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Most diarrhoea is transmitted by the faeco-oral route. The prevention of these infections will therefore depend on improved general hygiene, which is determined by the general level of poverty (standard of living). A few general tips and precautionary measures are recommended:
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Diarrhoea: prevention for travellers
Food: avoid raw vegetables, fruit you cannot peel yourself, unpasteurised dairy products, fish, shellfish and meat that is raw or not cooked through. (Cook it, peel it or leave it). Avoid food from street stalls. Food should be protected against flies.
Drink: drink tea, coffee or bottled water, preferably sparkling (less risk of having been tampered with). Beer can quench the thirst, but large quantities of alcoholic drinks are not recommended. Avoid bottles sealed with reused crown caps. Ice cubes are not to be trusted. Drinking water can be filtered. This can be done in a number of ways (large porcelain filters such as Berkefeld, active charcoal filters, portable Katadyne filters). Afterwards the water can be boiled or purified chemically with silver salts such as Micropur®, Drinkwell® (not active against viruses), Chloramine (250 mg per 10-50 litres), sodium hypochlorite (Javel, Drinkwell chlorine®, Hadex®). An unpleasant taste of chlorine can be removed by adding the non-toxic sodium thiosulphate (Drinkwell-antichlorine® drops) work in for an hour. Lugol or 2% tincture of iodine (eight drops per litre) can also be used and is more active against amoebic cysts. Long-term use (more than 3 months) is not recommended. Thyroid disorders and pregnancy are contra-indications.
Chemoprophylaxis: This is normally not advised routinely, but does provide partial protection (e.g. ofloxacin). Only to be considered for short journeys where absolutely nothing should go wrong.
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Note: Flies
Several species of flies live in close proximity to people and often eat organic waste and faeces as well as food intended for people. They lay eggs -often hundreds- on their food. When an adult fly feeds on infected material (on faeces for example), pathogens are taken in through the mouth and into the intestine. Pathogens can stick to the pads of the feet and on hairs of the legs and body. Later the insect can land on unprotected food. When walking over the food, the micro-organisms are deposited. Like all Diptera, flies eat liquid food. The fly vomits a little fluid to make the food liquid. This vomit can contain microbes from a previous meal. At the same time the fly defaecates the leftovers from a previous (infected) meal. Many pathogens causing enteritis can be transmitted in this way. Flies can also transmit trachoma, an infectious disease of the eye (Chlamydia trachomatis), which can cause blindness.
