’ebikowe oba ennyindo eby’omunda ebimyufu), okukoowa ennyo oba okunyiiga, okunyiga okutategeerekese oba obutundutundu obutono obwa kakobe obulaga ku lususu (petechiae), okuvaamu omusaayi okuva mu nnyindo oba ennyindo, okuzimba okufuukuuse okwetooloola amaaso, enkizi, n’emikono (edema), n’a okugwa okw’amangu oba okuyimirira ddala mu kufulumya omusulo (oba omusulo ogwa langi ya pinki/kola) oluvannyuma lw’ennaku 5 ku 14 oluvannyuma lw’ekiddukano ekivaamu omusaayi oba ekizimba.
• Ekikolwa eky’amangu: Twala omwana oba omuntu omukulu mu ddwaaliro ery’amangu mu bwangu; HUS yeetaaga okulabirira mu bwangu mu by’omusaayi n’ekibumba ky’abaana, okuteekebwamu omusaayi, n’okulongoosebwa ekibumba okumala akaseera.

3. Obulwadde bwa Guillain-Barre Syndrome (GBS) oluvannyuma lwa Campylobacter¶

Campylobacter jejuni (etera okukwatibwa okuva mu nkoko ezifumbiddwa obulungi oba amata agatali ga pasteurized) kye kimu ku bisinga okusiigibwa mu nsi yonna olw’obulwadde bwa Guillain-Barre Syndrome, obuzibu obw’amaanyi obw’obusimu obuziyiza endwadde obutera okutandika wiiki emu ku 3 oluvannyuma lw’okuwona ekiddukano.

• Engeri gye yawukana ku botulism: Nga botulism etandikira ku mutwe n’etambula wansi, Guillain-Barre Syndrome ereeta obunafu obulinnya obutandikira ku bigere ne butambula waggulu. Weetegereze okuwuuma "pini n'empiso" mu bigere n'engalo, okufiirwa enkola y'enkizi, okugwa mu bwangu oba obutasobola kulinnya madaala, n'obunafu okulinnya amagulu ng'oyolekera omugongo n'ebinywa by'okussa. Okunafuwa kwonna okw’amagulu okugenda mu maaso oluvannyuma lwa ssennyiga w’olubuto kyetaagisa okwekebejjebwa amangu mu kisenge ky’abalwadde ab’amangu.

4. Obulwadde bwa sepsis mu musaayi obuyingira mu musaayi n’obutwa obuyitibwa megacolon¶

Mu baana abawere abali wansi w’emyezi 3, abantu abakulu abasukka mu myaka 65, abalwadde ab’embuto, abantu abalina akawuka ka siriimu, abalwadde b’eddagala eriweweeza ku bulwadde, n’abantu ssekinnoomu abamira eddagala eriziyiza ppampu ya proton-pump erya ddoozi ennene buli lunaku (ezifuula ekiziyiza asidi w’olubuto ekikuuma), obuwuka nga Salmonella, Listeria, Campylobacter, ne Vbrio vulnificus (okuva mu nvubu embisi) basobola butereevu okuyita mu bbugwe w’ekyenda okuyingira mu musaayi, okutandika sepsis ne septic shock.

Singa ekiddukano ky’omulwadde kikoma mu bwangu ** ng’olubuto lwe luzimba ng’engooma ennywevu, ne lufuuka olugonvu mu ngeri ey’ekitalo bw’okwatako ennyo, era nga luwerekerwako omukka ogw’embiro n’omusujja ogw’amaanyi oba okukendeeza ku bbugumu, teebereza toxic megacolon oba intestinal perforation, ekyetaagisa okwekenneenya okw’amangu okulongoosebwa.

Amateeka agafuga eddagala eritali lya bulabe: kiki ekiyamba n’ekikosa¶

Abalabirira bangi abalina ebigendererwa ebirungi bongera ku yinfekisoni ezisibuka mu mmere nga batuuka ku ddagala lya kabineti ly’eddagala ly’awaka erya bulijjo. Goberera nnyo ebiragiro bino eby’obujjanjabi:

• Ddi lwe weewala Loperamide (Imodium) ne Diphenoxylate: Eddagala eriweweeza ku kutambula ku ddagala eritali ku ddagala likola nga lyesiba ku bikwata opioid mu bbugwe w’ekyenda, ne lisannyalaza okukonziba kw’ebinywa mu nnyimba (peristalsis) okugoba omusulo. Towa baana abali wansi w’emyaka 6 loperamide (era abaana abasinga obungi bawa amagezi obutagiwa mu baana bonna abali wansi w’emyaka 12 okutuuka ku 18 olw’obulabe bw’okusannyalala ileus, otulo, n’obutwa obuyitibwa megacolon). Mu bantu abakulu, tokozesangako loperamide singa oba olina omusujja, omusulo ogulimu omusaayi oba mucoid, oba okulumwa ennyo mu lubuto. Kiyinza okukozesebwa n’obwegendereza abantu abakulu abalamu obulungi bokka ku kiddukano ekitono, eky’amazzi, ekitali kya musaayi, ekitaliimu musujja nga batambula oba nga bakola.
• Ddi lwe weewala Bismuth Subsalicylate (Pepto-Bismol, Kaopectate): Bismuth subsalicylate erimu ekirungo kya salicylate ekikwatagana n’eddagala ne aspirin. Towa bismuth subsalicylate eri abaana abawere, abaana, oba abatiini abali wansi w’emyaka 18 abawona obulwadde bwa viral gastroenteritis olw’obulabe bwa Reye’s syndrome (acute liver failure and fatal brain swelling). Era weetegereze nti bismuth akolagana ne trace sulphur mu ntuuyo yo n’omusulo okukola bismuth sulfide, ekifuula olulimi lwo n’omusulo gwo jet black okumala akaseera; kino kiyinza okusiba oba okukoppa mu ngeri ey’akabi okuvaamu omusaayi ogwa nnamaddala ogwa waggulu mu lubuto (melena).
• Weewale eddagala lya NSAID (Ibuprofen, Naproxen, Aspirin) ng’olina amazzi mu mubiri: Eddagala eriziyiza okuzimba eritali lya steroid liziyiza prostaglandins ezikuuma emisuwa egiyingira mu kibumba zo nga gigaziye ng’amazzi gakulukuta. Okumira ibuprofen oba naproxen ku musujja oba okulumwa omubiri ng’olina amazzi mu mubiri olw’okusesema n’ekiddukano kitera okuvaako Drug-induced Acute Kidney Injury (AKI). Singa eddagala erikendeeza omusujja lyetaagisa oluvannyuma lw’amazzi g’omu kamwa okusigala wansi, paracetamol (acetaminophen) esinga bulabe eri ensigo, kasita tewali bulwadde bwa kibumba.
• Eddagala Ondansetron (Zofran) ne Zinc supplementation: Mu bitongole by’obujjanjabi obw’amangu n’eby’amangu, ddoozi emu eyesigamiziddwa ku buzito eya ondansetron esaanuusa mu kamwa eyimiriza bulungi okusiiyibwa okutasalako mu baana abasukka mu myezi 6 n’abantu abakulu, ne kisobozesa okuddamu amazzi mu kamwa okutuuka ku buwanguzi nga tekyetaagisa layini ya IV. Ku baana abali mu bifo ebitono oba abalina ekiddukano ekiwanvu, ekitongole ky’ebyobulamu mu nsi yonna kiwa amagezi Milligrams 10 ku 20 eza oral elemental zinc buli lunaku okumala ennaku 10 ku 14, eddaabiriza obutoffaali obukola ebyenda era n’ekendeeza ku buzibu bw’ekitundu ekiriwo kati n’okuddamu okulwala mu biseera eby’omu maaso mu myezi 3 egijja.

Okuddamu okuliisa nga bukyali: lwaki "endya ya BRAT" enkakali evudde ku mulembe¶

Okumala emyaka mingi, amaka gaali gagambibwa okufa enjala obulwadde bw’olubuto okumala essaawa 24 ku 48 olwo ne balya emmere ya BRAT yokka (Bannanas, Rice, Applesauce, and Toast). Enkola eziriwo kati okuva mu kitongole ky’ebyobulamu mu nsi yonna, American Academy of Pediatrics (AAP), ne European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) zikakasa nti okusiiba okumala ebbanga eddene n’endya ezikugira BRAT yokka zikendeeza ku kuwona kw’ekyenda kubanga obutoffaali bw’omu lubuto obw’ekyenda bwetaaga ebiriisa eby’omu luminal okuddamu okukola era kubanga emmere enkakali eya BRAT ebulamu puloteyina, obulamu obulungi amasavu mu mmere, n’ebiriisa ebitonotono.

1. Weeyongere okuyonsa n’okuyonsa abaana abawere bulijjo awatali kutaataaganyizibwa: Tolekera awo kuyonsa mwana muwere alina obulwadde bw’olubuto obw’amaanyi; amata g’amabeere galimu obutoffaali obuziyiza endwadde (protective secretory IgA antibodies) n’ebintu ebiziyiza obuwuka ate nga byangu okugaaya. Abaana abawere abaliisibwa mu ccupa balina okudda mu mmere y’abaana abawere nga balina amaanyi gonna, nga tebafukiddwa amangu ddala oluvannyuma lw’omutendera ogusooka ogw’okuzza amazzi mu mubiri ogwa ORS ogw’essaawa 4 (okufukirira emmere n’amazzi ag’enjawulo kifa enjala y’omwana omuwere kalori n’obusannyalazo).
2. Ddamu okulya emmere enkalu etuukana n’emyaka mu ssaawa 4 ku 6 ng’omaze okuddamu amazzi: Amangu ddala ng’okusiiyibwa kukendedde era ng’ekizibu kya ORS ekyasooka eky’essaawa 4 kikyusiddwa, waayo emmere entonotono, enfunda eziwera buli luvannyuma lwa ssaawa 3 ku 4.
3. Emmere esinga okulya ng’owona: Londa ebirungo ebizibu (complex carbohydrates) nga bigattiddwa wamu ne puloteyina ezitali nnungi ne potassium ow’obutonde: omuceere omweru ogwa bulijjo, amatooke agafumbiddwa oba agafumbiddwa nga galimu akatono k’omunnyo, oatmeal, crackers eza bulijjo, noodles mu mubisi gw’enkoko oba enva endiirwa omutangaavu, enkoko oba ekifuba ky’enkoko ekifumbe, amagi agafumbiddwa, ebijanjaalo ebikungu, applesauce, ne yogati ow’obutonde ow’obutonde (agaba enziyiza za lactase ez’obutonde ne bakitiriya ez’omugaso).
4. Emmere gy’olina okwewala okumala ennaku 3 ku 5: Weewale emmere erimu amasavu, agasiike, oba amasavu amangi (elwawo okufulumya amazzi mu lubuto n’okuziyira), entungo ya chili ey’akawoowo, caffeine n’omwenge (ebisitula okutambula kw’ekyenda n’okukola ng’okufulumya amazzi), ssweeta oba ennyindo ezitaliimu ssukaali ezirimu sorbitol, xylitol, oba mannitol (ezireeta ekiddukano eky’amaanyi eky’okusannyalala), n’egiraasi ennene ez’amata g’ente ag’amazzi agatali gazimbulukuse singa obutagumira lactose okumala akaseera oluvannyuma lw’okukwatibwa kireeta okuzimba ne ggaasi.

Okufuga yinfekisoni mu maka: okukomya okusaasaana kwa norovirus ne bacteria¶

Singa omuntu omu mu maka atandika okusesema n’ekiddukano oba ekiddukano ekisiigibwa, okukola emitendera egy’amangu egy’okussa mu kalantiini n’okutta obuwuka kiremesa amaka gonna okugwa omulundi gumu:

• Naaba mu ngalo ne ssabbuuni okumala sekondi 20 ezijjuvu: Gels z’omu ngalo ezirimu omwenge (ne bwe ziri ku 70% ethanol) teziziyiza mu ngeri eyesigika akawuka akatali kazingiddwa nga norovirus oba obuwuka obuleeta obuwuka nga Clostridioides difficile. Siimuula bulungi emikono ne ssabbuuni n’amazzi agakulukuta buli lw’omala okugenda mu kinaabiro, okukyusa nnappi, era nga tonnakwata ku mmere.
• Yambala ggalavu ne masiki nga tonnayonja kusesema: Okusesema kw’ekikompola okuva mu norovirus kusindika obukadde n’obukadde bw’amatondo g’akawuka agatonotono mu mpewo agatuula ku bbulawuzi z’amannyo eziriraanyewo, ebibalirirwa, n’emikono gy’enzigi. Yambala ggalavu za nitrile oba latex ezikozesebwa omulundi gumu ne masiki y’okulongoosa oba N95, ssungulula mpola ebisesema eby’amazzi n’obutambaala bw’empapula (tofuumuula oba okusenya ebisesema ebikalu), era osibe kasasiro munda mu kaveera akasibiddwa nga tonnamuteeka mu kasasiro ow’ebweru.
• Teeka obuwuka n’ekizimbulukusa kya chlorine bleach solution ya 1,000 ku 5,000 ppm: Tabula ebijiiko 5 ku 25 (mililita 75 ku 375) ebya chlorine bleach ow’awaka atalina kawoowo (5 ku 6% sodium hypochlorite) buli liita 3.8 (ggaloni emu) y’amazzi, osiige ku bifo ebikalu ebitaliimu buziba (ebibya bya kaabuyonjo, okufuuwa emikono, ttaapu, wansi wa tile, n’enkokola z’enzigi), zireke nga zirabika nga nnyogovu okumala waakiri eddakiika 5 ku 10, n’oluvannyuma onaabe n’amazzi amayonjo.
• Onaaba engoye encaafu ku muliro ogw’amaanyi amangu ddala: Ggyako ebitambaala ebicaafu, obutambaala, n’engoye n’obwegendereza nga tobikankanya mu bbanga. Zinaabe ku cycle esinga obuwanvu ku bbugumu ly’amazzi erisinga obunene erya waakiri diguli 60 Celsius (140 degrees Fahrenheit) n’eky’okunaaba, era zikale ku bbugumu erisinga obunene okutuusa lwe zikala ddala.
• Kuteeka mu nkola etteeka ly’okuggyako mu ffumbiro ery’essaawa 48: Omuntu yenna awona okusesema oba ekiddukano ekizibu ennyo talina kutegekera balala mmere, kukwata ice oba ebikozesebwa bye bagabana, okuwuga mu bidiba by’olukale, oba okudda mu mulimu gw’okuweereza emmere, eby’obulamu, oba okulabirira abaana okutuusa waakiri essaawa 48 ku 72 oluvannyuma lw’ekiseera kye ekisembayo ennyo eky’okusesema oba ekiddukano.

Ebibuuzo ebitera okubuuzibwa¶

Ensonda zeekebeddwa¶

• Ekitongole ky’ebyobulamu mu nsi yonna (WHO) ne UNICEF: Obujjanjabi bw’ekiddukano: Ekitabo ky’abasawo n’abakozi abalala abakulu mu by’obulamu (okugabanya amazzi mu malwaliro mu malwaliro, ensengeka ya ORS ekendedde-osmolarity, eddagala ly’omunnyo-ssukaali ery’awaka, n’enkola z’okugatta abaana zinki).
• Infectious Diseases Society of America (IDSA, United States): Endagiriro y’enkola y’obujjanjabi ey’okuzuula n’okuddukanya ekiddukano ekisiigibwa (emmeeza z’okufumbiza obuwuka obuleeta endwadde, STEC antibiotic and anti-motility contraindications, n’emisingi gy’okukebera omusulo).
• Ebifo ebifuga n’okuziyiza endwadde (CDC, Amerika): Obuwuka n’endwadde ezisibuka mu mmere, Ebiragiro ebikwata ku kulwanyisa okubutuka kw’obulwadde bwa Norovirus n’okutta obuwuka mu Bleach, ne Obulagirizi bw’obujjanjabi ku bulwadde bwa Botulism ne Hemolytic Uremic Syndrome (HUS).
• Ekitongole ky’eggwanga ekikola ku by’obulamu n’okulabirira obulungi (NICE, Bungereza) n’ekitongole ky’ebyobulamu mu ggwanga (NHS, Bungereza): Obulwadde bw’ekiddukano n’okusiiyibwa ebiva ku bulwadde bw’olubuto mu baana abali wansi w’emyaka 5: Okuzuula n’okuddukanya (CG84) n’omutindo gw’okusunsula amazzi mu bulwadde bw’omu lubuto bw’abantu abakulu.
• European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN): Endagiriro eyesigamiziddwa ku bujulizi ku kuddukanya obulwadde bw’olubuto obw’amangu mu baana mu Bulaaya (enkola z’okuddamu okuliisa amangu n’obujulizi bwa ondansetron/probiotic).

Ebiragiro ebikwatagana nabyo¶

• Okuweebwa obutwa
• Obulwadde bwa sepsis ne septic shock
• Emmere eyonoonese n’amasannyalaze ga firiigi okuvaako
• Ebiwandiiko ebikwata ku bulamu bw’amazzi n’okufumba