Introduction
Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Diarrhoea can last several days and can leave the body without the water and salts that are necessary for survival. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. This Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. In recent times, the majority of under-five diarrhoea cases has been of viral nature specifically caused predominantly by rota virus. The danger of diarrhoea comes from dehydration. It is a major cause of death and serious illness in children under five years old. The past outbreaks in children under five years old in Botswana have largely been due to rota virus infection.
According to the World Health Organization (WHO) Diarrhoeal disease is the second leading cause of death in children under five years old, and is responsible for killing around 525 000 children every year globally. Centre of disease Control and prevention (CDC) puts the figure at around 801 000 child deaths from diarrhoea every year which translates to about 2195 deaths per day globally. Even though diarrhoea is present globally among all regions and populations, an inequitable proportion of diarrhoea morbidity and mortality occurs in low-income countries, which have fewer resources and less robust infrastructure to manage burden than high-income countries. In Africa, diarrhoea is the third leading cause of death in children under five years old. Botswana recorded slightly more than 50 833 total diarrhoea cases (10 504 cases with dehydration) and 50 diarrhoea deaths in children under five years old in 2018.
Despite access to clean water supply, better sanitation and waste disposal compared to other developing countries, Botswana continues to record a significant number of diarrhoea cases and deaths on an annual basis. In 2006 Botswana witnessed one of the biggest diarrheal disease outbreaks to affect the country to date with 54 296 cases and 649 deaths recorded. Two years later, in 2008 yet another outbreak hit the nation and 27 011 cases and 98 deaths were recorded. In 2010 during another outbreak with 16 508 cases and 107 deaths were recorded and the following year in 2011, a total of 30, 759 Diarrhoea cases and 233 deaths were reported. However in 2011 during the outbreak from week 32 to week 47, about 12,433 cases and 124 deaths were reported. The last outbreak was in 2018 with 8 959 cases of diarrhoea with dehydration cases reported and 37 deaths in the week 36 – 42.
Botswana is currently, since week 31, experiencing a surge in the number of diarrhoea disease reported cases across the country standing at 1406 and 14 deaths by week 43.
Case definition
- Suspected case: a child below five years passing three or more loose or watery stools in the past 24 hours, with or without dehydration, since week 35 in any district in Botswana.
- Confirmed case: a suspected case confirmed with stool culture or microscopy (or other recommended test) for a known enteric pathogen. Assessment of the level of dehydration is based on the Integrated Management of Childhood Illnesses (IMCI) protocol.
Signs and Symptoms
- frequent loose, watery stools.
- abdominal cramps.
- abdominal pain.
- fever.
- bleeding.
- irritability and confusion
- lightheadedness or dizziness from dehydration.
- vomiting
Complications
- dehydration
- kidney failure
- heart attack
- death
Management
- plenty of fluids to prevent dehydration.
- oral rehydration drinks to replace lost salts and minerals.
- intravenous replacement of fluids in severe cases.
- medications such as antibiotics and anti-nausea drugs.
- anti-diarrhoeal medications, but only on the advice of your doctor.