Diarrhoea no longer a major killer in Nigeria

Eight-month-old Opeyemi Lawal started crawling last week. As many crawling children do, she picks things up from the floor and puts them in her mouth. One Saturday morning, her mother noticed that the child had begun stooling and vomiting uncontrollably. By the time little Opeyemi was rushed to the Apapa General Hospital, she was weak and dehydrated. Fluids were immediately ordered to be administered to the child intravenously but all her veins had collapsed. After pricking her in several parts in search of a vein, an erect vein was eventually found on her head. She was diagnosed with diarrhoea.

“I breastfeed her, but when I go to work, I give her other foods,” his 29 year-old mother said, answering the doctor’s questions.

Diarrhoea burden

According to a new report released by UNICEF and the World Health Organization, diarrhoea is the second leading killer of children, killing an estimated 1.5 million each year. Diarrhoea is the condition of having frequent loose or liquid bowel movements and can be caused by bacterial infections, parasites and viral infections like rotavirus. Researchers in Nigeria, however, say that diarrhoea is not the second, but the fourth killer of children after malaria, respiratory infections and HIV/AIDS. Nevertheless, they admit that diarrhoea remains a problem for children due to non-exclusive breastfeeding as was the case with little Opeyemi — poor hygiene and lack of clean water. Former minister of health and paediatrician, Adenike Grange said: “Hardly will you get a baby exclusively breastfed come down with diarrhoea; even after this period, when he/she is introduced to other foods, the immunity acquired will help. World over, paediatricians have found that exclusive breastfeeding in the first six to eight months of life will give a child antibodies that are resistant to rotavirus.”

According to her, diarrhoea is not the second highest killer of children in Nigeria, but respiratory diseases.

“I would rather the country spends money on pneumococcal vaccines, haemophila influenza, than on diarrhoea because diarrhoea is not the second killer of children. There may be a high incidence, but those children don’t die anymore. Let us conserve our funds to deal with cases that don’t have alternatives; diarrhoea has alternatives.”

Need for a vaccine?

A consultant paediatrician at Massey Street Children’s Hospital, Abieyuwa Emopkae, agreed with Dr. Grange, but advocated for the rotavirus vaccine.

“Yes, breastfeeding is effective, but you find that once a child starts crawling, he picks things from the ground and puts them into his mouth. Even in areas where you have clean water, you still get rotavirus because you can pick it up from touch,” he said. “Most children come in contact with [rotavirus] in the first year. You find out that even in developed countries where they have clean water, rotavirus is still the commonest form of infection. The vaccine is important.”

Dr. Emopkae also said that diarrhoea is not the second highest killer of children.

“In our hospital, malaria is the first killer, follow by respiratory infection, then HIV/AIDS and maybe diarrhoea follows. This is because we have, over the years, mastered how to manage diarrhoea using oral dehydration therapy and zinc.”

The UNICEF-WHO report recommends the rotavirus vaccine because it has the potential to reduce up to 40 percent of the hospital admissions that currently result from diarrhoea. But while it is affordable by the standards of developed nations, who bears the cost of supplying it to the millions of children at risk in the developing world. Dr. Grange, however, believes that Nigeria need not spend so much money on vaccines as there are other cost-effective ways of dealing with it.

“Although the vaccine will be good if we get it, but that is spending a lot of money,” she said. “I believe that there are other cost-effective and sustainable ways of dealing with it. For example, keeping the environment clean, getting clean water and using oral dehydration therapy.”