Diarrhea in children  : emphasizing home treatment

By

Dr.  Murtala Muhammad Umar

General Hospital Zurmi, ZAMFARA State

 

Diarrhea with dehydration is one of the leading causes of death in children in developing countries. It is estimated that at least 5 million children under 5 years of age die each year as a result of diarrhea complicated with dehydration. It is estimated that approximately one billion episodes of diarrhea occur yearly among children under 5 years of age, in Africa, Asia, and Latin America.   Children unlike adults do not tolerate dehydration for long due to their unique physiology. Their kidneys are not well developed to reabsorb enough water and electrolytes excreted like the matured kidneys leading to increase urinary out put. Also water is the largest single component of the body especially in children, comprising approximately 75% of total body weight in the term neonate { 0—4 weeks of life}, falling to about 60% by 4-6 months of age and gradually approaching adult values of 50-60% by puberty. In addition children tend to loose more water to the atmosphere because of their large body surface area. These factors combine to increase their daily demand for water and make them suffer adverse consequences of dehydration, which an adult can tolerate.

 

Diarrhea simply means a change in the consistency of the stools to being abnormally loose or fluid and increase in the frequency of stools to more than is normal for the age of the child. There is a wide range of normal patterns in children, which make more precise definition difficult. For example, Nigerian pre-school children open their bowels once every other day to 5 times per day.  However, for practical purpose, the passage of one watery or explosive stool, or 3 or more loose stools in 24 hours is generally considered abnormal. Loose stool is that stool that takes the shape of it’s container.

 

The causes of diarrhea abound ranging from non-infective causes such as food allergy, lactose intolerance [sugar contain in milk] to infective causes. Viruses, bacteria, protozoa or parasites are the major microorganisms that cause diarrhea. Rotavirus, have been identified as the major cause of acute diarrhea in childhood. Studies in Nigeria also found viruses as the major cause of diarrhea in 60% of cases, with bacterial organisms accounting for only 3-20%.

 

Children present with different features depending on the cause of the illness. The diarrhea is often preceded by cough and catarrh in case of viral agent. The stool may be bloody, and may contain mucus. Vomiting is a common complain and often precedes the diarrhea. Fever may be present especially in this environment where the diarrhea can be due to malaria. Features of dehydration depending on the severity range from body weakness, excessive intake of fluid, refusal to feed, lethargy, convulsion, loose of consciousness to death. Diarrhea disease in children if not promptly treated can result in renal failure characterized by decrease quantity of urine to inability to pass urine. Other complications include body electrolyte derangement [e.g, low sodium or potassium] and high acid in the body&n bsp; preparing ground for fatal complications especially in the heart and brain.

 

The features described above should send warning to parents that diarrhea disease is more complex than meets the eye and emphasis placed on prevention, early diagnosis and prompt treatment. The aim of this piece is to emphasize oral rehydration therapy [ORS] as a form of first aid to be administered by parents at home before presenting to the nearest health facility. ORS is cheap, easy to prepare and contains electrolyte such as sodium, potassium, chloride, and bicarbonate, in addition to glucose. As a reminder, two bottles [30cl] of boiled or swan water is mixed with one sachet of ORS. On the alternative salt sugar solution [SSS] can be prepared where ORS is not available. The quantity of water is the same only that in this case one level tee spoon of salt and ten level tee spoon of sugar [or 5 cubes] is added to the water. Either of this preparation must be discarded after 24 hours from the time it was prepared. The mother gives the child ORS or SSS as he or she tolerates. Emphasis must be made here that on no account should the mother stop feeding because of ongoing diarrhea. Parents should desist from giving their children antibiotics/antidiarrheal drugs since most of the causes as stressed earlier are viral which antibiotics have little or no effect on. However, the point must be stressed here that home treatment is not a substitute to hospital care especially when the diarrhea persist and the child not tolerating orally. Babies in their first 4 weeks of life are highly vulnerable to dehydration relative to other infants and older children and must be bought to the hospital regardless of the success achieved with home therapy. Prevention of diarrhea disease is incomplete without emphasis on personal and environmental hygiene. Exclusive breast-feeding for the first 6 months of life has the advantage of not only cheap and compatible with the infant’s immature intestine but preventing diarrhea disease. Some mothers despite strong warning by health workers on the danger of bottle-feeding still prefer it to feeding via cup and spoon. This unhygienic mode of infant feeding, apart from being expensive and environmentally unfriendly, also predisposes children to diarrhea and it’s attendant complications. The onus lies on parents to adopt healthier feeding practices so that innocent souls do not suffer due to their negligence. Let us say no to death due to preventable diarrhea disease today.