Millennium Post

Last giant children killer standing

Seasons bring their own joy and fun; and misery and agony, too. Rains add the much-craved for delight after the blistering heat of summer, but affect human health forcing many, especially young children, to visit the doctor. Water-borne and gastrointestinal diseases ruin the gaiety of monsoons.

Meteorological variations pose a serious problem to public health.  As germs and bacteria breed in large numbers during monsoon, food and water get contaminated easily, leading to water-borne diseases. Monsoon rains put children at high risk of diarrhoea. Over a few decades, diarrhoea patients have been increasing. Such cases surge in the years of El Nino and Southern Oscillation, research shows.

Diarrhoea is a common symptom of gastrointestinal infections caused by a wide range of pathogens (anything that causes a disease), including bacteria, viruses and protozoa (single-celled micro-organisms). However, just a handful of organisms are responsible for the most acute cases of childhood diarrhoea. The leading cause of acute diarrhoea is the rotavirus; a contagious virus responsible for about 40 per cent of all hospital admissions among children under five, worldwide. Other major bacterial pathogens include E. coli, Shigella, Campylobacter and Salmonella
Distinct seasonal patterns of diarrhoea occur in many geographical areas, according to the WHO.

In temperate climates, bacterial diarrhoea occur more frequently during the warm season, whereas viral diarrhoea, particularly caused by rotavirus, peak during the winter. In tropical area, rotavirus diarrhoea occurs throughout the year, increasing in frequency during the drier, cool months, whereas bacterial diarrhoea peaks during the warmer, rainy season. The incidence of persistent diarrhoea follows the same seasonal patterns as that of acute watery diarrhea.

Complex emergencies arise when rains play havoc and displace populations, forcing them to huddle in temporary, overcrowded shelters; these are often associated with polluted water sources, inadequate sanitation, poor hygiene practices, contaminated food and malnutrition. These unsanitary environments allow diarrhoea-causing pathogens to spread more easily, affecting mostly children. At the same time, lack of adequate health services and transport reduces the likelihood of prompt and appropriate treatment of diarrhoea cases. 

Diarrhoea is more common when there is a shortage of clean water for drinking, cooking and cleaning.  Water contaminated with human faeces from municipal sewage, septic tanks and latrines as well as animal faeces also contain microorganisms that can bring on the disease. It can extend from person to person, aggravated by poor personal hygiene. Another major cause is food, when prepared or stored in unhygienic conditions. Water can contaminate food during irrigation, and fish and seafood from polluted water may also contribute to the disease.

Diarrhoea causes rapid depletion of water and sodium -- essential for life. If the water and salts are not replaced fast, the body starts to ‘dry up’ or get dehydrated. If more than 10 per cent of the body’s fluid is lost, death occurs. Despite many advances, diarrhoeal diseases and the resulting dehydration are responsible for about 800,000 under-five child deaths globally every year — next only to the leading killer pneumonia. India accounts for the highest--nearly 2,00,000 (24 per cent) of all under-five deaths, according to the UNICEF.

An international study, the largest and most comprehensive of study of diarrhoeal diseases, by the Global Enteric Multicenter Study (GEMS) published last year in the Lancet journal found that rotavirus is the major cause of moderate to severe diarrhoea in India. Of the 4,50,000 children deaths every year worldwide, nearly 1,00,000 occur in India — the worst affected.

Early this week, the government launched a nationwide ‘Intensified Diarrhoea Control Fortnight’ (IDCF). Though a step in the right direction, the move has come at a very late stage; for the Millennium Development Goals (MDG) call for reducing child mortality by two-thirds between 1990 and 2015. With not even a year left for the deadline, it is almost impossible to achieve the target, despite progress being made.

The disease can be prevented and treated. Measures include enhancing advocacy, stepping up awareness generation, establishing more ORS-zinc corners, distributing oral rehydration solution (ORS) packets to families with children as well as detecting children in need of treatment. Diarrhoea can be prevented by breastfeeding, by immunising all children against measles, by using sanitary latrines, by keeping food and water clean and by washing hands before touching food.

Vaccines, including the indigenous Rotavac against rotavirus, alone cannot prevent or treat the disease. Deaths could be reduced by making readily available or delivering life-saving treatment of oral rehydration salts (ORS) and zinc tablets to all children in need. ‘Knowledge regarding ORS has shown a positive trend but the use rates have been consistently poor. Provider’s knowledge of ORS is universal but this again does not translate commonly into practice,’ says a team of doctors led by Dr Dheeraj Shah, Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi, in a paper published in Indian Pediatrics.

Public health systems do not reach every child. Hence, prevention and treatment should include improving water, sanitation and hygiene, which are pathetic across the country. Handwashing with soap alone could potentially reduce the number of diarrhoea cases by over 40 per cent. An ongoing awareness campaign along with improvement is sanitation facilities is certainly the need of the hour.

An easily preventable and treatable disease, why is it being considered as a little more than an inconvenience? Why is the intensified fight scheduled only for a fortnight? The limited campaign, now on through media, including the television, may have only a limited effect.

The author is an independent journalist
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