Tag Archives: diarrhoeal diseases

Kenya: plan to halve infant diarrhoea prevalence

Kenya has set its sights on halving the prevalence of infant diarrhoeal disease – which kills dozens of children daily – within five years, using new treatments and by boosting preventive measures.

Every Kenyan child under five has an average of three episodes of diarrhoea annually, according to the 2008 Demographic and Health Survey.

Hon Beth Mugo, EGH, MP

“With 86 children dying every day, diarrhoea is the third leading cause of death among under-fives in Kenya. It is unacceptable, but we can stop this!” said Beth Mugo, Minister for Public Health and Sanitation, at the 31 March 2010 launch in Nairobi of national policy guidelines [1].

The new guidelines, she said, complemented the government’s Child Survival and Development Strategy with a package of interventions based on using a new type of oral rehydration salts (ORS) containing lower concentrations of glucose and salt; zinc supplements to reduce the frequency of episodes; selective use of antibiotics; and encouraging prevention through breastfeeding.

“With exclusive breast feeding, vitamin A supplementation, strengthened routine childhood immunization, proper hygiene and access to improved water supplies, we can curb the number of deaths,”said David Okello, country representative of the World Health Organization (WHO).

“We are also looking forward to solutions such as PATH’s rotavirus vaccines. With 730,000 doses distributed this year, we could really make a difference for all the children of Kenya,” said Annah Wamae, head of the Department of Child Health at the ministry.

Kenya's new diarrhoeal disease control guidelines

According to the WHO, vaccination is the only preventive method for diarrhoeal disease cases caused by rotavirus, the most severe form of diarrhoea. In Kenya rotavirus causes 7,500 deaths each year.

At the launch, Sanjiv Kumar, the UN Children’s Fund Kenya (UNICEF) chief of health, announced a financial support package worth US$850,000 by the end of 2010. Aimed at control and management of diarrhoeal disease in Kenya, Kumar added that the focus of the funding was to scale up oral rehydration therapy to cover the whole country; train health staff in new enhanced diarrhoeal guidelines; and to support communication to promote appropriate household behaviours.

Calling for more resources from partners to implement child health programmes, Mugo said resources allocation would be increased to include training of health personnel on control and management of diarrhoeal diseases, strengthening of health systems and programmes aimed at empowering communities to control diarrhoeal diseases.

“The rate of exposure to diarrhoea and waterborne diseases in this country is extremely high because of the high fluoride content in groundwater and the poor wastewater treatment,” James Gesami, Assistant Minister for Public Health and Sanitation, told IRIN.

“In 2010, no single town in Kenya has a sustainable water supply,” he added. “We can’t do much about quantity, but when it comes to quality, the Ministry of Health is working together with USAID and other partners to set up a strategy that will include the protection of springs ready by 2015.”

Training parents

The new guidelines include training parents in home-based care to under-fives to help them recognize the symptoms of dehydration.

This follows the health ministry’s recognition that about 30 percent of children with diarrhoeal diseases are not getting any oral rehydration salts or fluids. Home therapy will include information about recommended fluid intake to prevent dehydration at the onset of diarrhoea as well as feeding, including breastfeeding, during and after diarrhoea.

“Together with our partners, we can save thousands of lives. A coordinated approach involving already proven prevention and treatment methods is the way to do it,” said Olivia Yambi from UNICEF.

[1] Wamae, A. … [et al.] (2010). Policy guidelines on control and management of diarrhoeal diseases in children below five years in Kenya. Division of Child and Adolescent Health, Ministry of Public Health and Sanitation. Download PDF file [407 KB]

Source: IRIN, 01 Apr 2010.

See also the press release by PATH “New policy unveiled to combat diarrhoeal disease, a leading killer of Kenyan children”, 31 Mar 2010

Brazil: Sanitation deficit “shameful” – expert

Nearly 50% of the nearly 200mn inhabitants of Brazil do not have access to sewerage networks, according to sanitation sector experts at a seminar in capital Brasília.

In addition, only a third of the sewage in the country is adequately treated, according to Raul Pinho, president of the institute Trata Brasil, which specializes in basic sanitation. Pinho said it is “shameful” that Brazil is among the most backward nations in the world in this sector, paper Ultimo Segundo reported.

While the government has invested around US$5.7bn in sanitation works during the last three years, different studies from the private sector show that about US$254bn needs to be invested to guarantee sewerage networks for the whole population, the report said.

It is an agenda that goes beyond the present government, because what are missing are long-term policies, compatible with the growth of cities and the population, Pinho said.

Experts that participated at the seminar attributed illnesses such as diarrhoea to the lack of sanitation. This illness is responsible for the annual deaths of nearly 2,500 children under five years in Brazil.

Source: BNamericas. com [subscription site], 22 Oct 2009

Bringing proper sanitation to rural Afghanistan

The second Global Handwashing Day was celebrated on 15 October 2009 in Kabul and 34 provinces of Afghanistan.

“At home, I wash my hands every morning and noon and evening, and also when I come from the toilet,” said 11-year-old Abdullah Farzad.

Afghanistan’s mortality rates are among the highest in the world. One out of four children dies before her or his fifth birthday. High diarrhoea prevalence resulting from poor hygiene practices, lack of access to sanitation facilities and clean water impact heavily on children’s survival and development. According to a joint UNICEF/WHO report released this week, more than 80,000 children under five died as a result of diarrhoea in Afghanistan in 2007.

“When I started to go to school one year ago, one of the first things our teacher explained to us was the importance of washing the hands before eating,” said Abdullah. “Since then, I have explained this to my mother. In the beginning she was skeptical, but when I told her about the examples that we heard at school – from babies who get sick and die – she started to change.”

Promoting a life-saving intervention

The village of Sohol, Afghanistan is enclaved within mountains. Its residents have no running water and access to safe water and sanitation supplies has been difficult for many.

Despite its life-saving potential, hand-washing with soap is seldom practiced in Afghanistan and not always easy to promote. About 22 per cent of households have access to safe water and less than one out of 10 families has access to latrine facilities.

“We have a water-point in Sohol, our village. Usually it is my sister who goes to fetch the water in the morning and the evening, but sometimes I have to help her. It takes about ten minutes from our house to the water-point,” said Abdullah.

Although people may be aware that water alone is not enough, many families still do not want to invest in buying soap.

“In the past many parents said that it is too expensive to buy soap. Last year, community animators came and made clear to them how much this little investment can do, to ensure the health of their families.” said teacher Mohammad Abdullah.

“It was not easy to make them change their mind, because in a remote place like Sohol it is not always simple to have water and soap at hand when you should have it.”

The ‘Healthy School Initiative’

As a follow-up to the 2008 International Year of Sanitation, UNICEF has initiated clean village projects promoting sustainable behaviour changes on key hygiene practices among families.

The ‘healthy schools’ initiative – which includes the construction of separate toilets for girls and boys, safe drinking water systems and the training of teachers on effective hygiene promotion – is also being implemented.

To date, 1,000 schools with a total of about 320,000 students benefit directly from this intervention.

Abdullah’s school is also one out of 126 schools chosen across 11 provinces for a pilot project of the World Food Programme (WFP) and UNICEF, where water and sanitation facilities are combined with a hot meal.

Water-points, toilets and hygiene education are taken care of by UNICEF, while WFP is providing food commodities and kitchen equipment.

It is estimated that more than 70,000 school children participated in this year’s Global Handwashing Day in Afghanistan. In spite of continued conflict, they celebrated together with millions of other children across five continents.

Source: Cornelia Walther, UNICEF, 16 Oct 2009

South Africa, Cape Town: basic services needed to save babies

Toddler Sanele Qaqa should have been running around his home by now. Instead, his family is grieving his death, which could have been prevented. Sanele, the youngest of six children, died in March [2009], just two weeks ahead of his second birthday.

[...] A shocking 37 city children younger than five died of diarrhoea in February, March and April [2009] – deaths that could easily have been avoided. In 2005, more than 100 children, most of them from poverty-stricken areas, died, statistics show.

But health officials are making headway in the war on this disease. According to the Department of Health, the main contributors to the death rate are lack of access to potable water, and inadequate sanitation, sewerage services, and hygiene practices. The deaths earlier this year were largely concentrated in informal settlements where access to clean water was limited.

[Cape Town] has said that although it spends R10-million a year installing sanitation infrastructure, it is costing it R60m a year to repair infrastructure that has been damaged.

Broken toilets, stagnant pools of dirty water and human waste are common in informal settlements. These are the conditions in which disease thrives.

[Sanele Qaqa died on 28 March 2009, two days after falling ill]. One week earlier, on March 17, one-year-old Unabantu Mali died, tied to the back of his grandmother, as she made the two-hour walk home after allegedly being turned away from three health-care centres at which she had sought help for the boy, who had diarrhoea. A probe later cleared the facilities of wrongdoing.

Sanele was one of 3 586 children admitted to hospital for diarrhoea in the past year. Provincial health department spokeswoman Faiza Steyn said there was no accurate picture of deaths from diarrhoea that occurred outside hospitals.

[...] Of the 37 children who died, four had malnutrition and 12 were HIV-positive. Dehydration was the direct cause of the deaths of 14 of the children, said Steyn.

[...] According to Jaco Muller, of the City of Cape Town’s water and sanitation department, the capital expenditure for these services was R23m, while operating expenditure was R80m. The city has 223 informal settlements. The number of toilets needed was 27 052. In May, there were 2 078. The required number of standpipes providing potable water was 5 148, compared with the 4 402 that were in place.

“If all families were to have ready access to clean potable water, the risk of contamination would be considerably reduced,” said Steyn. “The risk would be further reduced if water was stored in clean containers that were cleaned regularly.”

While 37 deaths in three months is high, the mortality rate has improved since 2005, when more than 100 children in the metropole died. The provincial and city health departments have tried to curb the number of deaths through, among other things, awareness campaigns.

From April 1, [2010], a new vaccine is to be introduced that can reduce the incidence and severity of diarrhoea.

Source: Esther Lewis and Lavern De Vries, Cape Argus / Mercury & Independent Online, 05 Oct 2009

Child undernutrition, tropical enteropathy, toilets, and handwashing

The impact of sanitation and hygiene on child mortality and health has been underestimated, contends Dr Jean Humphrey in The Lancet of 19 September 2009 [free registration required].

“Of the 555 million preschool children in developing countries, 32% are stunted and 20% are underweight. Child underweight or stunting causes about 20% of all mortality of children younger than 5 years of age and leads to long-term cognitive deficits, poorer performance in school and fewer years of completed schooling, and lower adult economic productivity.”

“A key cause of child undernutrition is a subclinical disorder of the small intestine known as tropical enteropathy”, Dr. Humphrey states, which “is caused by faecal bacteria ingested in large quantities by young children living in conditions of poor sanitation and hygiene”. “Provision of toilets and promotion of handwashing after faecal contact could reduce or prevent tropical enteropathy and its adverse effects on growth”. “The primary causal pathway from poor sanitation and hygiene to undernutrition is tropical enteropathy and not diarrhoea”.

Dr. Humphrey concludes that “that prevention of tropical enteropathy, which afflicts almost all children in the developing world, will be crucial to normalise child growth, and that this will not be possible without provision of toilets”.

Full reference:

Humphrey, J.H. (2009). Child undernutrition, tropical enteropathy, toilets, and handwashing. The Lancet ; vol. 374, no. 9694 ; p. 1032-1035. doi:10.1016/S0140-6736(09)60950-8

In an earlier WHO study, the authors estimated that 860 000 deaths per year in children under five years of age were “caused directly and indirectly by malnutrition induced by unsafe water, inadequate sanitation and insufficient hygiene”. This raises the total number of children that die every year as a result of unsafe water, inadequate sanitation or insufficient hygiene to 2.2 million instead of the 1.4 million usually quoted.

Full reference:

Pruss-Ustun, A.; Bos, R.; Gore, F. and Bartram, J. (2008). Safer water, better health : costs, benefits and sustainability of interventions to protect and promote health. Geneva, Switzerland, World Health Organization (WHO). Read the full report [PDF file].

Nepal: Government failing to curtail rural diarrhoea deaths – health workers

Neglect of the rural health system and poor preparedness result in thousands of avoidable diarrhoea-related deaths annually in Nepal, health analysts warn. “The diarrhoea epidemic has repeated again due to the government’s lack of effective preventive measures which we have been reminding the officials of every monsoon,” said Prakash Amatya, director of NGO Forum for Water and Sanitation.

Most deaths occurred in remote villages in the mid-west region where a large percentage of the population remains vulnerable due to poor sanitation, unsafe drinking water and illiteracy. Many are uneducated about basic hygiene and healthcare.

In addition, there are issues of access [impassable roads] and logistics [lack of electricity].

[...] While much of the mid-west was affected, worst hit was Jajarkot district (400km northwest of the capital), where 106 people have reportedly died since 1 May [2009], according to the District Public Health Office, followed by Rukum, about 300km northwest of Kathmandu, where 25 people died between 29 June and 13 July [2009]. Deaths have also been reported from the region’s remote Dailekh, Salyan, Dang and Doti districts.

Nearly 14 percent of the country’s 27 million people live [in mid-west region], despite limited access to health, education, roads, telephones, electricity, water supply and sanitation services. The region has long been isolated from development initiatives, held back by a decade-long armed conflict and political instability.

According to UNICEF, about 13,000 children under five die annually from diarrhoea because of poor hygiene and sanitation. A government report, Nepal Country Plan for International Year of Sanitation 2008 estimated that only 46 percent of the population had access to basic sanitation. More than 14 million people, mainly in rural areas, do not have access to latrines, states the report, while over 30 percent do not have access to potable water, according to the Department of Water Induced Disaster Prevention.

“This problem would have never existed if more attention was paid to improving health hygiene and sanitation situation in the rural areas,” Pitamber Sharma, director of the disaster department of the Nepal Red Cross Society (NRCS), said.

[...] But according to the UN: “It doesn’t help to blame but to look at what needs to be strengthened, what could have been done in terms of prevention and to make this a priority for our development partners,” said Wendy Cue, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA)

Source: IRIN, 17 Jul 2009

Kenya: water shortage increases cholera toll

An acute water shortage in parts of eastern and northeastern Kenya is fuelling the spread of acute watery diarrhoea (AWD) and cholera, with deaths from new cases being reported, a senior health official has said.

“People are resorting to drinking water from anywhere because of the shortage,” Shahnaaz Sharif, director of public health in the Ministry of Public Health, told IRIN.

“Recently, four deaths have been reported in Garbatulla [District] where about 280 AWD cases have been reported in the last three weeks,” Sharif said, adding that samples from those affected had been collected for laboratory testing. [...] “In total, 24 cholera deaths and 1,452 cases of diarrhoea have been recorded since January [2009],” he said.

[...]

Inadequate sanitation has exacerbated the situation. “We only have one toilet for 600 pupils. It is the main reason why our school has been affected,” Sora Boru, a head teacher at Bullesa primary school in Isiolo, told IRIN. “Many children have [not] reported for school… Parents are keeping them at home.”

Hygiene awareness campaigns have been intensified in the water-scarce region.

According to Yussuf Ali, a trader, the price of bottled water has increased. “A half litre [bottle] of water is selling at Ksh.100 [about US$1.3]… even higher than petrol.

See also: Kenya: Acute watery diarrhoea kills eight in Coast Province, IRIN, 18 Jun 2009

SourceIRIN, 17 Jun 2009

Preventing spread of infectious diseases is everyone’s responsibility – and everyone’s job

Good hygiene starts within the family, but families need better guidance and advice, says new report.

According to a report published today, we must all share responsibility for preventing the spread of diseases such as swine flu, SARS, avian influenza, diarrhoeal and skin diseases, and even the common cold.

The swine flu scare has prompted some to say that we are over-reacting but it is important  to look at the bigger picture – because the next new pathogens are always just around the corner. The regular emergence of new pathogenic strains, and their unpredictable behaviour, means that sustained investment in effective strategies of mitigation and containment make absolute sense.

But if infections are to be kept in check, there needs to be a fundamental change in our approach to hygiene, with more emphasis being placed on empowering families  to take on this responsibility.

Professor Sally Bloomfield of the London School of Hygiene & Tropical Medicine and one of the report’s authors,  comments: ‘Although antibiotics and vaccines have given us unprecedented ability to prevent and treat killer diseases, hygiene is still fundamental to winning the battle against infectious disease in both developed and developing countries – and that’s a job for all of us. This is not about shifting responsibility, it’s about facing reality’.

The report, published by an expert group for the International Scientific Forum of Home Hygiene, indicates that a significant proportion of global infectious disease could be prevented through improved hygiene practice coupled with the provision of adequate water and sanitation. One of its key conclusions is that, if the burden of these diseases is to be contained in a manner which is economically sustainable, it must be a responsibility which is shared by all of us.

Information around hygiene is still too fragmented and confusing, however. For example, advice on preventing spread of colds and flu is very different from that on preventing diarrhoeal diseases. What is needed, argue the authors, is a less agency-centred approach, and one that is more family-centred, empowering parents to better protect themselves and their families against infection.   Dr Elizabeth A Scott, also a co-author comments: ‘The key to getting people to change their behaviour is to find a way to make hygiene behaviour more appealing and relevant by realigning it with other aspects of healthy living such as diet and exercise. People also need to understand that they can be proactive in protecting themselves and reducing their risk of acquiring an infection in their everyday lives’.

If we can prevent infections through good hygiene, we can also reduce the amount of antibiotics we need to prescribe, according to co-author Professor Martin Exner. Overprescription of antibiotics is the main cause of antibiotic resistance, which is threatening our ability to treat infections effectively when they occur.

In developing countries, the huge burden of hygiene and sanitation-related infectious diseases continue to be the most critical public health threat. Says co-author Professor KJ Nath: ‘Much of the focus in developing countries is on investment in community water supply and sanitation in order to meet the Millennium Development Goals, but if the health benefits are to be realised, programmes of hygiene promotion must be implemented in conjunction with improvements in water and sanitation’.

Last week’s report on the state of the NHS called for greater emphasis on ‘disease prevention strategies’ as a means to reduce pressure on NHS budgets.  Infection prevention will be particularly important for the ever-increasing ageing population, for whom infectious diseases can have much more serious consequences which require hospitalisation.

All of these trends underline the need for greater collective effort in better standards of hygiene. Says Professor Bloomfield: ‘In the current climate where infectious disease agents and our immunity to these agents are constantly changing, we need to return to the “not-so-good old days” when our parents and grandparents knew that protecting themselves and their families against infectious diseases was part of their responsibility and an important part of daily life’.

The full reportThe global burden of hygiene-related diseases in relation to the home and community : an IFH expert review” can be downloaded here

Source: IFH Press Release, 17 June 2009

Afghanistan: Thousands of schools lack drinking water, sanitation

About two million state school students do not have access to safe drinking water and about 75 percent of these schools in Afghanistan do not have safe sanitation facilities, according to UNICEF. “Only 60 percent of schools have water [on site],” Zahida Stanikzai, UNICEF’s water and sanitation expert, told IRIN in Kabul.

Drinking water and sanitation facilities are also insufficient in many other schools. IRIN visited Char Qala Wazir Abad secondary school in Kabul where about 9,000 students have only one hand-operated water pump. “When it gets hot hundreds of students rush to the pump all at once,” said Sharifa, a teacher at the school.

[...] MoE officials acknowledge the lack of drinking water and sanitation facilities at schools but say such problems are limited to only 12 percent of state schools. “This year we will dig 5,000 wells at schools which lack water points,” Asif Nang, MoE’s spokesman, told IRIN.

“[School] toilets are not clean and well maintained. The current design and location of toilets are not acceptable for children, particularly girls… There are no facilities for grown-up girls,” Stanikzai said. “One of the reasons that the girls do not attend school is because there are no sanitation facilities,” said UNICEF’s Jalalabad head of office Prakash Tuladhar. “It is very important that water and sanitation [systems] are built as components of the school programme. If there are no latrines, then it is almost certain that girls will not be attending school.”

Washing hands with soap, particularly after visiting the toilet and before eating, can reduce child morbidity rates caused by diarrhoeal diseases by almost 50 percent, according to UNICEF. However, the practice is poorly understood and is rarely practiced by families, especially in rural communities. “In most of the schools hand washing facilities are not placed in a proper place. There is a lack of resources to provide soap for hand washing,” said UNICEF’s Stanikzai.

[...] Diarrhoea-related diseases account for 20 percent of deaths among children under five in Afghanistan, according to the UN Assistance Mission in Afghanistan. Despite these staggering figures, there is no nationwide data about school absences due to diseases. UNICEF said it had been helping MoE to provide “safe drinking water and sustainable child friendly sanitation facilities and hygiene promotion” in 500 schools over the past few years.

Source: IRIN, 12 May 2009

Diarrhoea: Donors urged to tackle leading killer of under-fives – reports by WaterAid and PATH

Two major aid agency reports published this week say millions of children’s lives are being put at risk because governments and the international aid community are not responding appropriately to diseases such as diarrhoea.

Fatal-Neglect“Diarrhoea kills more children than HIV/AIDS, malaria and TB combined, yet compared to these diseases receives little financing and is not prioritised by governments in donor and developing country governments alike,” said Oliver Cumming, co-author of a report by Water Aid, “Fatal neglect: How health systems are failing to comprehensively address child mortality” [Read the WaterAid press release , 12 May 2009, here]‘.

The report shows that between 2004 and 2006 only $1.5 billion was spent globally on improving sanitation. In the same period, $10.8 billion was spent on interventions for HIV/AIDS – responsible for 315,000 child deaths in that period, and $3.5 billion on interventions for malaria – responsible for 840,000 child deaths.

A health worker in the only government-run clinic in Kibera said diarrhoea was a major problem in the slum, which is home to over one million of Kenya’s poor. [...] “There are a lot of cases of children dying of diarrhoea because the health service in a slum setting such as this is not so well distributed,” added the health worker who asked to remain anonymous.

[...] Another report “Diarrheal Disease: Solutions to Defeat a Global Killer” by health advocacy group PATH, speculates that in the 1970s and 1980s awareness-raising and fund-raising for tackling the problem were so successful that the mortality rate fell by almost 50 percent. It says many donors, governments and aid agencies may have considered the problem solved.

But the issue is far from solved. Water Aid says that when taking into account adult deaths, funding for HIV/AIDS is balanced, but when considering child deaths, the large resources for fighting the disease are disproportionate.

Both reports highlight that relatively cheap fixes can be effective – for example educating people to wash their hands, using water purifiers and disinfectants and taking rehydration salts for diarrhoea. But the aid community is not devoting sufficient funds or attention to the problem, the reports say.

The Kenyan government is working with aid groups to educate the public on good hygiene, improve water chlorination and provide communities with water purifiers and disinfectants. But the financial burden is high, says Kenya’s Health Minister Shahnaaz Sharif. “A lot of donor agencies are not concentrating on diarrhoea and then it is left up to the individual governments to handle those programmes and most governments cannot cope,” Sharif told AlertNet.

The Kibera health worker said she believed some funding for HIV, TB and malaria would do more good if it was diverted to treating diarrhoeal diseases in young children. “If I was offered a wish list, I would say we channel a lot of funds (to) healthcare for children under five with an emphasis on diarrhoea and malnutrition,” she added.

Source: Natasha Elkington, Reuters AlertNet, 14 May 2009

From WaterAid report Fatal Neglect.

From WaterAid report "Fatal Neglect".