The leading cause of diarrhea is contaminated water and lack of proper hygiene. In the case of child mortality, the problem is compounded by the lack of treatment, particularly in managing dehydration.
By Dr. Neelam Mohan,
According to the World Health Organisation (WHO), diarrhea is the leading cause of child morbidity and mortality in the world. It is the second most common reason for death in children under five years old, accounting for approximately 525,000 deaths in the age group. Diarrhea is also a leading cause of malnutrition among children. In 2019, nearly 75,000 deaths in children under 5 years in India were due to diarrhoeal diseases. The tragedy here is that these deaths are preventable through proper treatment. The leading cause of diarrhea is contaminated water and lack of proper hygiene. In the case of child mortality, the problem is compounded by the lack of treatment, particularly in managing dehydration. Simple measures, such as taking Oral Rehydration Solution (ORS) can help address the problem.
Diarrhea and Dehydration
The biggest peril of diarrhea is dehydration. A diarrhea patient is more susceptible to dehydration because of the loss of water and electrolytes (potassium, sodium, chloride, and bicarbonate) through watery stools, vomit, sweat, and urine. The child becomes restless and irritable. While he/she will be thirsty initially, with severe dehydration, the child will be unable to drink properly and become lethargic.
To prevent dehydration, WHO recommends rehydration with Oral Rehydration Solution (ORS). It is a fine white powder, typically available in sachets of 21 g or 4.2 g which has to be mixed into one litre or 200 ml of water respectively. The solution is to be sipped slowly by the patients to compensate for the loss of essential minerals. It is important to make the right preparation for ORS. Inaccurate preparation and use of ORS will result in electrolyte imbalance.
The Importance of Using the Right ORS
Composed of glucose and salt-based formula, ORS is preferred for its balanced composition of sodium, potassium, sugar, and tri-sodium citrate. The sugar helps the intestines to absorb the sodium, which in turn, promotes water absorption in intestinal cells. The potassium is meant to compensate for its loss, while the citrate helps in reducing acidosis, a common problem in diarrhea. The composition of the ORS is, hence, a critical requirement for its efficacy. Tampering with this solution can cause undesirable effects like vomiting, increased stool output with electrolyte imbalance. Hence, it is critical that parents always check if the solution is WHO-recommended. No matter what the brand, this information will usually be displayed on the packaging. The recommended osmolarity of ORS by WHO is 215- 268 mosm/L, and the Government of India recommended low osmolar ORS has the osmolarity of 245 mosm/L, and is composed of sodium (75 meq/L), potassium (20meq/L), chloride (65 meq/L), citrate (10 mew/L) and glucose (75 mew/L).
In recent times, we are also seeing the mushrooming of brands that may seem sufficiently close to ORS, but the product composition is different. For example, products like ORSL, QRS although may sound synonymous to ORS contain high concentration of sugar. High amounts of glucose may be deleterious as it may aggravate diarrhea and thus dehydration. Ingredients such as magnesium, taurine, vitamin C, and calcium, are not required in ORS for diarrhea while trisodium citrate dihydrate or sodium citrate is essential in an ORS to reduce the acidosis, a common problem in diarrhea.
Inadequate Emphasis on Feeding
Diarrhea is a leading cause of child malnutrition. Research has shown that malnutrition can be both cause and effect of diarrhea. Malnutrition also lowers the body’s immunity, making it susceptible to other infections. Unfortunately, most parents fail to recognise the severity of the problem and in ensuring a proper diet for their children. Diarrhea can cause the loss of potassium, an essential element for our body. To compensate, children should be given food rich in potassium, such as potato, ripe banana, fish, and meat. Avoid rich and fatty food. Make sure that the food is properly cooked.
Another mineral that must be orally administered to a diarrhea patient is Zinc. It must be provided through supplements. WHO recommends 10 mg per day for children younger than six months, and 20 mg a day for those who are older than six months for 10–14 days. When used alongside rehydration therapy, probiotics appear to be safe and have some beneficial effect in shortening the duration and reducing stool frequency in acute watery diarrhoea, especially viral induced.
Mismanagement of Treatment
The irrational use of antimicrobials and other drugs can cause more harm than good. The widespread use of medicines that have no proven clinical benefits can cause significant harm. By replacing effective treatment like ORS and Zinc, it can delay remedy. The repeated use of antimicrobial drugs can also cause antibiotic resistance, a major concern when dealing with pediatric drugs. Most importantly, this is often completely unnecessary as diarrhea can usually be treated with a careful diet and milder drugs. Antimicrobial medicines have very limited indications and should be taken only under medical advice.
Prevention Better than Cure
Finally, one must always remember that prevention is better than cure. Diarrhea is usually caused due to the consumption of contaminated water or food and because of unsanitary conditions. It is important to ensure food safety through proper handling and preparation of food at home. Following hygienic practices, such as washing hands, is also critical. Parents and caregivers of small children must always ensure that the child’s food is handled with care, utensils are washed properly, and their surroundings are kept clean. Children also have a tendency to put their fingers on their faces or mouth. Hence, make hand-washing a habit by insisting they wash their hands as soon as they come home from outside, before meals, or after any activity that leaves them dirty.
(The author is Director – Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta The Medicity, Gurugram. The article is for informational purposes only. Please consult experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)