Focus on Diarrhoea, Dehydration and Rehydration.

During diarrhoea, the body loses water and electrolytes in the form of liquid stool. Fluids can also be lost through vomit, sweat, urine and breathing. Dehydration occurs when these losses are not adequately replaced. Diarrhoea may result in a decrease in food intake or nutrient absorption and an increase in nutrient requirements which often combine to cause weight loss and retarded growth. When a child's nutritional status declines, any pre-existing malnutrition becomes worse. In turn, a child with malnutrition can experience diarrhoea that is more severe, more prolonged and more frequent than a non-malnourished child.

Diarrhoea may present in different forms such as acute watery diarrhoea, dysentery (blood in stool), or persistent diarrhoea (more than 14 days). Antibiotics should not be used routinely. They are reliably helpful only for children with blood in the diarrhoea (probable shigellosis) and other serious non-intestinal infections such as pneumonia. Anti-diarrhoeal drugs and anti-emetics should not be given to young children with either acute or persistent diarrhoea since they do not prevent dehydration or improve nutritional status, and some have dangerous side-effect.

Diarrhoea causes dehydration. Children are more likely than adults to die from diarrhoea because they become dehydrated more quickly. Diarrhoea is also a major cause of child malnutrition.

The main causes of diarrhoea are poor hygiene, lack of clean drinking water, overcrowding, and the trend towards bottle-feeding rather than breastfeeding. Infants who are fed only breastmilk seldom get diarrhoea.

Diarrhoea can be prevented by breastfeeding, by immunizing all children against measles, by using latrines, by keeping food and water clean, and by washing hands before touching food.

Thousands of deaths could be averted through interventions such as Oral Rehydration Therapy, appropriate drug therapy, optimal breastfeeding practices, improved nutrition, increased access to clean water and sanitation facilities and improved personal and domestic hygiene. If families and communities work together, with support from governments and non-governmental organizations (NGOs), they can do much to prevent the conditions that cause diarrhoea.


What is Diarrhoea?

Diarrhoea is an intestinal disorder characterized by abnormal fluidity and frequency of fecal evacuations, generally the result of increased motility in the colon; may be an important symptom of such underlying disorders as dysenteric diseases, lactose intolerance, GI tumors, and inflammatory bowel disease.

Diarrhoea is the passage of watery stools, usually at least three times in a 24 hour period. However, it is the consistency of the stools rather than the number that is most important. Frequent passing of formed stools is not diarrhoea. Babies fed only breastmilk often pass loose, "pasty" stools; this also is not diarrhoea. Mothers usually know when their children have diarrhoea and may provide useful working definitions in local situations.


Clinical types of diarrhoeal diseases

It is most practical to base treatment of diarrhoea on the clinical type of the illness, which can easily be determined when a child is first examined. Laboratory studies are not needed. Four clinical types of diarrhoea can be recognized, each reflecting the basic underlying pathology and altered physiology:

* acute watery diarrhoea (including cholera) which lasts several hours or days:
the main danger is dehydration; weight loss also occurs if feeding is not continued;

* acute bloody diarrhoea (also called dysentery):
the main dangers are intestinal damage, sepsis and malnutrition; other complications, including dehydration, may also occur;

* persistent diarrhoea (which lasts 14 days or longer):
the main danger is malnutrition and serious non-intestinal infection; dehydration may also occur;

* diarrhoea with severe malnutrition (marasmus or kwashiorkor);
the main dangers are: severe systemic infection, dehydration, heart failure and vitamin and mineral deficiency.

The management of each type of diarrhoea should prevent or treat the main danger(s) that each presents.



Why is diarrhoea dangerous?

Diarrhoea causes rapid depletion of water and sodium - both of which are necessary for life. If the water and salts are not replaced fast, the body starts to "dry up" or get dehydrated. If more than 10% of the body's fluid is lost death occurs.

Severe dehydration can cause death.

Despite many advances, diarrhoeal diseases and the resulting dehydration are responsible for about 2.2 million child deaths every year. Of these, approximately

*

50% are due to watery diarrhoea and occur
- either because of lack of access to ORS and/or health facilities,
- or because of incorrect case management (home or health facility).

*

The remainder are accounted for by persistent diarrhoea (approximately 35%) and dysentery (approximately 15%).

Diarrhoea is caused by bacteria or viruses. Children who are malnourished suffer much more; in turn, diarrhoea weakens children and makes them more malnourished. Diarrhoea is also a major cause of child malnutrition.


How can diarrhoea be prevented?

Diarrhoea can be prevented by pursuing multisectoral efforts by:

* improving access to clean water and safe sanitation
* promoting hygiene education
* exclusive breast-feeding
* improved weaning practices
* immunizing all children; especially against measles
* using latrines
* keeping food and water clean
* washing hands with soap (the baby's as well) before touching food
* and by sanitary disposal of stools.

The above is most important message that can help parents governments and communities to prevent almost all of these deaths and most of the malnutrition caused by diarrhoea.

The key factors are unclean water, dirty hands at mealtime and spoilt food.


65% of all child deaths are from these 3 causes:

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Acute Respiratory tract Infections now kills 3.6 million children each year.
*

Diarrhoeal diseases are responsible for about 2.2 million child deaths every year.
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Immunisation preventable diseases: measles, tuberculosis, tetanus, diphtheria, polio, and pertussis are responsible for some 2.1 million child deaths every year. Of these, almost 1 million are attributed to measles.

The common thread that links these infectious diseases is the nutrition of the mother and child. Malnutrition predisposes children to disease, and diseases often result in worse nutritional status, and consequently a vicious cycle of cause and effect is established.

The main causes of diarrhoea are poor personal and food hygiene and lack of clean drinking water. It is the responsibility of government to support the community in tackling these basic problems.