Government of Andhra Pradesh Commissioned' the Institute of Health Systems to prepare a comprehensive manual to achieve better control of the gastroenteritis (GE) situation in the state. We, the GE Manual Preparation Team, at IHS are very pleased to offer, through this manual, our contributions towards control of G E in the state. Immediately after commissioning, we started collecting all available materials about gastroenteritis control activities in the state. We interacted with the officers in the Directorate of health dealing with communicable disease control and gastroenteritis. We discussed the matter among the Institute's faculty and attended the National Workshop on Communicable Disease Control conducted by the State Government in December 2000. The workshop was very informative.

This manual departs from traditional programme implementation manuals in the sense that this is a manual addressed to every one in the state, who has ';i role towards control of gastroenteritis. We start with a brief overview of causes of GE and basic insights which may help everyone contribute to its control. In Chapter-1 we argue that incidence of gastroenteritis is an indicator of our social and economic development. Access to adequate quantity of safe drinking water, closed sewerage system, and good nutritional status by most of the population will automatically result in a sustained reduction in the level of GE incidence. All these three factors are linked to economic development. In addition, literacy and resultant awareness among people about health status enhancing personal hygiene will contribute to reduction of GE incidence. This is the social factor we refer to. The second chapter describes the epidemiology of gastroenteritis, including how to recognise various manifestations like diarrhoea, dysentery, causative organisms and risk factors, etc. The chapter ends with an analysis of GE incidence in AP. The third chapter is addressed to all individuals, families and households. We feel this is the most important chapter of the manual. We describe about proper use of water for hygiene, and drinking and personal hygiene useful to avoid gastroenteritis. The next chapter is meant to assist community health workers with information and insights for management of gastroenteritis. Tips of recognition of gastroenteritis are provided. Steps for preparation of oral rehydration solution and its usefulness in management of GE are described. Chapter-5 is written from an public health managers point of view regarding prevention, control and management of GE. The Primary Health Centres in rural areas, and Health Officers in municipalities have a major role to play. The chapter gives instructions about surveillance of drinking water and food quality, early detection of GE outbreaks and medical management of GE cases. The need for proactive information and education strategy to secure community involvement in control of GE outbreaks is emphasised. Health officers are expected to proactively release press notes giving information about the cause of outbreak, and what can people do to avoid or minimise its adverse effect. The chapter ends with information about the status of vaccination. The purpose is to educate all concerned about the futility of running after vaccination to control adverse effect of a GE outbreak. Based, on available evidence, it is argued that control efforts should focus on supplying safe drinking water, removing sources of contamination, proper management of GE cases etc. rather than on vaccination. Chapter- 6 talks about epidemiological investigation of GE outbreaks. Case studies of a few actual GE outbreaks reported by the public health department are given. It is important that each outbreak is thoroughly investigated to localise the cause of outbreak. This will facilitate a rational and cost-effective response. Such investigations will also help educate public health officers to prevent similar outbreaks in future.

Water and food quality are the key to control of GE. Public health laboratory facility for testing of water and food samples play an important role. These facilities help public health officials properly investigate outbreaks. They also help members of public to get suspected water and food tested for their bacteriological quality. If more and more people use these facilities, they would have contributed to a more watchful society leading to eventual control of GE. To facilitate work of public health officials and empower general public in checking of water or food quality, Chapter- 7 describes the public health laboratory facilities in the state. Addresses and where ever available contact telephone numbers of public health laboratories, water and / or food testing laboratories, etc. have been given. Information about such laboratory facilities in the private sector is also provided. Chapter- 8 is about food hygiene. Our target audience are the caterers and food handlers. Public health officials and general public can also use information in this chapter to judge the extent to which particular food and catering establishments are operating in a hygienic manner.

This manual is a product of collaborative effort. We have received generous help from many people. Dr KV Satyanarayana Murthy, Associate Professor, Social and Preventive Medicine, Osmania Medical College was kind enough to spend two weeks with the Institute and helped us in getting started. Dr. Jaipal Reddy, Director Health has been very helpful in being available for discussions. We have learnt from his experience. Many a times we sounded him of our ideas and concerns and benefited from his assessment. Dr. Srinivasa Sarma, Additional Director, Communicable diseases, Dr. Gopal Reddy, Joint Director Epidemics, and Mrs. Krishnaveni, Deputy Statistical Officer were very helpful in providing us with official information and data on GE incidence. We are grateful to Dr. Sangram Singari, Director, IPM for having provided us with information about public health laboratories and comments on the draft manual. Mrs. Shyamala, Chief Analyst, IPM helped us with information about water quality testing. Our thanks are due to G Rama Naidu, Chief Engineer, (RWS), Mr. Satish, and Mr. Parthasaradhi, Assistant chemists, in the same department for information on water quality testing facilities in their department. We would also like to thank our colleagues at the IHS for their help. Dr. PV Chalapathi Rao, helped us in getting started and by reviewing our draft. Ms Kavitha provided library and documentation support. Shri Goverdhan, Research Assistant helped us in gathering literature and official documents.

We are very grateful to the Government of AP, Shri C. Arjun Rao, Special Chief Secretary to Government of AP Health, Medical and Family Welfare Department, and Shri AK Tigdi, for their encouragement. Shri Arjun Rao has been the primary source of inspiration for our work.