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Diarrhoeal diseases

A murderer that kills millions of children each year.

Diarrheal diseases are the second leading cause of death for children under five, and cause the death of 1.5 million children each year.

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Diarrhea can last several days and can deprive the body of water and salts necessary for survival. Most people who die from diarrhea actually die from severe dehydration and fluid loss. Malnourished children are at increased risk of life-threatening diarrheal diseases.

Diarrhea is defined as deposition, three or more times a day (or a higher than normal frequency for an individual) of loose or liquid stools. Frequent deposition of feces (solid consistency) is not diarrhea, nor deposition of loose stool or "doughy" consistency for breastfed babies. Diarrhea is usually a symptom of an infection of the digestive tract that can be caused by various bacterial, viral and parasitic organisms. Infection by consuming contaminated food or water, or transmission from one person to another as a result of poor hygiene is the most common causes. Diarrheal diseases can be treated with a solution of clean water, sugar and salt, and zinc supplements.

There are three clinical types of diarrhea

  • acute watery diarrhea, which lasts several hours or days, and includes cholera;
  • acute diarrhea with blood, also known as bloody diarrhea or dysentery; and
  • persistent diarrhea, lasting 14 days or more.

Scope of diarrheal diseases

Diarrheal diseases are a leading cause of mortality and morbidity in children in the world, and usually result from exposure to contaminated food or water. Worldwide, about one billion people lack access to improved water sources and about 2.5 billion lack access to basic sanitation.
Diarrhea caused by infection is common in developing countries.

In 2004, diarrheal diseases were the third leading cause of death in low-income countries, which caused 6.9% of deaths. They are the second leading cause of death for children under five, after pneumonia. Of the 1.5 million children who died from diarrheal diseases in 2004, 80% were less than two years old.

In developing countries, children under the age of three experience, on average, three episodes of diarrhea per year. Each episode deprives the child of nutrients needed for growth. Consequently, diarrhea is a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhea.

DEHYDRATION

The most serious threat of diarrheal disease is dehydration. During an episode of diarrhea, water and electrolytes (sodium, chloride, potassium and bicarbonate) in the liquid stool, vomit, sweat, urine and breath are lost. When these deficits are not replaced, dehydration occurs.

The degree of dehydration is measured on a scale of three

  • Incipient dehydration: no signs or symptoms.
  • Moderate dehydration:
    • thirst
    • restless or irritable behavior
    • reduction of skin elasticity
    • sunken eyes
  • Severe dehydration:
    • symptoms worsen
    • shock, with partial loss of consciousness, lack of urine output, cool, moist extremities, a rapid and weak pulse, blood pressure low or not detectable, and pallor.

Severe dehydration can be fatal if the water and electrolytes the body has lost are not replaced quickly. Standard treatment is a solution of oral rehydration salts (ORS), or by intravenous infusion.

CAUSES

Infection: Diarrhea is a symptom of infections caused by a variety of bacterial, viral and parasitic organisms, most of which are transmitted by water with contamination. The infection is most common when there is a shortage of clean water for drinking, cooking and washing. The two most common causes of diarrheal diseases in developing countries are the rotavirus and Escherichia coli.

Malnutrition: Children who die from diarrhea often suffer from underlying malnutrition, which makes them more vulnerable to diarrheal diseases. In turn, each episode of diarrhea worsens their nutritional status. Diarrhea is the second leading cause of malnutrition in children under five.

Source of water: Water contaminated with human feces from, for example, sewage, septic tanks or latrines, is particularly dangerous. Animal feces also contains microorganisms that can cause diarrheal diseases.

Other causes: Diarrheal diseases can also be transmitted from person to person, especially in conditions of poor personal hygiene. Food processed or stored in unhygienic conditions is another major cause of diarrhea, such as a substance contaminated by irrigation water. Fish and shellfish from contaminated waters can also cause diarrheal disease.

PREVENTION AND TREATMENT

Among the key measures to prevent diarrheal diseases include the following:

  • access to safe drinking water sources
  • improved sanitation
  • correct personal and food hygiene
  • health education covering transmission of infections
  • rotavirus vaccination.

Key measures to treat diarrhea include the following:

  • Solution of oral rehydration salts (ORS): with intravenous fluids in the case of severe dehydration or shock and/or with a solution of oral rehydration salts in the absence of dehydration or when the case is moderate. SROs are a mixture of clean water, salt and sugar that can be made safely at home. Each treatment costs a few cents. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in feces.
  • Zinc supplements: zinc supplements reduce by 25% the duration of episodes of diarrhea and are associated with a 30% reduction of the volume of stool.
  • Nutrient-rich foods: the vicious circle of malnutrition and diarrheal diseases may break following administration of nutrients-including breast milk- during episodes of diarrhea. Providing nutritious food- including exclusive breastfeeding during the first six months of life- is recommended for children when they are healthy.

Consult a health professional if signs of dehydration are detected.

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