Introduction

Childhood diarrhea disease is a global ailment affecting children everywhere.  It is a leading cause of childhood morbidity and mortality in developing countries.  The understanding of the condition varies from community to community and this variation leads to different modes of treatment.

It has been estimated that globally, over 1.8 billion episodes of childhood diarrhea occur annually, and mostly in developing countries.

In 1993, it was estimated that well over 3.20 million deaths occurred worldwide from childhood diarrhea in children aged less than 5 years of life with 80% in children aged less than 2 years of age (1).

Each episode of diarrhea, if not properly managed, may lead to malnutrition, and, if prolonged, could significantly impact on growth and development of the affected child.

There are four clinical types of diarrhea disease, namely acute watery diarrhea which includes cholera, acute bloody diarrhea which is also known as dysentery; persistent diarrhea; and diarrhea with severe malnutrition which includes marasmus and kwashiorkor (1, 2).

Worldwide, diarrhea diseases are a leading cause of paediatric mobidity and mortality.  Although the total number of deaths from diarrhea is still unacceptably high, these numbers have been reduced substantialy in the 1980’s and 1990’s.  For example, in 1982, an estimated 5 million deaths / year occurred and in 1992, the estimated annual deaths declined to 3 million / year (2).

Most of these decreases in mortality rate are due to increased medical knowledge about the disease and to worldwide campaigns to treat acute diarrhea with oral rehydration therapy.

The aim of this study is to enumerate the peoples beliefs of the cause of childhood diarrhea disease and from this, the necessary ministries will work out an evolving campaign to either enhance or disprove these beliefs.  This will eventually impact on treatment, morbidity and mortality rates.

Materials asnd Methods

Research Community

The research was done at Abraka town and environ in Ethiope East Local Environment Area, of Delta State, Nigeria.

Respondents

A total of fifty (50) mothers were interviewed using self administered questionnaires.

Information Collection

Responses to the research questions were obtained from the administered questionnaires and were then analysed.

Result

The information obtained from the survey are outlined on Tables 1 and 2.  Data shows that most mothers or 39.22% of the respondents describes acute watery diarrhea as the passage of stool with mucus, while 25.49% says that watery diarrhea is when a child passes stool more than six times in a day.  Only 15.69% of the respondents describes diarrhea as the passage of watery stool.

Findings also show that 73.68% of the respondents agreed that the child with diarrhea needs urgent medical attention and help when he is weaker than usual, while 10.53% says help is needed only when his skin is loose and both eyes are sunken into the sockets, and 8.77% says that help is sought for when the child is requesting for more water to drink.

Also, 38.46% of the respondents says that diarrhea disease is caused majorly by drinking unclean or bad water, and 32.69% agrees that it is due to eating contaminated or unhygienic food and drinking unclean water, and another 25.00% says that it is due to feeding child with contaminated and dirty eating utensils.  Only 3.85% says that diarrhea is due to the anger of ancestral spirits.

Incidentally, all the respondents agree that a child cannot get the disease by simply looking at another child with the disease, while 74% of the respondents gives oral antibiotics occasionally to the children to protect them from suffering from the disease.

Table 2 shows a list of suggested methods or care to be taken by the mothers to prevent diarrhea.  Most of them agree that drinking boiled but cooled water is necessary, another eleven says that the act of washing and sterilizing feeding utensils is also helpful, while another six suggests that the avoidance of contact of this and feeding utensils is also needful, while seven other suggestions were for discarding sour food rather than rewarming such meals and eating them.

Discussion

Diarrhea is a leading cause of childhood morbidity and mortality in the developing countries.  Diarrhea is increased water in stool, resulting in increased stool frequency or loose consistency.

Diarrhea could either be acute or chronic, and where chronic diarrhea is diarrhea lasting for more than 14 days.  Acute diarrhea is mostly commonly of an infection, usually viral, in aetiology.

A bacterial aetiology is more common in bloody diarrhea (3).

There are four clinical types of diarrhea diseases, namely acute watery diarrhea, acute bloody diarrhea, persistent diarrhea and diarrhea with severe malnutrition (4).

The aetiology of diarrhea may be infectious or malabsortive and the mechanism is either osmotic or secretory (3).  In osmotic diarrhea, non-absorbable intraluminal solutes causes outpouring of fluid, but usually ceases with fasting.  While secretory diarrhea leads to watery after profused stool, which is not affected by fasting.

The usual causes include viral infections such as rotavirus, Norwalk virus; and bacterial infections such as cholera, Enterotoxigenie, Escherichia coli and Staphylococcus aureus (4).

Other mechanism includes exudative pathway which is caused by Salmonella, shigella, Vibrio Paraheamolyticus and Clostridium difficile.  Other pathways are altered intestinal mobility and decreased absorptive surface which usually follows surgical manipulations (4).

About 52 million people died from all causes in 1995.  Out of these, more than 17 million were killed by infectious diseases.  Diarrhea diseases, including cholera, typhoid and dysentery, which are spread by contaminated water or food, killed more than 3.1 million, mostly children.  This was second only to acute lower respiratory infections which killed about 4.4 million people (5).

Nearly 50,000 men, women and children are dying everyday from infectious diseases.  Many of these diseases could be prevented or cured with minimal financial input.  “We are standing on the brink of a global crisis in infectious disease.  No country is safe from them.  No country can any longer afford to ignore their threat” says the Director – General of World Health Organization (WHO) (6).

Among the known causes of diarrhea diseases, rotavirus is responsible for 15 – 25% of diarrhea episodes in children aged 6 – 24 months visiting treatment centres.  Its prevalence is worldwide and it is spread by the faecal – oral route.  It causes watery non-bloody stooling.

Escherichia coli causes up to a quarter of all diarrhea in developing countries.  It is transmitted through eating contaminated food or drinking contaminated water.  The enterotoxigenic variant causes travelers – diarrhea.

Vibrio cholera is endemic in many African countries, Asia and Latin America where endemics often occurs annually.  In these areas, cholera occurs in children aged 2 – 9 years of age and many cases are severe.  Both contaminated water and food can transmit cholera.  Disease presents with abrupt onset of a watery diarrhea.  Cholera causes death by dehydration (1).

Poverty is the main reason why clean water and sanitation are not provided.  It is the main reason why babies are not vaccinated, why curative drugs and other treatments are unavailable (7).

The number of children under five years who died in 1993 was estimated at more than 12.2 million, of such deaths in the developing world, the great majority could have been avoided if these countries enjoyed the same health and social conditions as the worlds most developed nations.  The gap between the developed and the developing world in terms of infant and child survival is one of the strongest example of health inequity (8).

Diarrhea disease, resulting from unsafe water and poor sanitation coupled with poor food-handling practices are responsible for about 3 million death a year among children under age five in the developing world.  This is a graphic example of poverty and lack of knowledge.  Worldwide, there are an estimated 1.8 billion episodes of childhood diarrhea annually (8).

Our results showed that 39.22% of the respondents described acute watery diarrhea as children passing stool of any consistency but mixed with mucus, while another 25.49 says it is the act of passing stool more than six times a day regardless of the consistency.  Only 15.69% describes it as passing watery stool.  This varying definitions will naturally affect the mode and initiation of treatment by the parents, since most of these children are treated at home.

Most of the respondents or 73.68% agree that a child with diarrhea will need medical intervention when he is noticeably weaker than usual, while 8.77% says that help is sought for when the ill child is asking for more water to drink. These agree with the key messages from health workers to parents and carers about managing diarrhea at home. These key messages are for parents to give extra fluids, continue to feel, and to seek for help if the child’s conditions worsens (9).

All children with diarrhea need extra fluids to prevent dehydration as soon as the diarrhea starts.  Most fluids that a child takes can also be used for home therapy.  Those promoted however, should be ones the mother would agree to give in large amounts, be readily available and affordable.

Most of the mothers agree that drinking unsafe water (38.44%), and eating contaminated food or drinks (32.69) are mostly responsible for causing diarrhea in children.  Another 25.00% says that diarrhea can be caused by not keeping feeding articles or utensils clean.  These show that they agree that diarrhea can be caused by infective bacteria or viruses.

All of the mothers agree also that diarrhea cannot be transmitted from child to child by another child looking at one with diarrhea, and 74.00% of them say that they give oral antibiotics to their children occasionally to prevent the disease.  This act of using antibiotics irrationally and indiscriminately may lead to an increasing number of organisms developing drug resistance.  The WHO has noted that antibiotics and other life-saving drugs used against many diseases are rapidly losing their effectiveness as bacteria and other microbes are developing resistance to them (6).

Again, most mothers suggest key preventive measures which shows that they recognize that diarrhea can be caused by germs in what we eat and drink.

The Director – General of WHO once reported that we are standing on the brinks of a global crisis in infectious diseases.  The optimism of a few years ago that many of known infectious disease could be easily brought under control has led to a fatal complacency.  This complacency is now costing millions in lives.

The socio-economic development of many nations is being crippled by the burden of these diseases.  The world has lost sight of its priority to reduce poverty through better health and to foster development by fighting diseases.

Today, infectious diseases have become a serious health issue and a social problem with tremendous consequences for the wellbeing of the individual.

What is required is the commitment of the international community to help countries most at risk to help themselves.  By helping each other, nations protect the world and protect themselves.

Table 1:  Data obtained from respondent mothers.

Table 2:  Preventive measures employed by interviewed mothers

References

1. Slusher, T. Diarrhea Disease – Diagnosis and Treatment in the Developing World.  Rush Presbyterian – St. Luke’s Medical Centre. Chicago, Illinois, USA.
2. King, C. K., Glass, R., Breese, J. S., and Duggan, C. (Eds) Centers for Disease Control and Prevention.  Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy MMWR 2003; 52 (No. RR – 16).
3. Gunn, V. L., and Nechyba, C. Diarrhea. In:  The Harriet Lane Handbook.  Gunn, V. L., and Nechyba, C. (Eds).  16^th Edition. Mosby; Philadelphia 2002. Pp 257 – 262
4. Isselbacher, K. J., Braunwald, E., Wilson, J. D., Martin, J. B., Fauci, A. S., and Kasper, D. L. Diarrhea, constipation, and malabsorption. In: Harrison’s Principles of Internal Medicine.  13^th Edition.  McGraw – Hill, Inc (Publisher). 1995.  Pp 58 – 65.
5. World Health Organization. The World Health Report 1996.  The Ten Biggest Killers.  Available at: http://www.who.int/whr/1996/media_centre/pros_releax/en/index/1.html.
6. World Health Organization. World Health Report 1996.  Infectious diseases kill over 17 million people a year:  WHO warns of global crisis.  Available at: http://www.who.int/who/1996/media_centre/pron_release/en/index:html.
7. World Health Organization. The World Health Report 1995.   The state of World Health.  Available at: http://www.who/whr/1995/media_centre/executive_summary 1/en/index.html
8. World Health Organization. The World Health Report 1995. Child Health.    Available at: http://www.who.int/whr/1995/media_centre/executive_summary1/en/index1.html
9. Bang, A., Yunus, M., Aziz, K. M. A., and Zaman, K. Messages for parents. Child Health Dialogue, 4^th quarter 1996. issue 5.  Pp5.