ACCORDING to the World Health Organisation, “diarrhoeal disease is the second leading cause of death in children under five years of age”.

Annually, around 525 000 children under five-years-old succumb to the disease. Diarrhoea is also the leading cause of malnutrition in this age category.

Diarrhoea is defined as the passage of three or more watery stools per day. The disease is usually a symptom of an infection in the gastro-intestinal system. Bacterial, viral and parasitic organisms often cause infection.

Usually, it is spread from one person to another or from contaminated food or drinking water.

Across the world, 1,7 billion children under the age of five are affected by diarrhoeal diseases, with one in ten children succumbing to the disease.

The common symptoms for diarrhoeal disease are acute watery, persistent and bloody diarrhoea.

Acute watery diarrhoea is associated with dramatic dehydration and stool losses of approximately 250 millilitres per kilogramme per day or more.

Such dramatic dehydration is usually due to rotavirus, E. coli, or vibrio cholerae.

Clinically, the bodily fluid loss quickly exceeds total plasma and interstitial fluid volumes.

And unless fluid therapy is initiated, fatalities are inevitable.

Persistent diarrhoea is typically associated with malnutrition, either preceding or resulting from the illness itself.

Though persistent diarrhoea has a small percentage of the total number of diarrhoea episodes, it is disproportionately associated with increased risk of death.

In a 1993 study in Pakistan, persistent diarrhoea accounted for 8 to 18 percent of episodes and 54 percent of deaths.

More often, persistent diarrhoea occurs during an episode of bloody diarrhoea than an episode of watery diarrhoea.

The mortality rates when bloody diarrhoea progresses to persistent diarrhoea are 10 times greater than bloody diarrhoea without persistent diarrhoea.

Some health experts believe that “HIV is another risk factor for persistent diarrhoea in both adults and children”.

Crucially, medical and nursing interventions are designed to proportionally address nutritional imbalances caused by persistent diarrhoea.

Bloody diarrhoea is defined as watery stool with visible or microscopic blood.

The diarrhoea is usually associated with intestinal damage and nutritional deterioration.

More often, bloody diarrhoea is usually mistaken for dysentery.

But dysentery is a type of intestinal inflammation that results in diarrhoea with blood.

Simultaneously, organisms that cause bloody diarrhoea or dysentery can also provoke another form of diarrhoea that is not bloody diarrhoea.

Bloody diarrhoea requires management strategies that are markedly different from those of watery and persistent diarrhoea.

On the face of it, diarrhoea defies demographic factors.

It affects the young and old, the rich and poor, and developed and developing countries alike.

Apparently, poverty and diarrhoeal disease have a strong relationship.

Diarrhoea spread is often fuelled by poor housing, unhygienic conditions, lack of sufficient clean water and poor sanitation.

In 2006, an estimated 2,5 billion people were lacking improved sanitation facilities.

One-in-four people practiced open defecation methods (WHO).

Subsequently, poverty restricts the sufficient provision of balanced diets.

It also hampers efforts to modify diets when diarrhoea develops.

Lack of adequate, affordable and available healthcare services typically compounds the already dire situation.

Sadly, the young rarely receive appropriate preventive care.

As a result, children suffer from the never-ending sequence of infections.

More often than not, children are likely to receive medical attention when they are already severely ill.

Fortunately, diarrhoeal diseases are treatable with simple and cost-effective interventions. Antibiotics and intravenous fluids are particularly used in treating severe cases of diarrhoea.

More so, diarrhoeal disease can be minimised by cautiously avoiding coming in contact with infectious agents that cause it.

These include drinking safe water, even for tooth brushing, avoiding eating food from food vendors and eating only those fruits or vegetables that are cooked or can be peeled.

Equally, all foods must be thoroughly cooked and served steaming hot. Never eat raw or under cooked meat or seafood.

In addressing the deadly “child-killer” disease, the WHO (2004) recommended a combination of both low-osmolarity oral rehydration solution (ORS) and zinc.

ORS is a special combination of dry salts that is mixed with safe water.

It helps replace fluids lost due to diarrhoea and can be readily prepared at home.

In this rich vein, care-givers should be counselled to begin suitable home-prepared re-hydration fluids immediately on the onset of diarrhoea.

Early treatment of mild to moderate dehydration with ORS reserves intravenous electrolytes for severe cases.

Pharmacologically, zinc treatment reduces the duration and frequency of each illness episode. Zinc reduces childhood diarrhoea and is very important for normal growth and development.

The ORS-zinc treatment should be combined with continued feeding of the child, increasing fluid intake and breastfeeding.

Breast milk provides all the necessary nutrients required for child development and immunity.

Of note, Africa has progressively witnessed improved exclusive breastfeeding rates among infants in the first six months of life.

However, only 37 percent of infants in developing countries are exclusively breastfed for the first six months of life.

Continuing breastfeeding and complimentary foods during diarrhoea must be encouraged to prevent diarrhoeal deaths.

Henceforth, Governments and major stakeholders must scale up diarrhoea prevention, treatment and promote exclusive breastfeeding for the first six months of life.

On the other hand, improving safe water supplies, sanitation and hygiene – WASH – interventions such as hand washing with soap will go a long way in easing the diarrhoea burden.

Essentially, increased attention on child health in general, and on diarrhoeal disease will possibly promote the fight against the deadly “child-killer” disease.

As we battle diarrhoeal diseases, let us protect our children by religiously following the prescribed hand washing and hygiene protocols.

Everisto Mapfidze is a registered general nurse who holds a Bsc Honours in Sociology (UZ). For feedback: [email protected]