Related Print Articles
Seema Alam, Rajeev Khanna, Uzma Firdaus
Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh.
Corresponding Author: Dr Seema Alam, Reader, Department of Pediatrics, JN Medical College, AMU, Aligarh, UP. Email: email@example.com
Diarrhea is one of the most common causes of morbidity and mortality in children all over the world especially in developing countries. The median global incidence of diarrhea was 5 and 2.6 episodes per child per year in infants (6-11months) and for all children between 0-4 years respectively 1. Much higher rates are seen in children from low socioeconomic status. In India there has been an improvement in the situation from 6 diarrheal episodes per child per year in infants in 1984-85 to 2-3 episodes per child per year a decade later 1 . In 1980 it was estimated that 4.6 million children under 5 years age die annually due to diarrhea . Ten years later, the annual number of deaths attributable to diarrhea was estimated to be 3.3 millions which in 2000 was estimated to be 1.6- 2.5 million 1 . Median global mortality is highest among infants (8.5 per 1000 live births) while for children aged 1-4 years it was 4.6 deaths per 1000 live births 1 . Median global percentage of deaths due to diarrhea in 0-5 years is 21 % in the decade 1990-2000 1 . As evident from the developed countries effective interventions, including correct management (ORT, continued feeding and antibiotic in case of dysentery), promotion of exclusive breast-feeding, better weaning practices, improvement in socioeconomic and literacy status have the potential of reducing the diarrheal diseases. As is evident from Table 1 mortality rates have fallen substantially over the last few decades. In contrast incidence of diarrhea has remained stable, which is a worrying factor as multiple episodes have a harmful effect on physical growth and cognitive functions.
Table 1: Diarrheal estimates in children of developing countries
The causes of childhood diarrhea vary with location, season and population. With the advent of AIDS, various enteric pathogens are now being associated with diarrheal diseases. In a report 4 presented to World Health Organization in October 2002 a database was prepared on the proportion of diarrheal illness caused by each diarrheal pathogen, at the community and health facility level for each of the WHO regions and 14 sub-regions. This was done for the under-five children in the period 1990-2000. Table 2 represents the global and SEARO D ( India , Bangladesh , Myanmar and Nepal ) region data. According to the study globally ETEC was the main cause of diarrhea in the community while rotavirus infection was of major concern at the facility level. On the other hand in the Indian subcontinent mixed infections are one of the major problems at the community level and outpatient level while rotavirus is causing almost one fifth of all cases at the inpatient level
Table 2: Median percentages of diarrheal illness caused by various Enteropathogens in diarrhea of below five years at the community and facility level (1990 to 2000).
|Previous Print Article||Next Print Article|