Reducing Diarrhea in Small Children
Diarrheal disease kills 1.6 million children under five in developing nations each year- approximately 20% of deaths for children under five. Providing piped water and sanitation infrastructure can reduce child mortality. However, it is expensive to develop this infrastructure in dispersed rural communities, and potentially difficult for rural communities to maintain.
In Guatemala there is a high prevalence of malnutrition and of infectious diseases associated with poverty such as diarrhea and acute respiratory infections. The prevalence of diarrhea infections in children under six years old increased from 12% in a DHS survey (1998-99) to 30% in an ENCOVI 2000 (INE) study. 35% of these children in rural areas suffer from diarrhea compared to 25% of children in urban areas.
Malnutrition and diarrhea are linked to each other; inadequate dietary intakes and high rates of infections limit children’s growth and can cause stunting. In Guatemala, nearly 50% of children under 5 years of age have low height-for-age (INE, CDC 2003) and most of the height deficit of Guatemalan adults can be attributed to growth failure during early childhood (Martorell, 1995).
Diarrheal disease is transmitted by ingesting contaminated food or drink, by direct person-to-person contact, or from contaminated hands.
Randomized control trials have established that several child health interventions are effective in preventing and treating diarrhea in children. These include breast feeding, vaccination, oral rehydration therapy, micronutrient supplementation, hand washing, disinfection of water in the home and hygienic food preparation and storage.
In developing countries surface waters is often contaminated with pathogens due to contact with human and livestock waste. Drinking, handling, cooking and bathing exposes young people to diarrheal diseases. The lack of adequate water reduces the opportunity for bathing, and for washing food, dishes and clothing – thus contributing to the spread of disease.
Acute diarrhea can result in severe dehydration and lead to malnutrition, making children more susceptible to other diseases. Persistent diarrhea can lead to impaired weight gain, and reduced fitness and cognitive performance in children.
Hand washing with soap after defecation, after cleaning children and before and after handling food has been shown, in randomized trials, to reduce diarrhea in children by between 30% and 47%.
Point-of-use water treatment and improved water storage practices have been shown to reduce diarrhea in children by between 20-30% and reductions as high as 83%. A number of technologies are available including using household bleach, sodium hypochlorite, filtration, boiling and solar disinfection.
Multiple interventions which combined water pumps, hygiene education and latrines have shown a 25% reduction in Diarrhea. Other studies have shown that a combination of clean water, absence of faeces in the yard and hand-washing resulted in 40% less diarrhea than when one practice alone ws observed (Alam et al. (1989)). Other multiple interventions studied have included protecting springs from contamination, the provision of wells, hygiene education and treating water with sodium hypochlorite had a significant effect on diarrhea incidence among all ages. Recent evidence from randomized evaluations provides little evidence for substantial effects of communal water infrastructure on Diarrheal disease.
Attention should be given to efforts to understand effective promotion strategies and how to sustain behavior change. Studies have shown that 70% community participation was supported by daily or weekly reminders – expensive to provide on a large-scale basis. Family sanitation and hygiene education may be more effective than a community piped water system.
Links:
Enhanced Diarrheal Disease Control Resource Center
What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review
Alix Peterson Zwane and Michael Kremer
CID Working Paper No. 140
March 2007
Center for International Development at Harvard University
http://www.cid.harvard.edu/cidwp/pdf/140.pdf
Wash in Schools
http://www.schools.watsan.net/page/107
Hand washing for preventing diarrhoea
Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA
http://www.cochrane.org/reviews/en/ab004265.html
Health and Poverty in Guatemala
Michele Gragnolati and Alessandra Marini
World Bank
World Bank Policy Research Working Paper 2966, January 2003
http://ideas.repec.org/p/wbk/wbrwps/2966.html
Alam N, Henry FJ, Rahaman MM & Wojtyniak B (1989). Mother's personal and domestic hygiene and diarrheoa incidence in young children in rural Bangladesh. International Journal of Epidemiology 18, 242-247.
