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Gastroenteritis and Food/Waterborne Diseases

Gastroenteritis is very common in Indonesia due to ineffective public health controls and poor hygiene standards. The overall incidence of food- and water-borne disease is very high compared to the Western world. The traveler or resident needs to take great care and personal responsibility for maintaining a supply of safe food and drinking water due to this high risk of food poisoning from bacteria, parasites, or diseases such as cholera, typhoid fever, dysentry, amoebiasis, and giardiasis.

Acute gastroenteritis is caused by viruses, bacteria or parasites. The primary symptom of gastroenteritis is diarrhea, but it may be accompanied by nausea, vomiting, and abdominal pain. Vomiting usually subsides in a day or two. Diarrhea may last for up to 10 days, but usually lasts for two or three days. If fever is present, or blood and mucous is present in stools the strain is more likely to be contagious. Gastroenteritis-causing organisms live in the gastrointestinal tract, so it is important to thoroughly wash hands after using the toilet and before preparing food.

In a normal healthy person, a case of gastroenteritis is no more significant than the common cold. However, prolonged bouts of vomiting and diarrhea may lead to dehydration and disruption of body chemistry. Young children are in much greater danger from the disease. Chronic diseases such as diabetes mellitus or kidney problems may increase complications from gastroenteritis. The morbidity and mortality of the disese are much higher in the young and the very old.

If the illness is mild, you may follow the dietary advice below instead of seeing a doctor. It is important to consult your doctor if diarrhea is profuse (above 8 watery stools a day), vomiting is persistent, severe abdominal pain develops or if any of the following symptoms are present: listlessness, difficulty waking up, sunken eyes, very dry skin and tongue, pallor, and passing little or no urine. If these signs are present, the victim should quickly be admitted to a hospital.

It is common in Indonesia for doctors to prescribe antibiotics. If the gastroenteritis is caused by bacteria, antibiotics may shorten the course of the illness. Your doctor should do a stool culture so that the pathogenic cause can be identified and treatment specifically targeted.

Medication is often prescribed to harden stools or slow down bowel activity. In specific circumstances such as boarding an airplane or attending an important meeting, they can be useful to controlling the symptoms but do not hasten the recovery process. Anti-emetic drugs such as primperan are also often prescribed to stop vomiting, though these should be avoided for children.

Personal care

Stay at home and rest until symptoms subside. Avoid solid foods until vomiting stops. As soon as you are able, take small amounts (about 1 oz. every 15 minutes by the clock) of clear, bland liquids such as tea, ginger ale or broth. If vomiting recurs, wait 1-2 hours before trying clear liquids again. Once you are retaining fluids without difficulty, try to increase the amount you take each hour, gradually (or decrease the amount of time between sips).

After 24 hours without nausea, vomiting or diarrhea, or if hungry and not vomiting, try dry toast, saltines, or white rice with jelly or honey for energy. Progress to soft, mildly flavored foods that are low in fiber until you are back to good health. You may wish to use the bananas, (white) rice, applesauce and tea/toast (BRAT) diet as a guide.

Many people temporarily lose the ability to digest milk sugar for 1-2 weeks after an episode of gastroenteritis. Avoid milk products, oils and spices until you are feeling better and gradually resume intake as tolerable. A suggested diet for young children is given below:

Day 1

Give fluids a little at a time and often (eg. 50 mL every 15 minutes if vomiting a lot). A good method is to give 200 mL (about 1 cup) of fluid every time a watery stool is passed or large amounts of vomiting occurs.

The ideal fluid is Gastrolyte, a glucose and mineral powder added to water that you can obtain from local pharmacies or apotik. Alternatives to Gastrolyte are:
Lemonade (non-low-calorie): 1 part to 4 parts water
Sucrose (table sugar): 1 teaspoon to 120 mL water
Glucose: 1 teaspoon to 120 ml water
Cordials (non-low-calorie): 1 part to 6 parts water

Do NOT use undiluted lemonade or mix Gastrolyte with fluids other than water.

Days 2 and 3

Reintroduce usual milk or formula, diluted to half strength (i.e. mix equal quantities of milk/formula and water).

Do not worry about solid food, which can be reintroduced after 24 hours. Start with bread, plain biscuits, jelly, stewed apples, rice, porridge or non-fat potato chips. Avoid fatty foods, fried foods, raw vegetables and fruit, and whole grain bread.

Day 4

Increase milk/formula to normal strength and gradually reintroduce the usual daily diet. If diarrhea persists over long periods of time, especially if accompanied by weight loss, fatty stools that stick to the toilet/are hard to flush or a low Vitamin B12 result on a blood test, further investigation is required by your doctor. These are symptoms of malabsorption, which can be caused by a variety of diseases including tropical sprue, giardiasis and coeliac disease.

See related articles on Typhoid, Intestinal Worms and and food preparation tips.

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

Our sincere appreciation goes to Dr. Andrew Jeremijenko of VICO for his generous contribution of this article!