Diarrhoea in African Children: Types and who is at risk?

 

By Ibironke Taiwo. Datelinehealth Africa Volunteer and Freelance Writer, with medical review and editorial support by The DLHA Team

African children fetching and drinking contaminated water. Click on image to enlarge.

 

HIGHLIGHTS

• Diarrhoea disease is highly preventable and treatable but it remains the second leading cause of death in children under the age of 5 years in sub-Saharan Africa. 

• As at 2019, the World Health Organization estimated that diarrhoea disease affects and kills about 375,000 children under age five every year^.(1)

• The pooled proportion of children under five years old who suffer from diarrhoea disease at any point in time varies greatly from country to country in sub-Saharan Africa. ⁽²⁾ In twelve countries of East Africa for example, the pooled proportion is 1 in 7 children. Burundi has the highest number of affected children of 1 in 4.5 children while Madagascar has the lowest at 1 in 12 children.⁽³⁾ 

• Children born to younger aged women (15 - 34 years) are more prone to diarrhoea disease than those born to older women (35 - 49 years).

• Children between the ages of 7 - 24 months are at higher risk of diarrhoea disease compared to those within the age of 0- 6 months. Those aged 25 -59 months are at the least risk. Male children are generally more affected than females.

• Diarrhoea is eminently preventable through the provision of safe drinking water, improved environmental sanitation and hygiene. 

Read on to learn more about the types of diarrhoea and profile of African children at risk of the disease.

 

 

INTRODUCTION

 

Diarrhoea is the second leading cause of death and disability in children under 5 years of age in sub-Saharan Africa. It is associated with the occurrence of at least three loose, liquid, or watery bowel movements per day. ⁽¹⁾ The passage of frequent formed stool does not constitute diarrhoea.

 

When diarrhoea lasts only for a few days it is considered as acute. When it lasts longer, i.e. beyond 14 days, it is considered chronic.

 

Diarrhoea causes loss of water and salts from the body that are essential for survival. These loses may contribute to the cause of death. 

 

Although diarrhoea can be due to non-infectious causes, it generally is a symptom of an infection of the bowel that can be caused by a variety of germs (bacterial, viral and parasitic). The infection is commonly spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. 

 

Infections from germs are probably the most significant causes of diarrhoea related deaths in under-five years aged children in sub-Saharan Africa-

 

There are different types of diarrhoea ^{(1, 4)} and they are best described under two broad categories by:

a) Method of the causation (i.e., mechanism), and 

b) How they present (i.e. Clinical features).

 

TYPES OF DIARRHOEA BY METHOD OF CAUSATION

 

The following are the different types of diarrhoea that are in this category ⁽⁴⁾:

 

1. Osmotic Diarrhoea

 

This type of diarrhoea results from the presence of inadequate or poorly absorbed substances in the bowel lumen. These hinder the absorption of normal water and other electrolytes to provoke   loose, watery stool.

 

Medications such as laxatives or improper digestion of certain food substances such as milk are common causes. Osmotic diarrhoea ceases with fasting.

 

2. Secretory Diarrhoea

 

Secretory diarrhoea occurs when there is more water produced from the bowel than is absorbed.

 

Common causes of secretory diarrhoea include:

• Infective agents like Vibro cholerae
• Hormones secreted by certain tumors of the bowel
• Certain poisons like insecticides and mushroom toxins
• Some ingested metals like arsenic

 

3. Inflammatory Diarrhoea 

 

This results from inflammation or ulceration of the intestinal mucosa through auto-immune damage of the intestinal lumen as in Crohn’s or celiac disease.

 

It may also result from germs that invade and cause damage to the lining of the bowel with resultant outpouring of plasma, serum proteins, blood, and mucus into the intestinal lumen.

 

Some germs that cause inflammatory or infectious diarrhoea include:

• Certain bacteria (e.g., Salmonella and E.Coli)
• Viruses, like Noroviruses, Rotaviruses, etc.
• Parasites (e.g., Giardia)

 

4. Weaning Diarrhoea

 

This happens when new food is introduced to a child at the age of about 6 months. When the child's intestine is not used to the new food, diarrhoea occurs and this may last for 3 to 4 days.

 

5. Motility-Related Diarrhoea 

 

This type of diarrhoea occurs when there is not sufficient time for water to be absorbed from the normal intestinal lumen due to increase in the transit time.

 

Common causes of motility-related diarrhoea include food sensitivities and food allergies.

 

TYPES OF DIARRHOEA BY CLINICAL FEATURES

 

Clinically, there are three types of diarrhoea disease presentation ⁽¹⁾ as follows:

 

1. Acute Watery Diarrhoea

 

This usually lasts for several hours or few days, and is associated with infectious agents, like cholera.

 

2. Acute Bloody Diarrhoea

 

Acute bloody diarrhoea is also known as dysentery. Common causative agents are infectious bacteria like Shigella or parasites like Entamoeba histolytica which damage the intestinal lining to cause bleeding

 

3. Persistent or Chronic Diarrhoea

 

This type of diarrhoea lasts for about 14 days or longer. Chronic diarrhoea can either be watery or bloody too.

 

Common causes of persistent (chronic) watery diarrhoea in children include intolerance or increased sensitivity to milk and milk products and soy allergies. Others include inflammatory bowel diseases like ulcerative colitis or Crohn’s disease. 

 

WHO ARE THE CHILDREN AT MOST RISK OF DIARRHOEA?

 

The typical profile of sub-Saharan African children that are at highest risk of diarrhoea disease ^{(2, 3)} can be summarised as follows:

• Male and commonly aged 7 -24 months.

• Likely born to young women between ages 15 - 34 years old.

• Likely had delayed breastfeeding.

• Mothers have low community education status.

• Mothers likely work and are away from home during the day.

• Household income is typically low.

• They are likely to be malnourished with a weakened immune system.

• They are likely from household with traditional latrine and non-washable flooring.

• They likely do not have access to regular potable water.

 

The profile should help the public and other stakeholders in health in sub-Saharan African countries to develop policies and programs that work to reduce the occurrence of diarrhoea disease in the region.

 

 

CONCLUSION

 

Diarrhoea disease is a common but eminently preventable and treatable condition in children under 5 years of age living in sub-Saharan African countries. It is a disease that is associated with poverty, poor hygiene, inadequate access to clean water and low social development status.

There are different types of diarrhoea. The most common cause is usually infectious germs contracted through contaminated water, food and flooring.

Knowledge of the typical profile of sub-Saharan African children that suffer commonly from diarrhoea disease should help inform all stakeholders in health to implement public health interventions that will prevent and reduce the burden of this disease.

 

REFERENCES 

1. World Health Organization. Diarrhoea. (2019): Available from: https://www.who.int/health-topics/diarrhoea#tab=tab_1. Accessed: July 29, 2023.

2. Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities. Glob Health Action. 2016 May 11;9:30166. doi: 10.3402/gha.v9.30166.

3. Tareke AA, Enyew EB, Takele BA (2022) Pooled prevalence and associated factors of diarrhea among under-five years children in East Africa: A multilevel logistic regression analysis. PLoS ONE 17(4): e0264559. https://doi.org/10.1371/journal.pone.0264559

4. MedicineNet. What are the 4 different types of diarrhea? [Internet]. Last reviewed Nov. 30, 2022. Accessed: Jul 15, 2023. Available from: https://www.medicinenet.com/what_are_the_4_types_of_diarrhea/article.htm 

 

 

Related:

• Diarrhoea in African children: Causes and Symptoms

• Diarrhoea in African Children: Diagnosis and treatment

 

 

Published: August 3, 2023

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