Saturday Features

Dying of diarrhea

  • ‘Each child that dies of a vaccine-preventable illness is a tragedy’
- Manish Gautam
In 2003, an estimated 500 rotavirus deaths among children under five were recorded in Nepal. And rotavirus was responsible for approximately one in every three diarrhea deaths among children

Jun 24, 2017-Each year, during wet monsoons or the cold, dry winter, parents flock to the emergency and OPD units at the Kanti Children’s Hospital, infants afflicted with severe diarrhea in tow. During these two “peak” diarrhea seasons, the gaunt and haggard faces of the children and those of anxious parents fill up the wards and corridors.

These images are a common sight for Dr Ajit Rayamajhi, former director of the Hospital. Yet, he is fully aware that a distressing number of these hospitalisations could have been drastically reduced and easily prevented in the first place. According to Dr Rayamajhi, up to 39 percent of the diarrheal cases are caused by rotavirus, a killer disease in the country, which can be prevented through vaccination.

In 2013, rotavirus killed approximately 215,000 children under the age of five worldwide. That very year, an estimated 500 rotavirus deaths among children under five in Nepal were recorded. And rotavirus was responsible for approximately one in every three diarrhea deaths in Nepal among children.

A study published in the Journal of Nepal Health Research Council (2012) showed that among the patients linked to rotavirus that were directly admitted to the hospital, its prevalence is most common among children aged under two.

According to physicians, rotavirus causes gastroenteritis—an inflammation of the stomach and intestines. It primarily infects the small intestine, destroying the surface tissue and in turn preventing the absorption of nutrients which leads to diarrhea.

Typical symptoms can range from mild, watery diarrhea to severe ones accompanied by vomiting and fever.

Because the virus can cause moderate to severe dehydration, access to oral rehydration therapy (ORT) is vital while treating even the mildest of infections. And when the condition worsens the children ideally need an access to IV fluids.

However, with myths associated to diarrhea—drinking Oral Rehydration Solutions and fluids only exacerbates the condition—still prevalent, the possibility of children languishing in their own houses and perishing without any access to treatment poses as great threat.

The problem, however, goes beyond just access to timely medical attention. Say, even if the child is treated on time, the infected intestine takes around two months to recover. This means the intestine will fail to absorb important nutrients, which in turn can stunt their growth.

The Rota Council states that “children who suffer from an episode of moderate-to-severe diarrhea—from infections like rotavirus—are weakened and malnourished. They are more susceptible to the next illness that strikes, and have a more than eight-fold increase in their risk of death from any cause in the two to three months following an episode of diarrhea.”

The cost associated with the disease is equally troublesome. Studies in Bangladesh and Malaysia have shown that a significant portion of a family’s monthly income is spent on treatment. In Bangladesh, treating just one episode of rotavirus can amount to nearly 85 percent of the average family’s monthly income. These international findings resonate with Nepal as well. Unfortunately, the out-of-budget expenditure related to the disease only push people further into poverty.

Fortified future

“Rotavirus kills around 200,000 children each year, and gets millions of children hospitalised,” says Dr Mathuram Santosham, Professor of International Health and Pediatrics at the John Hopkins University in the United States. He adds, “In Asia alone, more than 170 children die each day due to the virus. Vaccines are the best way to prevent rotavirus-induced diarrhea.

“Currently, 92 countries have introduced rotavirus vaccines nationally or sub-nationally. The use of rotavirus vaccine has resulted in swift and significant decline in hospitalisation and deaths across many countries. But, that’s not enough because every child deserves access.”

Dr Santosham, also the Chair of ROTA Council—a dedicated team of technical experts working to accelerate the introduction of rotavirus vaccines—says that each child that dies of a vaccine-preventable illness is a tragedy.

Countries that have administered vaccine for rotavirus have witnessed rapid reduction in cases associated to hospitalisation linked to the disease. In Ghana, 65 percent reduction was reported; with 83 percent in Kenya, and 70 percent in Rwanda, among others.

Recent studies conducted in Nepal have also recommended that effective interventions for rotavirus would include administering the vaccine. And efforts are underway. A national hospital-based surveillance for rotavirus associated diarrhea has been on-going for last five years while monitoring of side-effects associated to the introduction of the vaccine is also underway. “The evidence obtained will help government make informed choices regarding the rotavirus vaccine and its potential adverse effects,” said Dr Rayamajhi.

Meanwhile, government officials have said that the Child Health Division of the government has planned to introduce the vaccine starting this year. Yet experts, like Dr Rayamajhi, urge that accelerating the introduction of the rotavirus vaccine should become a top priority—prevent the loss of hundreds of infants who would otherwise needlessly perish.

Published: 24-06-2017 08:40

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