We must stop diarrhoea in children now

Monday August 10 2020

 

By Kuduishe Kisowile kuduzekudu@gmail.com

One Friday evening, in an empty, quiet room, I sat on my bed, lost in thoughts. My three roommates had gone for a Friday night out. It was all quiet. I opened the curtains, looked through the window to see the lights of Mikocheni suburb. Even the party house nearby was quiet that day, no lights, no music, no cars going in and out.

Friday night in hospital

I took a shower, dressed up and picked up my medical equipment: a bag, pediatric guideline book and the clinical coat on my arm, switched off the lights, locked the door, off to a unique ‘Friday night.’

I didn’t have to direct the Bajaj driver who picked me up. He knew the place I usually go to almost every weekday: the teaching hospital. I reported to the in-charge and got ready for evening rounds. The paediatric ward was not packed, as usual. It was definitely going to be a quiet night shift. That was until we got a new admission, a one-year old baby boy, with severe diarrhoea.

Struggle to save a life

He was barely responsive. With a temperature of 41℃, cold extremities, convulsions, he could not drink water and he was desaturating. He was in shock. We scrambled to deliver fluid therapy directly into his vein but the veins had collapsed. A nurse from the newborns ward nearby who came to assist, finally secured the vein in the baby’s head.

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The boy was put in the pediatric intensive care unit (PICU) where I had to monitor his vitals constantly while thrusting IV fluids. After the first round, I re-assessed him, he was still in shock. We put another round of fluids. His mother sat there quietly, watching us do everything we could to ensure her son’s wellbeing. When we had controlled the convulsions, fever and shock, I sat down with her to take proper history.

The baby had been having diarrhoea for over a week, he had been given Oral Rehydration Salts (ORS) but since he seemed to hate it, the mother stopped the ORS gave him water. That night, he had 6 motions of diarrhoea and he collapsed, that is when she decided to bring him to the hospital. He spent four days at PICU. I continued monitoring him daily.

Not many children survive

On the fifth day, as I entered the ward, my eyes were almost teary when I saw him finally awake and playing. I picked him up and he smiled. I checked his vitals, they were normal. He was getting better.

In this part of the world, most such babies don’t survive. Not many have access to emergency care and on time, like this baby. They often die, even though diarrhea is preventable and treatable.

Each year diarrhoea kills around 525 000 children under the age of five globally, says the World Health Organization (WHO) in its 2017 report. There are nearly 1.7 billion cases of childhood diarrhoeal disease every year.

Situation in Tanzania

WHO data published in 2018 show diarrhoeal diseases deaths in Tanzania reached 30,859 or 8.49 percent of total deaths. You would wonder why a preventable disease such as diarrhoea still claims thousands of lives.

Is Covid-19 a blessing in disguise?

The handwashing rules that were enforced to prevent spread of the coronavirus, may have played a role in keeping our hands clean. This means a lot in preventing diarrhea too. Can we adapt to this as our daily life practice? That remains my wish. Why?

Tanzanians are still trapped in societal challenges that must be tackled. We must commit to good sanitation, preventing eating contaminated food and water, improving breastfeeding practices and vaccinating children. But this has to go hand in hand with provision of adequate health education and policymakers have to commit to fighting poverty, illiteracy and poor city planning. Most mothers tend to use self-prescribed syrup medications and antibiotics for children with diarrhoea. This is another big problem. Syrup medications worsen acute watery diarrhoea and antibiotics have been proved to be of little or no value because majority of diarrhoeal infections are viral rather than bacterial. Children with diarrhoea must be given ORS and Zinc supplements.

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