Diarrhoea - life or death ?

This blog will explore why diarrhoea caused by poor sanitation practices has such a large impact on communities in Africa. I am sure nearly everyone at some point either from eating bad food or form another reason has experienced diarrhoea. This for many people it is not regarded as a something that will end up killing you. 
In Africa as this blog will explain diarrhoea caused by poor sanitation and lack of toilets is a major life or death issue that cannot be ignored as harmless.

The amount of deaths caused by diarrhoea in 2012 was the third largest killer, 644000 people in sub saharan Africa lost there lives.

The factors that contribute are

1) Water contaminated faeces due to lack of facilities which can lead to infections caused by bacteria present such as Rotavirus and escherichia coli.
2) Poor personal hygiene
3) Food which are eaten or stored in dirty conditions  4) lack of education.

Figure 1


Diarrhoeal disease

Diarrhoea  is one of the three biggest factors of children's death in Sub - Sharan Africa, especially in those under 5 years old. Black R et al 2003 found that over 41 % of deaths are caused by diarrhoea. Around 20 % of those under five in South Africa die again due to diarrhoea and the cost to implement improved infrastructure in South Africa to reduce cases of diarrhoea will cost between 510 to 960 million dollars Chola L et al 2015.

There are three clinical types of diarrhoea.

1) Acute watery diarrhoea - which last around 7 days 
2) Acute bloody diarrhoea 
3) Persistent diarrhoea which last more than 14 days. 
UNICEF/WHO 2009 

Impact on children 

A study by Biritwun et al 1986 found that in Ghana, children who are already less than 80 % the average weight should experience higher cases of diarrhoea than other children. A child who is shorter than average for there age and have signs of stunting is normally a sign they are undernourished, figure 2 shows that Conga and zambia cases are over 40 %.  It has been found that acute and persistent diarrhoea is a major driver of chronic malnutrition, evidence from Gambia, Uganda and Sudan show that diarrhoea leads to children aged from 7 to 12 months had impaired weight gain.

Having enough nutrition is very important for growth, brain development and performance at school World Heath organisation 2015. A key threat and contributor to death from diarrhoea is dehydration due to large amounts of water and electrolytes are lost and if there is lack of water available to replace the losses then it can lead to death. 



Figure 2: Source



 Factors which increases the risk of Diarrhoea ?

Research conducted by  Tumwine K James et al (2002) found that the three safest supply of water in Uganda, Tanzania and Kenya that did not give diarrhoea came from a kiosk, vendor and rainfed cistern as represented in Figure 3. The three worse sources came from a reservoir/ pond, spring/seep and other.  


Figure 3, source Tumwine, J.K. et al., 2002.

The type of sanitation facility plays a close role to the amount of diarrhoea cases. As represented in Figure 4 homes which were pipped and has a flush toilet, experienced a 50 % reduction in diarrhoea cases then those who used a pit latrine or VIP – (ventilated improved privy. The largest number of diarrhoea cases at 66 % were homes which did not have piped water and a flush toilet.

 Gebremariam W 2000 paper on Eritrea, a country which is bordered by Sudan and Ethiopia and is one of the poorest country with a GDP per capita of $150 the results of the study supports the evidence that Tumwine 2002 provides. In Eritrea children who had both piped water and a working flush toilet throughout their childhood the likelihood they will die before the age of 5 is 7 %, while for those children who did not have these facilities the figure was over double at 15 %. 

Figure 4 source: Tumwine, J.K. et al., 2002.


In kenya diarrhoea cases between 1967 and 1997 increased around 13 % and in Uganda around 5 % the reason for the increase it was found in Uganda was down to poor water supplies and people having to get water from contaminated sources and the fact that there is a lack of latrines and good practices for disposal for faeces Tumwine, J.K. et al., 2002.


Breastfeeding & diarrhoea is there a link ?

Yes there is and the news is positive. A recent research paper by Ogbo F et al 2015  found that countries in sub-Saharan Africa; children who are exclusively breastfed from their mothers from a early age led to a large reduction in cases of diarrhoea. This finding is backed up by many other research papers such as Ahiadeke 2000 found that in a study in Ghana and Nigeria, in areas with poor sanitation and where the child has been mixed fed diarrhoea cases were high, but if they were exclusive breast-fed the cases reduced substantially. Victora et al 1989 found that every day the child is breastfed it reduces the chances of getting diarrhoea by 20 %.

The issue with using formula milk is that while it's convenient the water used could be contaminated and the bottles not washed well, which increases diarrhoea cases. The world heath organisation used to not advice mothers who have HIV to breastfeed now they have changed that and promote it - click this link to read more.

The Kenyan government is really promoting this to try and get more mothers to breastfeed to help reduce diarrhoea cases and death - click the link to read more

In the next blog I will explore why are not more people relying on piped water for their water supply.