Diarrhoea: Why children are the most vulnerable

Diarrhoea is characterised by passage of loose or watery stool or a more frequent need to have a bowel movement than is normal for the individual. The World Health Organisation (WHO) defines diarrhoea as the passage of three or more loose or watery stool per day. Globally, there are nearly 1.7 billion cases of diarrhoea every year. Diarrhoea affects all age groups, however, it’s more pronounced in very young people. It has proven to be among the leading causes of death in children under five years old. It gets worse when it comes with malnutrition and dehydration. Children who are malnourished or have impaired immunity are most at risk of life-threatening diarrhoea. According to WHO, in developing countries, children under three years old experience on average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea has become a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhoea. According to the Rwanda Demographic and Heath Survey (RDHS) 2014-2015, the prevalence of diarrhoea is especially high among children aged 6 months to 2 years. This high prevalence age group is also the age at which children begin to be weaned and consume other foods other than breast milk. Moreover, they correspond to the ages at which children begin to explore their environment, resulting in greater exposure to pathogens (bacteria, virus or microorganism that can cause diseases). Diarrhoea prevalence also varies by province, from a low of 8 percent in the City of Kigali to a high of 15 per cent in the Western Province. Diarrhoea is a symptom of an infection in the intestinal tract, and this is usually caused by a variety of bacterial, viral and parasitic organisms. Rotavirus is the leading cause of severe diarrhoea. In 2012, Rwanda, being among the first developing African nations, was third after Sudan and Ghana to officially launch the rotavirus vaccine in its routine immunisation programme to protect children from this killer disease, and a huge impact has been registered since then. The great majority of diarrhoea episodes last less than one week and sometimes disappear without any treatment. When diarrhoea persists for more than 14 days, it is called persistent or chronic diarrhoea, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. How is this infection spread? It is mostly through contaminated food or drinking water as a result of poor sanitation. Acute form of diarrhoea lasts for one to two days, and this is commonly due to food poisoning. That’s when one consumes undercooked meals or unclean salads and vegetables. One should always be careful of the ‘famous’ brochette we eat on our evening outs. There is even a condition known as traveler’s diarrhoea, most common illness in persons traveling from resource rich to resource poor regions of the world. Diarrhoea is mostly associated with symptoms such as nausea, vomiting, abdominal pain, cramping and fever, among others. Treatment of diarrhoeal is mostly by rehydration to replace the water and salts (electrolytes) lost with oral rehydration salts (ORS) solution and zinc supplements to reduce the duration of a diarrhoea episode. Thevicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient rich foods including breast milk for young children. And of course consulting a health professional, in particular for management of persistent diarrhoea or when there is blood in stool (dysentery). Good thing is diarrhea can be prevented in our homes. Key measures to prevent diarrhoea include access to safe drinking water, use of improved sanitation, hand washing with soap, good personal and food hygiene, health education about how infections spread, exclusive breastfeeding for the first six months of life and rotavirus vaccination to very young children. The writer is a final year medical student.