The Threat of Diarrheal Diseases

BY;MY ENVIRONMENT

Diarrhea may not seem deadly to Westerners who have access to improved sanitation. Nevertheless, it kills three-quarters of a million children every year, more than malaria, AIDS, and measles combined. The chief danger of diarrheal diseases is the loss of bodily fluids. “You get very weak within hours, and in fact you die of dehydration,” Sutton says. Worldwide, diarrheal diseases are the second leading cause of death of children under age 5 years and cause 40% of child deaths in the early stages of a humanitarian emergency, sometimes more

Disaster situations are prime settings for disease outbreaks: Limited water tends to go first to drinking and cooking, while hygiene gets short shrift, especially among people who are just being taught the connection between hygiene, sanitation, and health.If it’s too far to walk, people will only collect a very small amount of water,” says Sutton. “They’ll use it for drinking and cooking and won’t have enough water to practice good hygiene.”

But access to water isn’t enough; health-protective behaviors are critically important. Worldwide, only 19% of people on average are estimated to wash their hands with soap after defecating  Yet studies consistently show that handwashing with soap is effective at reducing diarrheal diseases; one systematic review of the literature estimated it reduces risk by 23–40%,9 while another estimated a 48% reduction.

Although workers can install latrines and teach the value of handwashing and latrine use, only the refugees themselves can choose to change their behaviors. And that means changing social norms. Open defecation is common practice in developing nations. Handwashing is often done without soap, and cultural traditions such as eating with the hands and sharing plates can spread infectious diseases.

“You need to understand the ‘F diagram,’” says Sutton, referring to the traditional schematic that sketches out all the fecal–oral disease transmission pathways (see figure). Feces, and whatever infectious agents are contained within it, can spread through fluids, fingers, flies, and the fields in which people defecate and/or grow crops. By not washing properly or keeping food in hygienic conditions, fingers, fluids, and flies can also contaminate food.

Drinking, bathing, and cooking with unclean water sources can cause illness as well. Surface waters are likely to be contaminated with fecal pathogens, especially during the rainy season when rainwater washes feces into waterways.