Diarrhoea deaths top among children in Nagaland

Our Reporter
Dimapur, Jan. 10 (EMN): Diarrhoea in children is a leading cause of death in many parts of the world and is one of the most dangerous diseases in childhood killing millions every year, stated Dr. Apong Longchar, a child specialist at Nikos Hospital and Research, Dimapur.

Having knowledge about diarrhoea and how to tackle the dehydration caused by severe diarrhoea could help save many children from this very common but often deadly disease, he added. diarrhoea, he said, causes rapid loss of water and salts from the body leading to dehydration, adding that dehydration leads to impairment of function of kidney, brain, heart and other organs.

Providing a chart on stool frequency, he informed that normal stool frequency in Indian children are 0-1 month about 5-6 stool/day; 1-3 months about 3-4 stool/day; 4-6 months 2 stool/ day; 7-24 months 1-2 stool/day and 1-18 years 1 stool/ day. This is the average number of daily stools as rounded off from available Indian studies. Some children could pass more or less than the number and may still be normal, he said.

‘When a child has diarrhoea, one should keep in mind to replace the water and salt loss with Oral Rehydration Solution (ORS), which is recommended by the World Health Organisation (WHO). Also, zinc can be provided according to the age of a child. For 6 months and above – 20 mg per day; and age less than 6 months -10 mg per day; to be given once a day for 14 days. Even a child with serious diarrhoea recovers within 5-7 days but zinc is to be given for 14 days as it is an immune booster and helps to control diarrhoea as well and prevent recurrence for around three months,” he emphasised.

He also observed that many people choose to take antibiotics, which is not recommended adding that antibiotics do not work in viral diarrhoea or viral fever. He explained that antibiotics should be given when a child has bacterial dysentery, diarrhoea with pneumonia, diarrhoea with ear infection, diarrhoea with urine infection. He also cautioned that antibiotics should be given as per the age and weight of a child with consultation from a doctor.

“As per my experience I have seen most of the people taking O2 antibiotic but most of the pediatricians do not use this as it is an irrational combination so I appeal to the people to understand that this antibiotic is not a specific antibiotic against diarrhoea.  Probiotics may be used when available,” he recommended.

During diarrhoea, he advised not to restrict food but give small frequent light meals as children who eat recovers faster and regain normal health earlier.

Salter rice water and dal water, lassi, coconut water and vegetable soups can be given to a child. Carbonated drinks, fruit juice, glucose solution, coffee and tea and high sugar drinks should be avoided as these increase diarrhoea.

The mild dehydration symptoms in a child with diarrhoea are irritation, thirst, dry tongue and skin; while the severe symptoms are lethargy, sunken eye, stool with blood, decreased urine, hands and feet become cold, weak pulse and repeated vomiting. When a child shows these danger signs, he/she should be immediately taken to a doctor, Longchar warned.

Diarrhoea is a problem of the gut and infection occurs through the oral route. He therefore advised hygiene as an important practice to prevent diarrhoea. Rotavirus vaccine starting from six weeks of age should be given to a child to prevent diarrhoea, he added.

Dr. Chuba Kumzuk, LCR (MD), a pediatrician at Nagaland Multispecialty Dimapur told Eastern Mirror that most episodes of acute diarrhoea were self-limited. Speaking on the usage of antibiotics by most of the people, he pointed out that routine antimicrobial therapy is not required and is limited to episodes that have gross blood in stools, culture positive shigella infection, vibrio cholera with severe dehydration, diarrhea due to giardia or E histolytica and associated non-gastrointestinal systemic infections.

‘For instance, in a case of cholera, antimicrobials like doxycycline and ciprofloxacon can be used. For dysentery and giardiasis, ciprofloxacin ,metronidazole or tinidazole can be used as suggested by the physician,’ he said.

The pediatrician further said that vomiting often precedes or is associated in most children with acute gastroenteritis, therefore antiemetics like domperidone or ondansetron can be used as and when required. Prebiotics and probiotics like Bacillus Clausii are an add-on therapy that shortens the duration of diarrhoeal episodes.