Last year, there was an outbreak of diarrhoea cases amongst children which affected most parts of the country. The Okavango region was also one of the regions which were affected with more than 10 children reported to have lost their lives. Current trends in the local hospitals in Maun show that there is an upsurge of cases of diarrhoea in children. Though the number of cases is not as severe as last year, I have decided to use this opportunity to remind ourselves about diarrhoea in children and how to manage it.
Diarrhoeal disease is the second leading cause of death in children under five years old. Each year diarrhoea kills around 525 000 children under five in the world. WHO defines a case of diarrhoea as the passage of three or more loose or liquid stools per day, or more frequently 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.
There are certain factors that can predispose children to having diarrhoeal illness. These include weak immune system which can be due to conditions such as HIV or Cancers, unvaccinated children and poor nutritional status. Environmental factors such as poor sanitation, lack of access to clean drinking water, poor hygiene and sanitation are also predisposing factors to having diarrhoeal illness.
The causes of diarrhoea can be divided into infectious and non-infectious causes. In developing countries, most of the causes of diarrhoea are bacteria such as salmonella, shigella, campylobacter and E. coli. Common viruses that cause diarrhoea include rotavirus and norovirus. In a few of the cases diarrhoea may be caused by protozoa such as giardia or cryptosporidium. It is worth noting that some cases may be due to mixed causes while in some the cause is not identified. Non-Infectious diarrhoea can be caused by malabsorption, anatomical defects, or inflammatory bowel disease.
Acute diarrhoea usually lasts hours to days. If it lasts for more than 14 days, it’s termed persistent diarrhoea. The most worrisome complication of diarrhoea is dehydration, which is due to loss of fluids and salts in the body. Clinical features of dehydration are dependent on the severity. Children with mild dehydration may have restlessness, irritability, sunken eyes and an eagerness to drink. Severe Dehydration on the other hand is shown by lethargy, sunken eyes, skin pinch that goes back very slowly and being unable to drink.
Strategies to prevent diarrhoea includes mitigation of risk factors mentioned above. These measures include drinking safe water. Water can be boiled and cooled before drinking. Improving sanitation and environmental health also leads to a decrease in cases of diarrhoea. Regular hand washing with soap and water is another important intervention, particularly when they were in contact with persons with diarrhoea.
Children should be immunized with the rotavirus vaccine those that are HIV infected or exposed should also receive vitamin A supplementation.
When diarrhoea has developed it is important to replenish fluids using oral rehydration solution when the child can drink. Children that show signs of dehydration and are unable to drink should see a healthcare professional as soon as possible.
