According to the World Health Organization, diarrhoea is the second leading cause of death in children under five years old. Worldwide, children under 5 experience up to 3 episodes a year with some children having an average of up to 9 episodes of diarrhoea every year. The main cause of death from diarrhoea is dehydration resulting from loss of water and electrolytes and septic bacterial infections. Diarrhoeal diseases are preventable and treatable. A great proportion of diarrhoeal diseases can be prevented by ensuring clean and safe water for drinking, adequate sanitation, hand washing with soap and proper hygiene. Also, vaccination against Rota virus, a common cause of diarrhoea helps prevent diarrhoeal episodes.
Diarrhoea is the passage of three or more loose or liquid stools per day. The frequent passage of formed stool is not diarrhoea.
Certain practices increase the risk of diarrhoea:
Failing to breastfeed exclusively for the first 6mths of life: Breast milk has been found to contain all the necessary nutrients the child needs for the first few months of life and also a host of immune molecules that protect the child from common childhood illnesses like diarrhoea and pneumonia.
Use of infant feeding bottles: The use of feeding bottles has been associated with a higher risk of diarrhoea illnesses as improper cleaning and non-sterilization of bottle teats enhances the proliferation of bacteria and disease causing organisms.
Storing cooked food at room temperature: Most germs grow faster at room temperature so keep hot foods hot and cold foods cold (in the refrigerator). If serving later, refrigerate and reheat when ready.
Improper disposal of faecal matter: Having a toilet at home that can be flushed with water and ensuring everyone uses it is the best way to dispose of the faecal matter. If you don’t have a toilet or latrine in your home, ensure that where faeces are disposed are away from the home, walk ways, sources of water and places where children play and are properly covered with mud.
Diarrhoea can be treated at home but not all diarrhoea should be treated at home. The biggest risk in diarrhoea is dehydration and electrolyte imbalance and so it is important to assess the child with diarrhoea for dehydration.
Key areas to assess
The general condition of the child: is the child well and alert?
The eyes: do they appear normal?
Tears: does this child cry with tears and are the eyes wet?
Mouth and tongue: are they moist?
Thirst: does the child drink normally and is the child thirsty?
If the answer to all the questions above is yes, the child is unlikely to be dehydrated.
Next, pinch the skin; does it go back quickly? It should If there are no signs of dehydration.
Basic things to do
• Give the child more fluids than usual to prevent dehydration. Avoid sweetened drinks like soft drinks and commercial fruit drinks as they can worsen dehydration. Water prevents dehydration but doesn’t handle the electrolyte derangement. Commercially available ORS powders should be used as instructed as over diluting or under diluting can worsen child’s condition. In the absence of ORS, salt sugar solution (SSS) can be made.
Simply put 1 level teaspoon of salt and 10 level teaspoons of sugar into a bottle of 600ml of clean water. 600mls of water is 1 beer bottle or 2 soft drink bottles. It should taste slightly salty and slightly sweet. Give as much fluids as the child can take after each loose stool. ORS does not stop diarrhoea, it usually should resolve on its own. ORS just helps to prevent dehydration.
• Give the child plenty of nutritious food to prevent malnutrition, preferably every 3-4hours. If still breastfeeding, continue.
• Take the child to a health facility immediately if diarrhoea doesn’t get better or if there is repeated vomiting, Increased thirst, failure to eat or drink normally, fever, blood in the stool.
Do not self-medicate and give anti-diarrheal drugs or antibiotics to the child.
You can prevent diarrhoea by:
- Giving breast milk for the first 4-6months and continuing to breastfeed till at least 1year.
- Giving milk by cup and spoon instead of a feeding bottle
- Washing hands after passing stool and before preparing food.
- Having your child immunised as at when due especially to measles and rota virus.
No child should die from diarrhoea, ensure good hygiene, stay alert and act fast.
