Diarrhoea in Infants Requires Urgent Attention

Diarrhoea remains one of the leading causes of death, ill health and disability among children under five years of age in developing countries,¹ accounting for 19% of deaths of under-fives in South Africa and for 46% on the African continent.¹ Globally, diarrhoea is the second leading infectious cause of death, accounting for 9.2% of deaths in under-fives.¹

The high incidence of malnutrition in South Africa² adds to this toll. The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea may lead to malnutrition, while malnutrition may aggravate the course of diarrhoea.³ Diarrhoea is more common and more severe in children with malnutrition (ie, undernutrition), and malnourished children often have persistent or repeated diarrhoea.⁴ In addition, malnourished children are more likely to develop severe diarrhoea and die from it.⁴ Vulnerable groups such as pregnant women and children under five years of age are the most affected by malnutrition, especially in rural areas.⁵

Identifying children at risk

The Centres for Disease Control advises that caregivers should be trained to recognise signs of illness or treatment failure that necessitate medical intervention.⁶ Infants with acute diarrhoea are more prone to becoming dehydrated than older children,⁶ and healthcare workers or parents of infants with diarrhoea should promptly seek medical evaluation as soon as the child appears to be in distress. Reports of changing mental status in the child are of particular concern.⁶

When the child’s condition is in doubt, immediate evaluation by a healthcare professional is recommended.⁶ Clinical examination of the child provides an opportunity for physical assessment, including vital signs, degree of dehydration, and a more detailed history, and for providing better instructions to the caregivers.⁶

Treatment

The treatment emphasis for acute diarrhoea in children is the prevention and management of dehydration, electrolyte abnormalities and comorbid conditions.³ The objectives of diarrhoeal disease management are to prevent weight loss, encourage catch-up growth during recovery, shorten the duration and decrease the impact of the diarrhoea on the child’s health.³

A number of studies have shown that probiotics shorten the duration of diarrhoea and prevent recurrence of other episodes.⁷ Furthermore, probiotics can prevent diarrhoea from infection in infants with malnutrition.⁷

Momeena Omarjee, Consumer Healthcare Country Head: Scientific Affairs, at Sanofi South Africa says: “Good gut health is crucial for one’s wellbeing – and healthcare professionals should encourage parents to give children a daily, regular probiotic which could go a long way in preventing diarrhoea and illness.”

How can the risk of diarrhoea be reduced?

Breastfeeding, a clean safe water supply, appropriate hand-washing and good sanitation will prevent most cases of diarrhoea.⁸

Research shows that diarrhoea is closely linked to socioeconomic status and has the most adverse effects in South Africa’s impoverished communities.⁹ South African children living in poverty are approximately 10 times more likely to die from diarrhoea than their more privileged counterparts.⁹

Says Omarjee: “Many of these under-privileged children in South Africa do not have adequate access to clean, potable water and quality early childcare and development, and they experience limited access to health and nutrition services. KwaZulu-Natal (KZN), for example, is experiencing outbreaks of diarrhoea and other water-borne diseases due to the recent floods.”

Although government and NGOs have been working tirelessly to distribute clean, potable water to affected areas in the province, many communities continue to face challenges and intervention is needed to not only provide clean water to the communities, but also to manage the high risk of diarrhoea and related water-borne diseases.

“Sanofi has therefore embarked on an ambitious campaign, in partnership with a non-profit organisation, Save the Children South Africa, from October 2022 to assist these areas in need, and to impact over 2,000,000 lives through hygiene education and access to water,” says Omarjee.

Sanofi, working together with Save the children South Africa, will donate water tanks to Early Childhood Care and Development (ECCD) centres in the communities identified, based on Save the Children’s baseline assessment, and will ensure access to clean, potable water.

The provision of information, counselling, education and support to children and their caregivers is also limited, which translates into low use of services and uptake of practices promoting good health. Education campaigns on healthy hygiene habits will be rolled out to children and their caregivers and will be run through the Child Health Awareness Days (CHAD) events, training of ECCD centres practitioners, and community health workers.

Sanofi is committed to ensuring that no child dies of a preventable disease, especially when there are effective treatments available. Says Omarjee: “Healthcare professionals need to encourage parents and caregivers to act promptly and seek assistance when instances of diarrhoea in children under age five do not abate swiftly.”

1. Awotione, O.F., et al. 2016. Systematic review: Diarrhoea in children under five years of age in South Africa (1997-2014). Tropical Medicine and International Health, 21(9), 1060-1070.
2. Cleary, K. 2020. In-depth: The long shadow of malnutrition in South Africa. Available from: https://www.spotlightnsp.co.za, accessed 29 September 2022.
3. Nel, E. 2010. Diarrhoea and malnutrition. South African Journal of Clinical Nutrition, 23, suppl 1, 15-18.
4. Child Healthcare. n.d. What is the relationship between diarrhoea and malnutrition? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
5. Govender, L., et al. 2021. Assessment of the nutritional status of four selected rural communities in KwaZulu-Natal, South Africa. Nutrients, 13(9), 2920.
6. Centers for Disease Control. 2003. Managing acute gastro-enteritis among children. MMWR, 52(RR16), 1-16.
7. Solis, B. et al. 2002. Probiotics as a help in children suffering from malnutrition and diarrhoea. European Journal of Clinical Nutrition, 56, S57-59.
8. Child Healthcare. n.d. How can the risk of diarrhoea be reduced? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
9. Chola, L., et al. 2015. Reducing diarrhoea deaths in South Africa: costs and effects of scaling up essential interventions to prevent and treat diarrhoea in under five children. BMC Public Health, 15, 394.