Diarrhea in Developing Nations

Diarrhea is a major cause of death in much of the world, particularly in developing nations, where the effect is greatest among the young. The World Health Organization (WHO) attributes 3.5 million deaths a year to diarrhea, with 80 percent of these deaths occurring in children under the age of five, and most occurring in children between six months and three years of age. Children are the most susceptible because a smaller amount of fluid prevalence: describing the number of cases in a population at any one time acute: rapid-onset and short-lived chronic: over a long period asymptomatic: without symptoms dehydration: loss of water intestines: the two long tubes that carry out the bulk of the processes of digestion nutrient: dietary substance necessary for health bowel: intestines and rectum toxins: poison electrolyte: salt dissolved in fluid acidosis: elevated acid level in the blood shock: state of dangerously low blood pressure and loss of blood delivered to the tissues socioeconomic status: level of income and social class socioeconomic status: level of income and social class

CAUSES OF DIARRHEA

Causes

Examples

Viral infections Bacterial infections Parasites

Helminths (intestinal worms) Allergic

Rotavirus, Norwalk virus

E. coli, Vibrio cholerae, Campylobacter, Shigella

Giardia, Entamoeba

Strongyloides

Lactose intolerance, celiac sprue, medication side effects

Ulcerative colitis, Crohn's disease Pancreatic deficiency, biliary disease

Zinc deficiency, vitamin A deficiency, enteral feedings consisting of liquid nutritional formulas delivered straight to the bowels

Irritable bowel syndrome, short bowel syndrome, cancer

Autoimmune

Malabsorptive

Nutritional

Functional energy: technically, the ability to perform work; the content of a substance that allows it to be useful as a fuel malnutrition: chronic lack of sufficient nutrients to maintain health absorption: uptake by the digestive tract immune system: the set of organs and cells, including white blood cells, that protect the body from infection malnourished: lack of adequate nutrients in the diet zinc: mineral necessary for many enzyme processes catabolism: breakdown of complex molecules protein: complex molecule composed of amino acids that performs vital functions in the cell; necessary part of the diet undernutrition: food intake too low to maintain adequate energy expenditure without weight loss calorie: unit of food energy wean: cease breastfeeding loss is necessary to result in significant dehydration, because they have fewer internal resources, and because their energy requirements are higher.

Children in developing nations suffer from an average of four cases of diarrhea a year. Most of these cases are infectious diarrhea. Infectious diarrhea also contributes to malnutrition due to a decreased nutritional intake and diminished absorption of vital nutrients during the acute episode and recovery period. Malnutrition, in turn, decreases the ability of the immune system to fight further infections, making diarrheal episodes more frequent.

Studies have shown that poor nutritional status can double the risk of contracting diarrhea when exposed to an infectious agent. In addition, the duration of the acute episode can be up to three times as long in malnourished children. In addition, reduced immunity and deficiencies of nutrients such as vitamin A and zinc, which are common in malnourished individuals, can increase the health risks from diarrhea. Diarrhea also causes decreased appetite and food intake, decreased absorption of nutrients from the food that is ingested, and increased catabolism of body proteins. The resulting undernutrition stunts future mental and physical development.

Eating patterns before and after diarrheal episodes play an important role in this cycle. In developing countries, environmental factors, such as pervasive bacterial contamination of water used for drinking, cooking, and cleaning, contribute to continued exposure to agents that cause diarrhea. Maternal practices related to feeding are also a factor. Reduced breastfeeding rates in developing nations mean that fewer children receive the protective and nutritional benefits of breast milk. Nursing allows for the delivery of milk high in fats, proteins, and calories in a sterile fashion. When illness causes mothers to wean their children too early, nutritious breast milk is replaced with cereals and gruels that are often low in calories and proteins and are made with contaminated water. Commercial formulas are also often diluted with contaminated water and put in bottles that are not sterile.

A lack of maternal education often leads to the common practice of withholding food during acute episodes of diarrhea out of fear that eating will exacerbate the symptoms. Because of the nutritional losses from diarrhea, children actually need up to a 30 percent increase in calories and a 100 per-

cent increase in protein intake during the acute and recovery stages of diarrhea. Studies have shown that children who receive increased nourishment during this time suffer less from the acute and long-term effects of diarrhea. The WHO recommends the continuation of breastfeeding throughout an acute episode, as well as the use of mixed food cereals high in calories and protein. There is also evidence to support zinc supplementation, which can reduce the morbidity rates from diarrhea. morbidity: illness or accident

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