Doris Obinna  

Each rainy season Nigerians face a higher risk of different types of bacteria spreading diseases. Bacteria often multiply in food, and can’t usually be detected based on a certain smell or taste. All types of bacteria can be spread from one person to another through direct contact or by touching contaminated objects as well. Many different types of bacteria can cause infectious diarrhoea.

Diarrhoea is one of such disease according to reports as it remains an important cause of mortality and morbidity among children, particularly in low- and middle-income countries. In Senegal, diarrhoea is responsible for 15 per cent of all deaths in children under the age of five and is the third leading cause of childhood deaths. Diarrhoea is usually a symptom of gastrointestinal infection, which can be caused by bacterial, viral or parasitic organisms. Infection is spread through contaminated food or water, or from person to person as a result of poor hygiene.

According to the World Health Organisation (WHO), diarrhoea disease is the second leading cause of death in children under five years old. In communities where there is poor sanitation and hygiene practice, outbreaks of acute watery diarrhoea are likely to occur. In Nigeria, cholera is endemic, with acute watery diarrhoea as the presenting symptom. Cholera is the most important cause of acute watery diarrhoea from a public health perspective because of its potential to cause large outbreaks with a high associated mortality.

The U.S department of Health and Human Services Centres for Disease record states that diarrhoea kills 2,195 children every day more than acquired immune deficiency syndrome (AIDs), malaria, and measles combined. Diarrhoea diseases account for one in nine child deaths worldwide, making diarrhoea the second leading cause of death among children under the age of five. For children with HIV, diarrhea is even more deadly; the death rate for these children is 11 times higher than the rate for children without HIV. Despite these sobering statistics, strides made over the last 20 years have shown that, in addition to rotavirus vaccination and breastfeeding, diarrhea prevention focused on safe water and improved hygiene and sanitation is not only possible, but cost effective.

Diarrhoea that comes on suddenly and last for no longer than a couple of days according to experts, are usually referred to as, “acute diarrhoea.” Most people with acute diarrhoea recover on their own. Diarrhoea that lasts more than two weeks is thought of as “chronic diarrhoea.” Typically, chronic diarrhoea requires medical care to find the underlying cause and treat complications, such as dehydration.

According to a Lagos doctor, Dr Gabriel Omonaiye, diarrhoea is a symptom of several disease entities. It is not a diagnosis. It is an increase in the frequency, fluidity (wateriness), volume and mass of stool (feces) or bowel movement of an individual. It could also be described as an increase in the volume, fluidity and mass of excreta above 200g per day. In severe cases, up to 14 liters of fluids may be lost in a day.

On his part, the National Coordinator/Chief Executive Officer, Nigeria Centre for Disease and Control, (NCDC), Dr. Chikwe Ihekweazu, said, cholera is an illness which presents as profuse watery diarrhoea caused by vibrio cholerae serogroups 01 or 0139. Humans are the main reservoir of vibrio cholera but water, mollusc, fish and aquatic plants are potential reservoirs. Vibrio cholerae causes rapidly progressive outbreaks and can cause pandemics. Sporadic cases and small outbreaks may also occur in endemic areas.

“Cholera can be predicted, prevented, and treated. Areas with poor sanitation, limited access to safe water and deficient hygiene practices are considered at high risk for cholera infection.

In addition, limited access to health care facilities and inadequate treatment of cases are factors associated with high cholera related mortality.

“Long term multi-sectoral prevention and control strategies to ensure adequate access to water and sanitation, social mobilisation for health and hygiene promotion, immunization, surveillance, and rapid adequate case management, are essential for reducing the morbidity and mortality from cholera in endemic and epidemic contexts.”

He said: “Diarrhoea with dehydration in under-fives is a priority disease reportable under the Integrated Disease Surveillance and Response (IDSR) strategy. This condition which represents one of the leading causes of death among children is usually due to gastrointestinal infections with Rotavirus, Escherichia coli, Salmonella, Shigella, Campylobacter and Yersinia.

“Different Epidemiological patterns are observed for the various pathogens. These are reported monthly but an unusual increase or suspected outbreak should be reported immediately following the IDSR strategy.

“Also, food borne illness is considered to be any illness that occurs among two or more people within a short period of time after sharing the same food or drink. Symptoms of food borne illness may include: acute/ prolonged watery diarrhoea leading to dehydration.”

Speaking further, Omonaiye said, there are different ways of classifying diarrhoea. There are also numerous causes of diarrhoea and could be classified as follows:

Secretory: it persists during fasting and the stools are isotonic with the body plasma.

Osmotic: are stools that contain unabsorbed solutes. It reduces or stops with fasting.

Malabsorptive: due to the different malabsorption disorders and it stops with fasting.

Exudative: due to inflammatory disease and the stools are commonly bloody and purulent. It persists during fasting.

He continued, “Diarrhoea can occur in all the age groups. However, diarrhoea in children is of public health concern as a result of the associated mortality if not promptly and adequately treated.

Causes

According to Omonaiye, the causes of diarrhoea are many. In children, viruses are the cause of a large percentage of diarrhoea cases. Examples include, rotavirus, adenovirus, norovirus, coxachie virus. Viral diarrhoea tends to be self-limiting and is comparatively easy to treat.

“Different types of bacteria can cause diarrhoea e.g staphylococcus in staphylococcal food poisoning), salmonella species, escherichia coli, yersinia enterocolitica, campylobacter jejuni. Parasites are known to also cause diarrhoea.”

Explaining further, he said that in our environment, malaria fever in children may cause frequent watery stooling. Drugs including antibiotics, laxatives, and magnesium-containing antacids can induce diarrhoea.

“Medical and surgical conditions may precipitate diarrhoea, for example, thyrotoxicosis, intestinal hurry, zollinger-ellison syndrome, post vagotomy, surgical removal of part of the stomach, small intestine or large intestine, surgical bypass of part of the intestine.

“Some tumours (carcinoid tumors for instance) can cause diarrhoea. Stress in certain people causes it as well. Also, some food items are responsible for diarrhoea e.g; sugar in persons with sucrose intolerance, apple juice and pear juice in fructose intolerance. Also, milk, ice cream, yogurt, and chocolate in persons suffering from lactose intolerance.

“Lactose, fructose, and fructose intolerance are due to the deficiency of the enzymes that are needed in the metabolism of the respective monosaccharides,” said he.

Related News

Symptoms

“The symptoms include frequent stooling of watery, loose feces. There may be abdominal pain or cramps. There may be fever, weakness, thirst, lethargy, and restlessness. There may or may not be vomiting.

“The color of the stool can range from clear to brown, with or without mucous. The patient may clinically be weak, dehydrated, dry and furry tongue. The eyes may be sunken. Loss of skin turgor may be seen. The output of urine may decrease.  There could be abdominal tenderness and changes noticed in the bowel sounds.

“Diarrhoea alias abdominal flu tends to be self limiting. The patient should take copious amounts of fluids, and oral salt sugar solution.”

He continued, some over the counter (OTC) medicines always come in handy.

“But if the symptoms are not abating, then the patient should urgently seek for proper medical attention, as delay may be fatal,” Omonaiye advised.

Treatment

“The best ways to manage and treat diarrhoea for children with no signs of dehydration need extra fluids and salt to replace their losses of water and electrolytes due to diarrhoea. If these are not given, signs of dehydration may develop.

“Mothers should be taught how to prevent dehydration at home by giving the child more fluid than usual, how to prevent malnutrition by continuing to feed the child, and why these actions are important. They should also know what signs indicate that the child should be taken to a health worker.

“Children with some dehydration should receive oral rehydration therapy (ORT) with ORS solution in a health facility.”

Omonaiye advised however to see a doctor, who will assess the clinical state of the patient and outline the most suitable management plan, which may entail admission, investigations, intravenous therapy, other medicines and perhaps dietary restrictions.

However, the bacteria are transmitted mainly through the fecal-oral route via ingestion of contaminated food or water. Major vehicles of transmission include: fecally contaminated food or water; human to human (e.g. dirty hands); corpses of infected patients; cholera treatment centres with insufficient hygiene measures. Cholera which has an incubation period of between two hours and five days is asymptomatic or mild in 80 per cent of cases.

Severe cases which can lead to death within hours due to dehydration. Cholera is characterised by rapid onset of profuse watery diarrhoea (rice water stools), with or without vomiting. It is usually not associated with fever, and is highly contagious. Case fatality ratios can be up to 50 per cent especially in people without access to treatment but drops to 1 per cent with adequate treatment.

Diet

Nutritionist offer some nutritional tips for diarrhoea as sip on clear, still liquids such as fruit juice without added sugar. After each loose stool, replace lost fluids with at least one cup of liquid. Do most of the drinking between, not during meals. Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes without the skin, and bananas.

Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and salted crackers.

Eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken the stool. Limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods

Prevention

Omonaiye noted however that personal and community hygiene is key to preventing diarrhoea.

Regular washing of hands especially after visiting the toilet, before and after meals should be imbibed. Good and adequate supply of portable water. Cessation of the use of human excreta as farm manure.

Regular food handlers’ tests should be routinely done for food vendors, caterers. Washing of fruits and vegetables before eating them also an important way to preventing cholera. Keep toilets and bathrooms clean. Refrigerate meat.”

Complications

Omonaiye noted that dehydration is one of the most critical complications of diarrhoea. Dehydration if not well corrected in good time, can cause fluids and electrolytes imbalance with drop in the levels of sodium (hyponatriemia), potassium, bicarbonate. The kidneys could be adversely affected, resulting into acute renal failure. Metabolic acidosis can follow the low potassium levels.

“Severe dehydration (loss of weight equal to or greater than 10 percent of the body weight) can rapidly lead to death.

Diarrhoea diseases constitute one of the major killers of children under the age of five years.

“Another, that is travellers diarrhoea is a form of diarrhoea found among international travellers and one of the causative organisms is campylobacter jejuni.”