Diarrhoeal disease, a major cause of death among children

Take safe drinking water, wash hands with soap and clean water before and after using toilets. Net photo

According to World Health Organization (WHO), diarrhoeal disease is the second leading cause of death in children under five years of age. Every year, diarrhoea kills around 525,000 children under five.

“Worldwide, there are approximately 1.7 billion cases of childhood diarrhoeal disease, every year. Diarrhoea can last several days, and can leave the body without water and salts that are necessary for survival.

“Diarrhoea is a leading cause of malnutrition in children under five years old. In the past, for most people, severe dehydration and fluid loss were the main causes of diarrhoea deaths. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths. Children who are malnourished or have impaired immunity as well as people living with HIV, are most at risk of life-threatening diarrhoea,” WHO states.

According to The United Nations Children’s Fund-UNICEF data, diarrhoea remains a leading killer of young children, in spite of the availability of a simple treatment solution. Diarrhoea accounted for approximately eight per cent of all deaths among children under age five worldwide, in 2017. This interprets to over 1,300 young children dying each day, or about 480,000 children a year, regardless of the availability of simple effective treatment.

From 2000 to 2017, the total annual number of deaths from diarrhoea among children under five decreased by 60 per cent. Many more children could be saved through basic interventions.

For Emmy Ntamanga, a Kigali-based nutrition consultant, diarrheal diseases are caused by host bacterial, viral and parasitic organisms known as escherichia coli and rotavirus, which spread through faeces, contaminated water or person-to-person. This is due to poor hygiene and sanitation. Other causes could be through consuming fish and seafood from polluted water, or contaminated food, among others.

WHO also notes that diarrhoea is the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose “pasty” stools by breastfed babies.

Ntamanga says that people at risk are children under five years old, the elderly, malnourished children and HIV positive people. The elderly can’t afford to lose much fluid, either, but that’s because their circulatory system has changed with ageing. Fluid loss can reduce the body’s ability to circulate blood, raising the risk of stroke, heart attack or kidney failure.

WHO states that a momentous percentage of the diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. It is both preventable and treatable.

Ntamanga explains, diarrhoea kills because it leaves the body dehydrated due to fluid loss and the bacteria affects the intestinal tract or digestive tract.

He says, diarrhoea is usually short-lived, as it can last not more than a few days. But, when it persists for weeks, it usually suggests a problem. There might be a condition such as irritable bowel disorder, or a more serious disorder, such as a persistent infection or inflammatory bowel disease.

When a person notices such signs and symptoms like, loose, watery stools, stomach cramps, abdominal pain, fever, blood in the stool, mucus in the stool, bloating, or nausea, it is evident enough that they have a diarrhoeal disease.


“Nutrient-rich food composed of breast milk as well as feeding on a balanced diet, all with good hygiene and sanitation, are recommended. However, always see a health professional for early management,” Ntamanga states.

He urges everyone to take safe drinking water, wash hands with soap and clean water before and after using toilets, and keep proper hygiene and sanitation but also, use the ORS (Oral Rehydration Solution, a solution of clean water, sugar and salt, zinc supplements).

UNICEF notes that adequate complementary feeding and continued breastfeeding or good nutrition support strong immune systems and provides protection from disease. From six months to two years of age, adequate complementary feeding and providing children with adequate quantities of safe, nutritious and age-appropriate foods alongside continued breastfeeding can reduce child deaths, including those due to pneumonia and diarrhoea.

“Exclusive breastfeeding, for the first six months of life, exclusive breastfeeding (without additional foods or liquids, including water) protects infants from disease and guarantees them a food source that is safe, clean, accessible and perfectly tailored to their needs,” states UNICEF.

UNICEF data, also shows that the availability and accessibility of these treatments to all children, especially those in poor, rural and marginalised populations, could save the lives of hundreds of thousands additional children each year. These interventions have proved cost-effective, affordable and relatively straightforward to implement. However, worldwide, just 44 per cent of children under age five with diarrhoea receive the recommended treatment of oral rehydration solution, which represents only a marginal increase from 2000.

Ntamanga says, you should see a doctor if your diarrhoea persists beyond a few days, become dehydrated, have severe abdominal or rectal pain, have bloody or black stools or have a fever above 102 F (39 C), that’s if you are an adult.

According to Healthline, call your child’s doctor or seek emergency care if you see symptoms of dehydration, such as; decreased urination, dry mouth, headache, fatigue, lack of tears when crying, dry skin, sunken eyes, sunken fontanel, sleepiness, irritability.

“If the toddler has diarrhoea for 24 hours or more, a fever of 102°F (39°C) or higher, have stools that contain blood or stools that contain pus, or stools that are black and tarry, seek immediate treatment,” suggests Healthline.


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