Study finds causes of diarrhoea in East Africa

A study by the Global Enteric Multicenter Study (GEMS) has found out that Rotavirus as the leading cause of diarrhoea among children below one year of age in East Africa.

According to Dr. Richard Omore, one of the Principle Investigators of the study from KEMRI-CDC the findings re-enforced the need for Rotavirus vaccines expected to significantly reduce child deaths due to diarrhoea in East Africa.

As of now, Rwanda and Tanzania have already introduced the vaccine in their routine national immunization programme while Burundi, Kenya and Uganda are yet to do so.

The GEMS findings cited Cryptosporidium, Shigella and ST-ETEC (a type of E-coli) as other major causes of diarrheal diseases.

Dr. Omore says that “for a long time, Cryptosporidium has not been viewed as a major cause of diarrhoea, apart from when it affects people with low immunity such as those with HIV and AIDS”

However, GEMS researchers found that it affected children in all study sites regardless of their HIV prevalence. It was also associated with death cases reported. “This highlights the need to develop resources to diagnose, treat and prevent cryptosporidiosis in resource poor settings,” they said.

According to the World Health Organisation (WHO), Diarrhoea is the second leading killer of young children globally, claiming more than 700,000 lives each year despite it being preventable and treatable. Majority of those deaths occur in developing countries.

Diarrhoea is also the leading cause of malnutrition – responsible for 35 percent of deaths among children below five years old. Malnutrition causes stunting and interferes with a child’s brain development. Stunting that occurs after two years of life is irreversible.

The study noted that children with moderate to severe diarrhoea were 8.5 times more likely to die especially within the first two years of life. Sixty one percent of those deaths occurred more than a week after the initial diarrhoea episode, with 56 percent happening after families had returned home from a health care facility.

“Our health care systems need to find ways of following up and monitoring children discharged from hospitals after a bout of diarrhoea to prevent further complications from arising,” says Dr. Omore.

He also advises care givers to be on the lookout, and rush children with diarrhoea symptoms to hospitals. Some symptoms of the disease include three or more loose stools within 24 hours, sunken eyes and skin that take more than two seconds to flatten when pinched.

Based on the study, diarrhoea interferes with children’s normal growth. “When a child has diarrhoea, they lose so much fluid leading to loss of body nutrients. The child is thus denied the opportunity for normal cell growth,” explains Dr. Omore.

Since dehydration is the most significant threat posed by diarrhoea, Dr. Omore notes that caretakers can prevent this through early administration of appropriate fluids.

“These children should be given more fluids than usual and mothers should continue breastfeeding them,” he says.

The WHO recommends the use of Oral Rehydration Salts (ORS) for treatment of diarrhoea cases – so as to prevent infant mortality. But according to the 2013 UNICEF State of the World’s Children Report, only 29, 39 and 44 percent of children were treated with ORS in Rwanda, Kenya, Tanzania and Uganda respectively.

Similarly, use of improved sanitation facilities – another key intervention to diarrhoea control – is still low at 10, 32, 34 and 55 percent in Tanzania, Kenya, Uganda and Rwanda respectively.

Dr. Omore says that diarrhoea can also be prevented through access to safe drinking water, hand washing with soap, exclusive breastfeeding for the first six months of life and health education on how the infection spreads.