A SEMINAR PRESENTATION
ON
CURRENT GLOBAL BURDEN OF DIARRHOEA
AMONG CHILDREN
MATRIC NUMBER:AUPG/13/0212
DEPARTMENT OF MICROBIOLOGY.
BY
OYEBODE, GANIYAT OLAWUNMI
FACULTY OF SCIENCE,
ADELEKE UNIVERSITY, EDE
JULY, 2021
OUTLINE
INTRODUCTION
MEANING OF DIARRHOEA
CASUSES
SYMPTOMS OF DIARRHEA
ESTIMATE OF DISEASE BURDEN OF DIARRHEA IN CHILDREN
INTERVENTIONS FOR DIARRHOEAL DISEASE
CONCLUSION
SELECTED REFERENCES
INTRODUCTION
Diarrhoea is one of the principal causes of morbidity and mortality among
children in the developing world. In 1982, on the basis of a review of active
surveillance data from studies conducted in the 1950s, 1960s and 1970s, it was
estimated that 4.6 million children died annually from diarrhoea. In 1992, a
review of studies conducted in the 1980s suggested that diarrhoeal mortality had
declined to approximately 3.3 million annually. Both reviews estimated that
children in the developing world experienced a median of between two and three
episodes of diarrhoea every year. Neither review included data from China.
However, an analysis conducted in 2000 by Murray et al. estimates that diarrhoea
accounts for only 13% of all childhood deaths, amounting to 1.4 million deaths
per year. These figures were based on information from national vital registration
systems, sample registration systems, population laboratories, and
epidemiological studies.
DIARRHOEA
• Diarrhoea is when your bowel movements become loose or watery. The
definition of diarrhoea is passing loose or watery bowel movements 3 or
more times in a day (or more frequently than usual).
• Diarrhoea occurs when the lining of the intestine is unable to absorb fluid,
or it actively secretes fluid. There are many causes, including infection and
inflammation.
• Many cases of diarrhoea are self-limiting and don’t need specific treatment.
However, it’s important in any case of diarrhoea to stay hydrated by
drinking plenty of liquids.
CAUSES
Diarrhoea may have many different causes including the following:
• Infection (with a virus, bacteria or parasite). Infectious diarrhoea is most commonly caused by viruses passed
from person to person, or by eating or drinking food or water contaminated with viruses, bacteria – such
as Salmonella, or a parasite – such as Cryptosporidium.
• A change in diet:
Food intolerance (e.g. lactose intolerance). Some people have diarrhoea after eating foods containing fructose (a
type of sugar) or artificial sweeteners such as sorbitol and mannitol.
• Drinking excess alcohol:
• Bowel conditions such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease), coeliac
disease or irritable bowel syndrome (IBS).
• Malabsorption (e.g. due to problems with the pancreas).
• Surgery (e.g. when part of the bowel has been removed).
• Some medicines can cause diarrhoea as a side effect. Antibiotics are a common example. They can disrupt the
balance of bacteria in your gut, which can lead to diarrhoea. Other examples of medicines that can cause
diarrhoea include some antacids and diabetes tablets.
• Diarrhoea in very young children is often caused by viral infections. Rotavirus infections were a common cause,
but this risk is reduced by the rotavirus vaccine, which can prevent gastroenteritis (or reduce the risk of severe
gastroenteritis) caused by rotavirus infection. Many other viruses still commonly cause diarrhoea in infants and
toddlers.
SYMPTOMS OF DIARRHOEA
In addition to frequent, watery bowel movements, the stool may also contain
mucus, pus, blood or excessive amounts of fat. Diarrhoea can be accompanied by:
• painful abdominal cramps, nausea, fever, bloating, and generalised weakness.
• Diarrhoea can cause dehydration, especially in young children and older people.
Symptoms of dehydration in adults can include: thirst, lack of energy, passing
less urine than normal, dizziness or light-headedness and the skin on the back of
your hand being slow to return to position after being pinched upwards.
• Symptoms of mild to moderate dehydration in children can include: dry mouth,
passing less urine than usual (often noticed as fewer wet nappies in babies and
toddlers), irritability, listlessness and less tears when crying.
• Signs of severe dehydration in children include sunken eyes, cheeks or belly, or a
sunken fontanelle (the soft spot on the top of the head in babies and toddlers).
• People with diarrhoea, especially the very young and the very elderly, are at risk
of becoming rapidly dehydrated. This requires immediate medical attention.
ESTIMATE OF DISEASE BURDEN OF DIARRHEA IN CHILDREN
One in 12 of the children born in 2001 have died or will die before their fifth
birthday. This represents an annual total of 10.8 million childhood deaths,
about 70% of which occur in infancy. Child mortality has declined from an
estimated 15 million deaths in 1980, but eminently preventable and treatable
conditions, such as pneumonia, diarrhoea, malaria, measles, and malnutrition,
are still leading killers of children. Aggressive efforts to reduce child mortality
must continue. Hard data on the cause-specific disease burden will assist in
planning interventions and measuring their impact.
Cont.
It is well known that diarrhoeal disease is one of the leading causes of
illness and death in young children in developing countries.
Kosek et al. have recently made a further update by reviewing 60 studies
of diarrhoea morbidity and mortality published from 1990 to 2000. They
conclude that diarrhoea accounts for 21% of all deaths at under five years
of age and causes 2.5 million deaths per year, although diarrhoea
morbidity remains relatively unchanged.
Cont.
Despite the different methods and sources of information, each successive
review of the diarrhoea burden over the past three decades has
demonstrated declining mortality but relatively stable morbidity. The
decline in global diarrhoea mortality is confirmed by detailed information
from monitoring in certain countries over time. Increased use of oral
rehydration therapy, improved nutrition, increased breastfeeding, better
supplemental feeding, female education, measles immunization, and
improvements in hygiene and sanitation are believed to have contributed to
this decline.
Cont.
Although few would disagree that there has been a decline in diarrhoea
mortality, the wide range in current figures reflects the inherent uncertainty of
these estimates. Earlier studies do not reflect the current situation and, in
addition, cause of death was often ascertained by verbal autopsies, which have
variable sensitivity and specificity. The WHO estimates were based on more
recent vital registration data, but only countries from Latin America had
registration coverage reaching 28%. Substantial extrapolation and modelling
were needed to produce estimates for regions such as sub-Saharan Africa,
with its estimated coverage of 0.4%.
Initially, cause-specific disease burden data were used for advocating broad-
based health programmes to the donor community, and relatively crude
estimates were adequate for this purpose. Now such data are increasingly used
to prioritize disease-specific intervention programmes and allocate limited
resources.
INTERVENTIONS FOR DIARRHOEAL DISEASE
Most interventions for diarrhoeal disease, e.g. increased breastfeeding,
better weaning practices, improved sanitation and higher rates of
measles immunization, would be expected to affect mortality and
morbidity simultaneously. The use of oral rehydration therapy is an
exception, its increased use over the past two decades probably having
been responsible for some of the decrease in case-fatality rates,
especially from acute dehydrating diarrhea.
The interaction between malnutrition and diarrhoeal disease is bi-
directional. Increases in immunization coverage, better health care
access, improvements in water and sanitation, and other
socioeconomic changes affect both diarrhoeal mortality and childhood
nutrition. Recent trends in mortality from diarrhoea and the prevalence
of malnutrition should be interpreted in the light of these complex
relationships.
CONCLUSION
The current childhood mortality burden highlights the need of a
focused global diarrhea action plan. Proper packaging of
interventions and delivery platforms is required to reduced the
burden of childhood diarrhea to a greater extent. All that is
required is greater attention and steps toward right direction.
SELECTED REFERENCES
Kosek M et al. 2003
Lima AM et al. 2000
Mirza NM, 2000
Murray CJL et al. 2001
Newman RD, 1999
Victora CG et al. 2000
THANK
YOU
