We can prevent infant mortality from acute diarrhea


Diarrheal diseases are one of the five leading causes of death in children under three years of age and although it is preventable and treatable, each year it kills around 760,000 children under the age of five in the world and is the leading cause of malnutrition in this age group.

Although there are several factors involved in the occurrence of the disease, the most frequent is viral infection at any time of the year, it is one of the problems that young children face in nurseries and schools.

In an interview, Dr. Sarbelio Moreno Espinosa, an infectious disease pediatrician, assures that in our country diarrhea goes hand in hand with full access to health services, therefore it has to do with poverty. “Although a significant decrease in morbidity has been achieved, mortality still persists, as long as there are people who live in unfavorable situations, the disease will continue to exist, but mortality must definitely disappear due to this cause.”

The example, he said, is rotavirus, a disease that the specialist calls “democratic”, because the incidence is the same in industrialized countries as in developing countries, what changes is the prognosis. “Now we have removed that rotavirus distractor because we have an effective vaccine and the other causes of viral diarrhea are important, but not fatal like rotavirus.”

He explains that the diarrheas that persist and endanger life are invasive, that is, bacterial, these are associated with the lack of drainage, cleanliness, lack of hand washing, many times due to issues of access to water. “As long as these circumstances exist, the diarrhea will continue.”

He assures that it is very difficult for an adult to become severely dehydrated, in a child 80% of his body composition is water, against 60% in an adult, with a mature cardiovascular system and who can pump blood adequately, a small child with two or three evacuations he becomes dehydrated and compromises his life. “The adult’s immune system is already fully formed, it is rare for it to form a bacteremia (bacteria going into the bloodstream causing a serious infection) from diarrhea, while for a child this is very possible. The same happens with a large intestine, which is not so easy to be perforated by diarrhea in an adult person, than in a minor”.

The time of year is also a factor that aggravates the problem, with the hot season gastrointestinal infections increase by up to 90%, due to high temperatures that cause faster food decomposition.

Now that the pandemic has subsided, many people are also on the streets or have activities outside their home, and generally consume food that they buy in stores, where they do not know if they were hygienically prepared. With this background, bacteria grow a little faster and that could be conditioning the increase at this time of year.

According to the specialist, diarrhea is a preventable problem from several sides:

  • Direct prevention, with vaccination against rotavirus. “Another cause of frequent diarrhea is a norovirus, for which there is a vaccine in some countries, but it is difficult to do because it is a very diverse virus and since it does not have so much mortality, the cost-benefit ratio is difficult to establish as part of the vaccination in developing countries. growth”.
  • Health care promotion. Hygiene and means of sanitation are key to avoiding the problem. Frequent washing, disinfection, drainage services, among others. Just proper hand washing with soap and water can reduce cases of diarrhea by more than 40%. However, to achieve this, it is necessary to educate the population about the correct washing technique, the cases in which it should be carried out and the frequency. These can be simple programs, but with high impact, for example, the program restoring lives, fighting against diarrhea, of Sanofi CHC and Save the Children (SCMx), has sought to bring sanitization kits, educational and recreational activities that seek to amplify the message.
  • Regulation of antibiotic consumption. Because now that we no longer have such serious infectious diarrhoea, we are left with those secondary to antibiotics and that has to be mainly medical education, so as not to medicate with antibiotics.

In this sense, Moreno Espinosa explains that as a cornerstone we must be aware that an antibiotic is rarely required and that it can affect our microbiota, which we can define as an organ, “just as the digestive system is, we have these bacteria that if we put them all together, we would have the volume of the vessel or the pancreas and have specific functions (production of vitamins, receptors for neurotransmitters and elements of the immune system)”.

For each human cell we have 10 bacteria in the body, the intestinal microbiota produces substances that favor the mobility of the intestine, it produces substances that prevent the cells from migrating to cancer, that they have a good metabolism and absorption, that gas is not produced in excess, it has many functions that we are unaware of and become evident the moment we lose it. Today it is estimated that we know only 30% of the microbiota and 10 to 15% of its functions, hence its importance. For this reason, it is also important to promote the balance of the intestinal microbiota through probiotics such as Bacillus clausii.

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