Diarrhoea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. It is most commonly caused by gastrointestinal infections which kill around 2.2 million people globally each year, mostly children in developing countries. The use of water in hygiene is an important preventive measure but contaminated water is also an important cause of diarrhoea. Cholera and dysentery cause severe, sometimes life threatening forms of diarrhoea.
The disease and how it affects people
Diarrhoea is the passage of loose or liquid stools more frequently than is normal for the individual. It is primarily a symptom of gastrointestinal infection. Depending on the type of infection, the diarrhoea may be watery (for example in cholera) or passed with blood (in dysentery for example).
Diarrhoea due to infection may last a few days, or several weeks, as in persistent diarrhoea. Severe diarrhoea may be life threatening due to fluid loss in watery diarrhoea, particularly in infants and young children, the malnourished and people with impaired immunity.
The impact of repeated or persistent diarrhoea on nutrition and the effect of malnutrition on susceptibility to infectious diarrhoea can be linked in a vicious cycle amongst children, especially in developing countries.
Diarrhoea is also associated with other infections such as malaria and measles. Chemical irritation of the gut or non-infectious bowel disease can also result in diarrhoea.
Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. It is more common when there is a shortage of clean water for drinking, cooking and cleaning and basic hygiene is important in prevention.
Water contaminated with human faeces for example from municipal sewage, septic tanks and latrines is of special concern. Animal faeces also contain microorganisms that can cause diarrhoea.
Diarrhoea can also spread from person to person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation, and fish and seafood from polluted water may also contribute to the disease.
The infectious agents that cause diarrhoea are present or are sporadically introduced throughout the world. Diarrhoea is a rare occurrence for most people who live in developed countries where sanitation is widely available, access to safe water is high and personal and domestic hygiene is relatively good. World-wide around 1.1 billion people lack access to improved water sources and 2.4 billion have no basic sanitation. Diarrhoea due to infection is widespread throughout the developing world. In Southeast Asia and Africa, diarrhoea is responsible for as much as 8.5% and 7.7% of all deaths respectively.
Scope of the Problem
Amongst the poor and especially in developing countries, diarrhoea is a major killer. In 1998, diarrhoea was estimated to have killed 2.2 million people, most of whom were under 5 years of age (WHO, 2000). Each year there are approximately 4 billion cases of diarrhoea worldwide.
Key measures to reduce the number of cases of diarrhoea include:
- Access to safe drinking water.
- Improved sanitation.
- Good personal and food hygiene.
- Health education about how infections spread.
Key measures to treat diarrhoea include:
- Giving more fluids than usual, including oral rehydration salts solution, to prevent dehydration.
- Continue feeding.
- Consulting a health worker if there are signs of dehydration or other problems.
WHO(2000) Global Water Supply and Sanitation Assessment. World Health Organization. Geneva
The World Health Report 2000, World Health Organization (WHO), Geneva
Prepared for World Water Day. Reviewed by staff and experts in Family and Community Health Unit (FCH), and the Water, Sanitation and Health Unit (WSH), World Health Organization (WHO), Geneva.