Diarrhea in Developing Countries

Introduction:

Frequent passing of solid stools and passing of loose, ‘pasty’ stools by babies who breastfeed are not considered diarrhea. According to reports by the World Health Organization, about 7,60,000 children under five years of age are killed due to diarrhea which is the second major reason for child deaths around the globe. India, Nigeria, Pakistan, and Ethiopia account for over half of these fatalities. Malnutrition is one of the underlying reasons responsible for one-third of preventable child deaths and plays a major role in fatal diarrhea episodes.

What Are the Types of Diarrhea?

The following are the types of diarrhea:

• Acute Diarrhea: This is the most common type and is characterized by loose, watery diarrhea that can last for one to two days. Acute diarrhea does not require any medical intervention and resolves within a few days.

• Persistent Diarrhea: As the name suggests, this diarrhea can persist for two to four weeks.

• Chronic Diarrhea: Diarrhea that persists for more than four weeks or relapses and resolves regularly over a prolonged period is termed chronic diarrhea.

When Can Diarrhea Be Harmful?

Usually, diarrhea is self-resolving without the need for any medical intervention. If it does not resolve, then it can lead to certain complications like dehydration, electrolyte imbalance, organ damage, and kidney failure. The following symptoms indicate that diarrhea can turn harmful:

• Rapid heart rate.

• Loss of urine production or dark and small amounts of urine.

• Flushed, dry skin.

• Headaches.

• Irritability and confusion.

• Light-headedness and dizziness.

• Severe nausea and vomiting.

What Are the Reasons for Diarrhea?

The most common reason for diarrhea is an infection in the bowel caused by a virus. This is called viral gastroenteritis. It is also called ‘intestinal flu’ and can last for a couple of days. Other possible reasons for diarrhea include:

• Bacterial infections.

• Eating foods that could affect the digestive system.

• Infections are caused by pre-formed toxins or other organisms.

• Medications.

• Radiation therapy.

• Poor absorption (malabsorption) of food.

• Intolerances to certain foods or allergies.

Why Are Bacterial, Viral, or Parasitic Infections Prevalent in Developing Countries?

Diarrhea is usually caused as a result of bacterial, viral, or parasitic infections which are transmitted through drinking polluted water or eating contaminated foods or can spread from one person to another. These infections are prevalent in developing countries because of the following reasons:

• Poor hygiene practices.

• Lack of basic sanitation facilities.

• Lack of safe drinking water.

• High prevalence of malnutrition.

• Lower health status on the whole.

Reports state that about 2.5 billion people are without appropriate access to basic sanitation. About one billion people are found to excrete in open spaces, which plays a major role in causing diarrhea. About 748 million people are found dependent on drinking water sources that are not considered safe.

What Are the Actions Being Taken to Treat Diarrhea in Developing Countries?

The UNICEF and the World Health Organization recommend the use of oral rehydration salts and zinc to treat diarrhea. This regimen aims to enhance the immune response in children who lack zinc and is especially recommended in frequent episodes of diarrhea. Many children who live in vulnerable conditions in developing countries suffer from a lack of access to this vital regimen. Hence, many countries are working in collaboration to ensure that the necessary treatment is available in countries that are in need.

What Are the Water and Sanitation Interventions to Control Diarrheal Disease in Developing Countries?

The water and sanitation interventions are categorized into four categories namely:

• Water Provision: Many people across the globe lack access to safe drinking water. The Millenium Development Goal (MDG) was developed to halve the proportion of people without adequate access to safe drinking water by the year 2015. Though achieving the target of MDG would provide access to safe drinking water, it was predicted that it would affect over 600 million people without adequate access to improved water supplies in 2015 and also the safety of the water was not addressed by the MDG target.

Examples of improved water supplies are boreholes, public standpipes, protected dug wells, household connections, protected springs, and rainwater collections. Selecting a suitable improved water supply is influenced by an understanding of the local hydrological conditions. Water from these improved supplies is made potable (safe to drink) by treating it at the community level.

• Household Water Treatment: Household water treatment and safe water storage interventions have been found to be effective in reducing the incidence of diarrheal disease in developing countries and the quality of the water has also improved. Through chlorination, ceramic filtration, solar disinfection, and PuR (flocculant-disinfectant powder), the treatment of untreated, unimproved, and improved water supplies has got better and is especially beneficial in enhancing the microbiological safety of the water during storage and transportation.

• Handwashing Promotion: Practicing the habit of washing hands with soap and water is important in the eradication of many diarrheal diseases. Successful handwashing programs aim at educating people to wash their hands correctly at necessary times through a demonstration. It also focuses on ensuring a reliable soap supply. Washing the hands is especially important before eating and cooking, after changing the baby’s diaper, and after toileting. All health programs can include handwashing protocols as a means of spreading awareness among people.

• Sanitation: Sanitation facilities can be improved by including septic system connections, public sewer connections, pit latrines, pour-flush latrines, and ventilated pit latrines. Step-wise sanitation improvements are now a focus of many organizations and are educating people to refrain from open defecation and poor hygiene methods and move towards total sanitation.

The most suitable intervention for a particular location is influenced by existing water and sanitation conditions, hydrology, cultural acceptability, water quality, local conditions, and implementation feasibility.

What Are the Preventive Measures to Prevent Diarrheal Diseases in Developing Countries?

The following are a few preventive measures:

• Washing the hands with soap.

• Breastfeeding and vitamin A supplementation.

• Rotavirus and measles vaccination.

• Basic sanitation.

• Improved drinking water supply.

What Are Metagenomics and Bioinformatics?

Metagenomics refers to the culture-independent genomic analysis (identification, measurement, or comparison of features like gene expression, DNA sequence, structural variation, and so on) of microbial communities.

Bioinformatics utilizes computer software to characterize the molecular components in living beings. This is being put to use in strain typing for any outbreak and surveillance investigation. Modern molecular epidemiology (scientific study regarding the spread and control of diseases) uses these new methods to analyze genetic data. This can be used to assess the epidemiologic parameters so that the epidemic processes could be linked with the evolution of pathogens.

Can Diarrhea Cause Death?

Though diarrhea is common, it can be dangerous at times. In severe cases, excessive dehydration can lead to serious complications, especially in very young infants, children, and the elderly. It is vital to drink plenty of fluids containing electrolytes during diarrhea. This replenishes the body with fluids and electrolytes that were lost during diarrhea.

Conclusion:

Diarrheal diseases pose a risk to global public health particularly in children below five years of age. This is especially prevalent in low-income and middle-income countries where there is insufficient access to quality healthcare and healthcare is not affordable by many people in these countries. Metagenomics and bioinformatics offer great scope in making a rapid diagnosis and facilitating epidemiological monitoring of diarrheal diseases. This will enhance the rapid management, treatment, prevention, and control of diarrhea in developing countries.