The Cause Might Surprise You
Celiac disease is an autoimmune gastrointestinal condition that affects about 1% of the North American population.1 The worldwide prevalence is unknown, due to lack of awareness and testing in developing countries and insufficient research. A group of international researchers recently completed a study that they hope will stimulate debate and serve as a first step toward understanding and lessening the impact of celiac disease around the world, especially in poorer countries in Africa and Asia, where they propose most celiac-related, preventable, childhood deaths occur.2
For individuals with celiac disease, eating gliadin, a grain-based protein found in gluten, causes an unusual immune response that leads to the flattening and altering of the millions of microscopic finger-like projections that line the inner wall of the small intestine. Since the villi are responsible for absorbing nutrients from our food, those who have celiac disease can experience nutritional deficiencies. Celiac disease causes symptoms such as iron deficiency anemia, diarrhea, weight loss, fatigue, breathlessness, cramps, bloating, irritability, and skin problems. Although there is no cure, the treatment for celiac disease is very simple: consume absolutely no gluten, as even one molecule of gluten can trigger the immune response. In most cases, an entirely gluten-free diet allows the intestine to repair itself and recover fully.
First published in the Inside Tract® newsletter issue 181 2012
How Can We Stop Child Deaths From Diarrhea
Diarrheal diseases are both preventable and treatable, as the WHO says, because we already know how to deal with many of the risk factors that may lead to diarrhea and, if diarrhea cannot be avoided, we know how to treat it.
The table below lists the range of interventions available for the treatment of diarrhea we have today.5
Some of these interventions, such as ORS, breastfeeding and improvements in sanitation broadly target all-causes of diarrhea, whereas, vaccination and antibiotic use are specifically directed against the causative agents of the disease.
Water, sanitation and hygiene interventions are the best way to prevent diarrheal diseases. Hand washing with soap, better water quality and better sanitation have been shown to reduce the risk of diarrheal infections by 47%, 17% and 36%, respectively.6
Educating mothers about the importance of breastfeeding is also important. Breastfeeding allows for the transfer of maternal immunity to the child in developing countries infants that are not breastfed are six times more likely to die from infectious diseases, such as those causing to diarrhea, in the first 2 months of their lives.7
In 2006, however, new vaccines against rotavirus the leading cause of childhood diarrhea as the treemap above shows have been introduced. The most recent studies show that, while the effectiveness of the new rotavirus vaccines vary across different countries, it works well in protecting children against rotavirus disease.9
How Can You Die Of Diarrhea
The cause of the diarrhea itself is not usually deadly. Instead it is the complications that arise as a consequence of diarrhea. It is important to remember that diarrhea is just a symptom and not a disease on its own. By far the most common cause of death from diarrheal illnesses is a result of severe dehydration.
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Preventive Strategies And Role Of Public Health
Measures for prevention of diarrheal diseases include the use of safe water, hand-washing, food safety, safe disposal of excreta, promoting exclusive breastfeeding and immunization against measles. Vitamin A supplementation does not reduce the incidence of diarrhea or diarrhea-related mortality in neonates and children < 6 months, but there is a benefit in children aged 6-59 months.
How Many More Lives Could Ort Save
An analysis from 2010 by Munos et al. in the International Journal of Epidemiology is the most widely cited study that provides estimates for the number of potential lives a wider use of ORT could save. The study looked at all the available literature on ORT at the time and suggested that, if every child who needs ORT would receive it, 93% of child deaths caused by diarrhea could be prevented.33
This implies a huge potential for ORT.
We should be somewhat cautious, however. The study is the only currently available published research review that measures the effectiveness of ORT. And because there are only a few studies that have looked at how providing ORT directly affects child mortality, the 93% figure was determined based on a very small sample. Furthermore, it should be noted that children with diarrhea often have associated comorbidities, such as malnutrition and viral or bacterial infections. These comorbidities may require treatments in addition to ORT, which was not assessed in the Munos et al. study.343536 Organizations including WHO, UNICEF and GiveWell cite the 93% figure, but also note its limitations.37
World Health Organization, and Unicef. Ending preventable child deaths from pneumonia and Diarrhea by 2025: the integrated global action plan for pneumonia and Diarrhea . .
How ORT works
In clinical settings in the UK, ORT has been estimated to be between £351.84 and £630.48 cheaper per course of treatment than IVT.50
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Can Adults Die From Diarrhea
Diarrhea: What we know It causes death by depleting body fluids resulting in profound dehydration. Diarrhea can have a detrimental impact on childhood growth and cognitive development 4. About 88% of diarrhea-associated deaths are attributable to unsafe water, inadequate sanitation, and insufficient hygiene 5, 6.
Mostly Lower Rates Over 16 Years
The researchers produced high-resolution maps of illnesses from 2000 through 2015. The study includes diarrheal illnesses in children under the age of 5 in 55 of Africa’s 57 countries .
“Diarrhea is highly preventable, and tens of thousands of child deaths from diarrhea could be averted each year if interventions targeted mortality hot spots across Africa,” said Bobby Reiner, PhD, lead author and assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington, in a press release.
Overall, most countries noted a reduction of diarrheal activity between 2000 to 2015, but the burden of diseases was distributed unequally across the continent.
According to the study, 9.4% of all the severe cases of diarrhea in 2015 occurred in two countries: Ethiopia and the Democratic Republic of the Congo.
Nigeria had the most variance of disease rates among African countries, with estimates ranging from 1.6 deaths per 1,000 children in Bayelsa state in the southwest to 9.5 deaths per 1,000 in Yobe state in the northeast. Certain parts of the Central African Republic, Gabon, Ivory Coast, Nigeria, and Zimbabwe saw disease increases over the 15 years.
The highest diarrhea-related case fatality rates in Africa were in Lesotho , Mali , Sierra Leone , Benin , and Nigeria .
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Problem Burden And Determinants
Globally, four billion episodes of diarrhea were estimated to occur each year, with > 90% occurring in developing countries. Diarrheal disease is an important public health problem among under-five children in developing countries. Total diarrheal deaths in India among children aged 0-6 years was estimated to be 158,209 and proportionate mortality due to diarrhea in this age-group was 9.1%. Average estimated incidence of diarrhea in children aged 0-6 years was 1.71 and 1.09 episodes/person/year in rural and urban areas. According to National Family Health Survey-3 report, 9% of all under-five children were reported to be suffering from diarrhea in last 2 weeks. Studies have shown that the incidence of acute diarrheal diseases was as low as 1 episode/child/year in some urban areas. shows the incidence of acute diarrheal disease in children as reported from studies done across India.
Diarrhea Can Be Caused By Diseases And Other Conditions Namely:
- Infections — most common cause
- The infection is due to either a virus, bacteria, or parasite
- The most commonly identified causes of acute diarrhea in the United States are the bacteria Salmonella, Campylobacter, Shigella, and Shiga-toxin-producing Escherichia coli.
- a condition known as gastroenteritis.
- These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected.
- It may be divided into three types: short duration watery diarrhea, short duration bloody diarrhea, and if it lasts for more than two weeks, persistent diarrhea. The short duration watery diarrhea may be due to an infection by cholera. If blood is present it is also known as dysentery.
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Scope For Future Action
Overall, the steady decline in under-five mortality in a large country like India is laudable however, acceleration through greater investment, focus, and innovation is needed in regions and districts that are doing less well. Inclusion of Rotavirus vaccination of infants into national immunization programs has been recommended in areas where under-five mortality due to diarrheal diseases is > 10%. The vaccine for rota virus has been launched in 62 countries and has been included the national immunization schedule in 11 countries. Though introduction of rotavirus vaccine into the national immunization program of India at an affordable price would be a cost-effective way to reduce morbidity and mortality, there is a need for sufficient and reliable efficacy and effectiveness data from the country.
Apart from improved case management strategies, measures like environmental sanitation, health promotion and preventive practices like breastfeeding and use of clean drinking water are essential to reduce transmission of diarrheal diseases. Addressing other social determinants of health with respect to diarrheal diseases, poverty alleviation efforts in concert with programs to educate women and girls are necessary measures for improving overall children’s health and reducing diarrheal mortality.
Benefits Of Improving Sanitation
Benefits of improved sanitation extend well beyond reducing the risk of diarrhoea. These include:
- reducing the spread of intestinal worms, schistosomiasis and trachoma, which are neglected tropical diseases that cause suffering for millions
- reducing the severity and impact of malnutrition
- promoting dignity and boosting safety, particularly among women and girls
- promoting school attendance: girls school attendance is particularly boosted by the provision of separate sanitary facilities and
- potential recovery of water, renewable energy and nutrients from faecal waste.
A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US$ 5.50 in lower health costs, more productivity, and fewer premature deaths.
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Data Sources And Literature Review: Morbidity
The usual sources of diarrhea morbidity data are either national surveys, such as Demographic and Health Surveys and the United Nations Children’s Fund Multiple Indicator Cluster Surveys , or the published literature.
The main limitation of using currently available national survey data to estimate diarrhea morbidity is the cross-sectional nature of data collection. The information obtained from these surveys is of diarrhea prevalence in the two weeks previous to the survey, which does not account for seasonality. Therefore, data are not comparable either across sites or over time. Moreover, there is a potential for important recall bias in such morbidity surveys . Some of the major limitations of longitudinal studies are lack of representativeness, possible site bias, low frequency of surveillance visits, and recall bias.
Most reviews carried out so far have relied on published studies to estimate the incidence or prevalence of diarrheal disease. Some of the limitations of this type of study are the small number of data points and the lack of representativeness, given the specific sites where most studies are carried out.
The most recent morbidity review included five prospective studies from African countries, carried out between 1987 and 1990: two studies were from the AFR D subregion and three from the AFR E subregion . These studies are listed in .
Main Characteristics of the Studies Included in the Morbidity Review.
Diarrhoea Cases In 2015
- 2.39 billion episodes of diarrhoea
- Almost half of those involved children.
- 1.3 million deaths
- The highest death rates were in Chad and Niger
While deaths from diarrhoea have dropped by just over 20% overall, and 34% in children, the rate of infection has been falling far more slowly.
For children it dropped by just over 10% between 2005 and 2015.
Of all the diarrhoeal diseases, rotavirus remains the biggest killer of under-fives, according to this study.
But death rates for the disease were down by 44% in 2015.
The researchers attribute much of this to a relatively new vaccine.
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Please Add The Profiles For Those Who Died From Diarrhea
Be aware there is also a project for Dysentery
- Dysentery is an intestinal inflammation, especially in the colon, that can lead to severe diarrhea with mucus or blood in the feces.
- Flux is the discharge of large quantities of fluid material from the body, especially the discharge of watery feces from the intestines or hemorrhage. This is an old term frequently used on death certificates. The free dictionary flux& Old Disease Names Frequently found on Death Certificates
Diarrhea, also spelled diarrhoea, is the condition of having three or more loose or liquid stools per day, or as having more stools than is normal for that person as defined by the World Health Organization. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization.
It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and changes in personality. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non watery stools in babies who are breastfed, however, may be normal.
Diarrheal Diseases Are One Of The Biggest Killers Of Children Worldwide
In 2017, almost 1.6 million people died from diarrheal diseases globally.
This is more than all deaths from all intentional injuries combined in the same year: almost 800,000 died from suicide, 405,000 from homicide, 130,000 in conflict, and 26,500 from terrorism in total 1,355,000.1
As the visualization shows, one-third of all who died from diarrheal diseases were children under five years old. For most of the past three decades under-5s have accounted for the majority of deaths from diarrheal diseases back in 1990 it killed 1.7 million children.
Diarrheal disease was the cause of every tenth childs death in 2017 more than half a million of the 5.4 million children that died in 2017 died from diarrheal disease.
Diarrheal diseases are the third leading cause of child mortality globally, falling just behind pneumonia and preterm birth complications.
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The Role Of Interventions To Control Diarrheal Diseases
There is sufficient evidence that several interventions are effective in the prevention and treatment of diarrheal diseases . These interventions are exclusive breastfeeding, complementary feeding, safe water, good sanitation and hygiene, zinc and vitamin A supplementation, ORT, and antibiotics for dysentery. It is estimated that these interventions could prevent 22 percent of deaths due to diarrhea . Most of these interventions are feasible for implementation in low-income countries such as those in the African region however, the capacity to deliver these important interventions effectively should be strengthened . The availability of safe and effective rotavirus vaccines , introduced in several countries in Latin America in 2005 are likely to complement these interventions, if effectively delivered. However, the stability of diarrhea rates observed in all reviews done since the 1980s shows that despite the reduction of diarrhea mortality, most likely through better case management, very little has been done to prevent the transmission of diarrheal diseases. The progress toward better water and sanitation observed in other regions has not yielded a reduction of diarrhea morbidity, suggesting that poor hygiene practices and the ingestion of contaminated food may be the most important factors and where preventive interventions, like handwashing , should be promoted.
Where Are Children Dying From Diarrheal Diseases
The death rate from diarrheal diseases is highest in the worlds poorest countries: this chart shows the relationship between the death rate from diarrheal diseases and the countrys average income.
The death rate from diarrheal diseases in many of the poorest countries is higher than 100 annual deaths per 100,000 children. In those countries with the worst health including Madagascar, Chad and the Central African Republic the rate is higher than 300 per 100,000.
In high-income countries the death rate is very low. In many European countries, but also some rich Asian countries the rate is below 1 per 100,000 per year.
Understanding the cause of disease is important so that we can set our priorities on the interventions and treatments that save most lives.
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