Booklet 4: Diarrhoeal Disease

In South Africa, it is the major single cause of death of young children in the poorest communities. The major cause of death is dehydration, resulting from loss of fluid and salts (electrolytes). Repeated attacks of diarrhoea affect the child's growth and development, and cause a deterioration in the nutritional state, which in turn leads to further recurrences of diarrhoea. Diarrhoea is more common in poorer communities due to contamination of the environment, inadequate or unhygienic water supplies, inadequate or non-existent sanitary facilities, and over-crowded housing. Transmission to the individual occurs through poor domestic and personal hygiene, lack of education, bottle rather than breast-feeding, and improper preparation and storage of weaning foods. Malnutrition and infection outside the gastro-intestinal tract may also cause diarrhoea. Parasites cause fewer than 5% of cases of diarrhoea, with the most important parasites being protozoa. Entamoeba histolytica causes amoebic dysentery, while Giardia lamblia causes watery diarrhoea and malabsorption. Cryptosporidium causes long-continued watery diarrhoea, particularly in children who are immune-suppressed or HIV infected. Assessment of diarrhoea involves identifying danger signs, which include inability to drink or breastfeed, vomiting everything, convulsions, lethargy or unconsciousness, and convulsing at present. A child with any danger sign needs urgent attention and referral. Dehydration is assessed by determining the severity of loss of fluids and salts, which can be done by offering fluids to drink, assessing thirst, and looking for signs of dehydration such as sunken eyes, dry mouth and tongue, and breathing deep and rapid. The main danger in diarrhoeal disease is loss of fluids and salts, and dehydration can be classified as severe, some, or no dehydration. Severe dehydration is indicated by a raised skin fold that stays raised for several seconds, a slow pulse, and poor circulation. Some dehydration is indicated by a skin fold that takes a second or two to disappear, and a normal pulse. No dehydration is indicated by a skin fold that flattens immediately, and a normal pulse. In assessing a child with diarrhoea, such as Sandra, a nurse would first determine if there are any general danger signs. If there are no danger signs, the nurse would then assess the child for dehydration by determining the severity of loss of fluids and salts. This can be done by offering fluids to drink, assessing thirst, and looking for signs of dehydration such as sunken eyes, dry mouth and tongue, and breathing deep and rapid. The nurse would also ask questions to determine if the child has had diarrhoea for a long time, if there is blood in the stools, and if the child is able to drink.