Low maternal education, income status linked to childhood diarrhoea —Expert
Low maternal education, income status linked to childhood diarrhoea —Expert
Dr Doyin Ogunyemi is a public health physician and Senior Lecturer, Department of Community Health and Primary Care, College of Medicine, University of Lagos. In this interview with TOBI AWORINDE, she discusses the reasons for Nigeria’s high mortality and morbidity from diarrhoea
What are diarrhoeal diseases?
Diarrhoeal diseases are a collection of diseases that share the common symptom of diarrhoea which is defined as the passage of three or more loose or liquid stools per day. Examples of diarrhoeal diseases include cholera, typhoid, rotavirus and shigellosis. Diarrheoa is one of the most common health complaints and can range from a mild, temporary condition to a potentially life-threatening one due to fluid loss and dehydration.
What are the causes of this disease?
Diarrhoeal diseases are caused by multiple viral, bacterial, and parasitic organisms that cause an infection in the intestinal tract. Infection is spread through contaminated food or drinking water, or from person-to-person as a result of poor hygiene and hygienic conditions.
According to the World Health Organisation, globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year. How much of this can be ascribed to Nigeria and what is responsible for this rate of infection?
The prevalence rates of diarrhoea vary in different parts of the country from 18 per cent to as high as 35 per cent and the estimated childhood deaths from diarrhoea in Nigeria is about 151,700 to 175,000 annually. Majority of the illnesses and deaths from diarrhoea occur in low- and middle-income countries, especially in rural areas. The vicious cycle of poverty, ignorance and disease (malnutrition and infections) are interlinked with socio-environmental factors, such as lack of access to clean water, poor sanitation, sub-optimal feeding practices and inadequate hand-washing that can result in diarrhoeal diseases. Other factors, such as inadequate breastfeeding, zinc deficiency and poor health care access, are other contributors to the disease burden, especially among children under five.
Why are children particularly vulnerable to this disease, compared to other demographics?
Diarrhoeal disease is reported to be the second leading cause of deaths among children under the age of five years, after acute respiratory infections, particularly pneumonia. Underlying malnutrition in children makes them more vulnerable to diarrhoea by altering the body protective factors and promoting the invasion of intestinal tissues by the organisms. In turn, severe diarrhoea also contributes to malnutrition, both feeding off each other in a vicious cycle with short- and long-term consequences. Overall, children with poor nutritional and health status, as well as those exposed to poor environmental conditions, are more susceptible to severe diarrhoea and dehydration than healthy children.
Children are also at greater risk than adults of severe dehydration since water constitutes a greater proportion of children’s bodyweight. Young children use more water over the course of a day given their higher metabolism; their bodies are less able to conserve water compared to older children and adults. To take a step back, it will be important to also consider the causes of childhood malnutrition, which, according to the United Nations Children’s Fund, can be categorised into three main underlying factors: household food insecurity; inadequate care and unhealthy household environment; and lack of health care services.
Is any other demographic vulnerable to it, especially in Nigeria?
The elderly are vulnerable as well and some conditions increase vulnerability such as immunosuppressed states like HIV/AIDS, cancer and cancer chemotherapy; and also among travellers.
What are the symptoms of diarrhoeal disease?
The symptoms include frequent loose, watery stools, abdominal cramps, abdominal pain, fever, blood in stool, light-headedness or dizziness from dehydration. These symptoms may be associated with fever, vomiting and abdominal pain in some disease conditions.
Is it in any way contagious?
Yes, particularly diarrhoea caused by viruses. They are highly contagious and the duration during which a sick person can give the illness to others differs with each virus and in some cases, persons may remain contagious up to two weeks after their own recovery. The viruses that cause diarrhoea in the stool are spread through close contact with infected people, such as by sharing food or eating utensils, and by touching contaminated hands, surfaces and objects. This contamination occurs through the faecal-oral route.
Dietary requirements are not often a consideration in low-income households, especially in Nigeria. How much of a role do diet and nutrition play in diarrhoeal disease?
Diet has a great role in prevention by ensuring healthy and adequate diet to prevent malnutrition. Babies six months and below should be exclusively breastfed (no water or other food included) from birth. Breastfeeding should continue until 18 to 24 months. Complementary foods for weaning after six months of age should be appropriate, adequate, balanced and hygienically prepared. Local available foods can be used to prepare balanced diet for children at minimal cost even for low-income households. Food demonstration clinics for mothers are usually available in primary health care centres.
If mild diarrhoea occurs, diet still plays a significant role such as sipping on clear liquids, preparation of oral rehydration solution (most of the drinking should be between and not during meals). Consuming high potassium foods and liquids, such as diluted non-sugary fruit juices, potatoes and bananas. Eating foods high in soluble fibre such as banana, oatmeal, and rice helps thicken the stool. Foods to be avoided include fried foods, dairy products, sugary foods, as well as caffeinated drinks.
How can the disease be differentiated from cholera, dysentery, and the like?
These are both examples of diarrhoea diseases but they have different causative agents. The diarrhoea in cholera is very watery stool (described as rice-water) with no blood, while dysentery is presented as a mucoid stool that may be accompanied by blood.
How does one prevent it?
Diarrhoeal diseases can be prevented by promoting exclusive breastfeeding, hygienic weaning practices, safe drinking water and hand-washing, improved host defences by breastfeeding, improved nutrition, Vitamin A supplementation, measles vaccine and other vaccines against intestinal pathogens and promotion of standard case management with special emphasis on nutritional support and rehabilitation.
How should one treat diarrhoeal disease?
Diarrhoea often resolves without medical treatment, especially in adults, but it is important to seek medical help when there is persistent vomiting, persistent stooling, dehydration, pus in the stool or blood in the stool. Replacement fluids and electrolytes, symptomatic treatment and other therapies are often used for treatment, depending on the cause of the diarrhoea. Children are not able to sustain significant fluid loss and should see a doctor as soon as possible or if diarrhoea is accompanied with vomiting.
Are there any known after-effects of diarrhoeal disease or its treatment?
The main after-effect of diarrhoea is fluid loss, including salts and minerals, such as sodium, chloride, and potassium. These salts and minerals affect the amount of water that stays in the body. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.
How would you rate the level of awareness in the country to diarrhoeal disease?
Considering the high prevalence of childhood diarrhoea and deaths that result from it, there’s need for increased awareness, especially among low-income families living in poor housing conditions. Research has shown that lower levels of maternal education and household income status are significantly associated with childhood diarrhoea. To minimise the magnitude of childhood diarrhoea, implementing various prevention strategies, such as health education, child care, personal hygiene, and household sanitation should be intensified at the existing community health programmes at the primary health care centres and in the local government areas.
Would you say the COVID-19 pandemic has impacted on the infection rate from diarrhoeal disease?
In general, COVID-19 has led to the disruption of the health system and the rendering of health services. This coupled with the imposition of restricted movement could see a substantial increase in child deaths from childhood illnesses such as diarrhoea. It has also affected preventive services, such as immunisation and other health promotion activities that are crucial to child survival. However, this impact will also be seen in various other health conditions and more among those living in the poorest neighbourhoods who have barriers to accessing health care. Diarrhoea is also an early symptom of COVID-19 that requires treatment, depending on the severity.