Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-13T12:18:06.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Diarrhoeal disease in early childhood: experiences from Sierra Leone

Published online by Cambridge University Press:  06 April 2009

M. Hodges
M. Hodges
Affiliation:
St Andrew's Clinics for Children(STACC), PO Box 919, Freetown, Sierra Leone
Get access Rights & Permissions [Opens in a new window]

Summary

In the Freetown area of Sierra Leone, the proportion of children under five years of age dying from diarrhoea-associated conditions has decreased since the 1970s from 4% to 3%. This reduction relates to children between 12 months and 5 years; deaths associated with diarrhoeal disease in infancy do not appear to have decreased significantly. Currently, 2% of children die in infancy and a further 1% before their fifth birthday from diarrhoeal diseases. Thirty-one percent of short-term growth-faltering in children under five years of age is attributed to diarrhoeal disease. Reasons for improvement in mortality may include the implementation of a National Diarrhoeal Diseases Control Programme and improved case management; some 55% of cases of acute diarrhoea in Freetown now receive oral rehydration therapy. Morbidity and mortality are influenced by the seasons. This is likely to be related to the fact that the nutritional status of children shows a significant deterioration in the early rainy season. At this time incidence of severe diarrhoea warranting hospital admission and diarrhoea mortality rates in hospital and at a Rehydration Center increased significantly. On the other hand, the presentation of dehydrating diarrhoea is greatest in the driest months of the year. Progress in the rural areas of Sierra Leone may not have been so evident although 60% of the population now have access to primary health units within 4 miles and efforts to increase host resistance have included the measles immunization programme which currently protects 60% of under-fives nation-wide. Efforts to reduce the transmission of pathogens have meant increasing access to safe water to 22% and to improved sanitation to 35% in rural areas of Sierra Leone. The sustainable prevention and control of diarrhoeal diseases in developing countries depends also upon increasing levels of adult literacy especially of women.

Keywords

Diarrhoeal diseasesinfant mortality rateSierra Leone.
Type
Research Article
Information
Parasitology , Volume 107 , supplement S1: Human nutrition and parasitic infection , January 1993 , pp. S37 - S51
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

ACC/SCN (1989). Malnutrition and infection: a review by Tomkins, A. and Watson, F.United Nations ACC/SCN State-of-the-Art Series Nutrition Policy Discussion Paper 5. Geneva: World Health Organisation.Google Scholar
Alcorn, N., Peason, D., Crompton, D. W. T. & Hodges, M. (1993). Prevalence of intestinal helminths amongst children aged 1–4 years in Moyamba district, Sierra Leone. Journal of the Sierra Leone Medical & Dental Association (in press).Google Scholar
Alghali, S. T. O., Gage, G. N., Bockarie, A. & Collier, H. E. (1990). Schistosomiasis in Sierra Leone, a longitudinal study of its epidemiology in Moyamba district, Southern Province. Department of Community Health, University of Sierra Leone: IDRC Project No. 3-P-86–0129, p. 41.Google Scholar
Ashford, R. W., Barnish, G. & Viney, M. E. (1992). Strongyloides fuelleborni kellyi: infection and disease in Papua New Guinea. Parasitology Today 8, 314–18.CrossRefGoogle ScholarPubMed
Ashworth, A. & Feachem, R. G. (1985 a). Interventions for the control of diarrhoeal disease among young children: improving lactation. World Health Organisation Centre for Diarrhoeal Diseases. Report no. 85,2.Google Scholar
Ashworth, A. & Feachem, R. G. (1985 b). Interventions for the control of diarrhoeal disease among young children: prevention of low birth weight. Bulletin of the World Health Organisation 63, 165–84.Google ScholarPubMed
Ashworth, A. & Feachem, R. G. (1986). Interventions for the control of diarrhoeal disease among young children: growth monitoring. World Health Organisation Centre for Diarrhoeal Diseases. Report no. 86, 1.Google Scholar
Awosika-Sekoni, O. G. (1987). The prevalence of intestinal helminthiasis among children of Fourah Bay College, Freetown. Dissertation for Diploma in Community Medicine and Health, University of Sierra Leone.Google Scholar
Bamako Initiative, Sierra Leone. UNICEF (1990). Improved health, nutrition and sanitation through commuity-orientated MCH/PHC interventions 1990–95. Ministry of Health, Government of Sierra Leone.Google Scholar
Bayoh, M. N. (1991). The prevalence of geohelminthiases among children aged 4–12 years in some parts of Freetown, Sierra Leone. Dissertation for BSc in Zoology, University of Sierra Leone.Google Scholar
Bhan, M. K., Raj, P., Levine, M. M., Kaper, J. B., Bhandari, N., Srivastava, R., Kumar, R. & Sazawai, S. (1989). Enteroaggregative E. coli associated with persistent diarrhoea in a cohort of rural children in India. Journal of Infectious Diseases 159, 1061–4.CrossRefGoogle Scholar
Briend, A. (1990). Is diarrhoea a major cause of malnutrition among the under-fives in developing countries? European Journal of Clinical Nutrition 44, 611–28.Google Scholar
Brown, K. H., Gastanaduy, A. S., Saavedra, J. M., Lembcke, J., Rivas, D., Robertson, A. D., Yolken, R. & Sack, B. (1988). Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhoea in children. Journal of Pediatrics 112, 191–200.CrossRefGoogle Scholar
Brown, R. C. & Girardeau, M. H. E. (1977). Transmammary passage of Strongyloides spp. larvae in the human host. American Journal of Tropical Medicine and Hygiene 26, 215–19.CrossRefGoogle Scholar
Chandra, R. K. (1983). Malnutrition and immunocompetence: an overview. In Acute Diarrhoea: Its Nutritional Consequences in Children (ed. Bellant, J. A.), pp. 131–50. Vevey: Nestle's; New York: Raven Press.Google Scholar
Claeson, M. & Clements, M. L. (1989). Ridding the world of hydroxyquinolines. British Medical Journal 299, 527–8.CrossRefGoogle ScholarPubMed
Claeson, M. & Merson, M. H. (1990). Global progress in the control of diarrhoeal disease. Paediatric Infectious Disease Journal 9, 345–55.CrossRefGoogle Scholar
Clemens, J. D., Sack, D. A., Harris, J. R., Loon, F. van, Chakraborty, J., Ahmed, F., Rao, M. R., Khan, M. R., Yunus, M. D., Huda, N., Stanton, B. F., Kay, B. A., Walter, S., Eeckels, R., Svennerholm, A. M. & Holmgren, J. (1990). Field trial of oral cholera vaccines in Bangladesh: results from a three-year follow-up. Lancet 335, 270–3.CrossRefGoogle ScholarPubMed
Clements, M. L., Levine, M. M., Cleaves, F., Hughes, T., Caceres, M., Aleman, E., Black, R. E. & Rust, J. (1985). A comparison of single sugar/salt versus glucose/electrolyte oral rehydration solutions in infant diarrhoea. Journal of Tropical Medicine and Hygiene 84, 189–94.Google Scholar
Cooper, E. S., Spencer, J., Whyte-Alleng, C. A. M., Cromwell, O., Whitney, P., Venugopal, S., Bundy, D. A. P., Haynes, B. & Macdonald, T. T. (1991). Immediate hypersensitivity reaction in the colon of children with chronic Trichuris trichiura dysentery. Lancet 338, 1104–7.CrossRefGoogle ScholarPubMed
Corcoran, G. D., O'Connell, B., Gilleec, A. & Mulvihill, T. E. (1991). Entamoeba coli as a possible cause of diarrhoea. Lancet 338, 254.CrossRefGoogle ScholarPubMed
Crompton, D. W. T., Kamara, C., Ferret, E., Hodges, M. & Stoddart, R. C. (1992). Intestinal helminth infections in children under 5 years of age from Moyamba District Southern Province, Sierra Leone. Journal of the Sierra Leone Medical & Dental Association 6, 24–31.Google Scholar
De Zoysa, I. & Feachem, R. G. (1985 a). Interventions for the control of DD among young children: chemoprophylaxis. Bulletin of the World Health Organisation 63, 295–315.Google Scholar
De Zoysa, I. & Feachem, R. G. (1985 b). Interventions for the control of diarrhoeal diseases among young children: rotavirus and cholera immunization. Bulletin of the World Health Organisation 63, 569–83.Google ScholarPubMed
Duncan, J. W. K. (1991). Prevalence rates of intestinal parasitic disease agents in four African townships and a practical solution to excreta disposal. Engineering Focus, Jan.–Mar.Google Scholar
Ebrahim, G. J. (1992). Cryptosporidium: an unrecognised enteropathogen (Editorial). Journal of Tropical Paediatrics 38, 98–9.CrossRefGoogle Scholar
El, H. E. Bustra, Ash, L. R., Coulson, A. H. & Neuman, C G. (1992). The interrelationship between diarrhoea and Vitamin A deficiency. Paediatric Infectious Disease Journal 11, 380–4.Google Scholar
Esrey, S. A. (1991). Interventions for the control of diarrhoeal disease among young children: fly control. World Health Organisation Centre for Diarrhoeal Diseases. Report no. 91, 37.Google Scholar
Esrey, S. A. & Feachem, R. G. (1989). Interventions for the control of diarrhoeal disease among young children: promotion of food hygiene. World Health Organsion Centre for Diarrhoeal Diseases. Report no. 89, 30.Google Scholar
Esrey, S. A., Feachem, R. G. & Hughes, J. M. (1985). Interventions for the control of diarrhoeal disease among young children: Improving water supplies and excreta disposal. Bulletin of the World Health Organisation 63, 757–72.Google ScholarPubMed
Ewald, J. A., Bayoh, M. N., Crompton, D. W. T. & Hodges, M. H. (1993). Prevalence and intensity of intestinal helminth infections from three communities in Sierra Leone. Journal of the Sierra Leone Medical & Dental Association (in press).Google Scholar
Farthing, M. J. G. (1990). Immunopathology of giardiasis. Springer's Seminars on Immunology. Springer-Verlag, C. 12, 269–82.Google Scholar
Feachem, R. G. (1984). Interventions for the control of diarrhoeal diseases among young children: promotion of personal and domestic hygiene. Bulletin of the World Health Organisation 62, 467–76.Google ScholarPubMed
Feachem, R. G., Hogan, R. C. & Merson, M. H. (1983). Diarrhoeal disease control: reviews of potential interventions. Bulletin of the World Health Organisation 61, 637–40.Google ScholarPubMed
Feachem, R. G. & Koblinsky, M. A. (1984). Inteventions for the control of diarrhoeal disease among young children: promotion of breast feeding. Bulletin of the World Health Organisation 62, 271–91.Google Scholar
Glass, R. I., Cleason, M., Blake, P. A., Waldman, R. J. & Pierce, N. F. (1991). Cholera in Africa: lessons on transmission and control for Latin America. Lancet 338, 791–5.CrossRefGoogle ScholarPubMed
Gomwalk, N. E., Gosham, L. T. & Umoh, U. J. (1990). Rotavirus diarrhoea in paediatric diarrhoea in Jos, Nigeria. Journal of Tropical Paediatrics 36, 52–5.CrossRefGoogle ScholarPubMed
Gore, S. M., Fontaine, O. & Pierce, N. F. (1992). Impact of rice-based oral solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. British Medical Journal 304, 287–91.CrossRefGoogle ScholarPubMed
Grant, C. J. O. (1989). A survey of some of the factors influencing the health status of children aged 0–5 years in Freetown. Dissertation for B.Sc. Zoology, University of Sierra Leone.Google Scholar
Hodges, M. (1991). Clinical implications of growth monitoring: experiences from Sierra Leone. Journal of Tropical Paediatrics 37, 244–9.CrossRefGoogle ScholarPubMed
Hodges, M., Kingston, K., Brydon, W. G., Sallam, J. & Ferguson, A. (1993). Use of Gut Lavage Fluid to measure intestinal humoral immunity, in healthy Sierra Leonean children, (unpublished data).CrossRefGoogle Scholar
Huilan, S., Guang, Zhen Lu, Mathan, M. M., Mathews, M. M., Olarte, J., Espejo, R., Maung, U. Khin, Ghafoor, M. A., Khan, M. A., Sami, Z. & Sutton, R. G. (1991). Aetiology of acute diarrhoea among children in developing countries: a multicentre study in five countries. Bulletin of the World Health Organisation 69, 549–55.Google ScholarPubMed
Kandeh, B. S. (1988). Causes of infant and early childhood deaths in Sierra Leone. Social Science and Medicine 23, 297–303.CrossRefGoogle Scholar
Kreusch, G. T. (1990). Malnutrition, infection and immune function. In The Malnourished Child (ed. Suskind, M. & Lewinter-Suskind, L.), pp. 37–55. Nestlé Nutrition Workshop Series, no. 19, Vevey. New York: Raven Press.Google Scholar
Lebenthal, E. (1986). Prolonged small intestinal mucosal injury as a primary cause of intractable diarrhoea of infancy. In Chronic Diarrhoea (ed. Lebenthal, E.), pp. 5–29. Nestlé Nutrition, Workshop Series. New York: Raven Press.Google Scholar
Leigh, B., Kella, F. Y. & Kanda, H. B. S. (1993). Maternal mortality: preliminary study in the Western Area. Maternal & Child Health. Ministry of Health, Government of Sierra Leone.Google Scholar
Lunn, P. G., Northrop-Clewes, C. A. & Downes, R. M. (1991). Intestinal permeability, mucosal injury and growth faltering in Gambian infants. Lancet 338, 907–10.CrossRefGoogle ScholarPubMed
Mahalanabis, D. (1985). Development of an improved oral rehydration salt (ORS) with antidiarrhoeal properties, a ‘Super ORS’. World Health Organisation unpublished document Centre for diarrhoeal diseases DDM/85.3.Google Scholar
Molla, A. M., Molla, A. & Khatun, N. (1986). Absorption of macronutrients in children during acute diarrhoea and after recovery. In Proceedings of the XIIIth International Congress of Nutrition (ed. Taylor, T. G. & Jenkins, N. K.), pp. 113–15. London: Libbey.Google Scholar
Neto, U. F., De Castro Ferreira, V., Patricio, F. R. S., Mostaco, V. L. & Trabulsi, L. R. (1989). Protracted diarrhoea: the importance of the enteropathogenic E. coli (EPEC) strains and salmonella in its genesis. Journal of Paediatric Gastroenterology and Nutrition 8, 207–11.CrossRefGoogle Scholar
Penny, M. E., De Silva, D. G. H. & McNeish, A. S. (1986). Bacterial contamination of the small intestine of infants with enteropathogenic E. coli and other enteric infections: a factor in the aetiology of persistent diarrhoea. British Medical Journal 292, 1223–1226.CrossRefGoogle ScholarPubMed
PMISU (1993). National Nutritional Suvey 89/90. Planning Management Information and Statistics Unit, Ministry of Health, Government of Sierra Leone & UNICEF.Google Scholar
Roy, S. K., Behrens, R. H., Haider, R., Akramuzzaman, S. M., Mahalanabis, D., Wahed, M. A. & Tomkins, A. M. (1992). Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhoea and persistent diarrhoea syndrome. Journal of Paediatric Gastroenterology and Nutrition 15, 289–96.Google ScholarPubMed
Rubino, A. & Guandalini, S. (1986). Mechanisms of secretory diarrhoea caused by bacterial enterotoxins. In Chronic Diarrhoea in children (ed. Lebenthal, E.), pp. 319–28. Nestlé's Nutrition Workshop Series, no. 6, Vevey. New York: Raven Press.Google Scholar
Sargeaunt, P. G. (1988). Zymodemes of Entamoeba histolytica. In Ameobiasis. Human Infection by Entamoeba histolytica (ed. Ravdin, J. I.), pp. 370–87. New York: Wiley & Sons.Google Scholar
Sen-Hai, Y. & Wei-Xia, W. (1990). Hookworm infection and disease in China. In Hookworm Disease (ed. Schad, G. A. & Warren, K. S.), pp. 44–54. London & Philadelphia: Taylor & Francis.Google Scholar
Shahid, N. S., Sack, D., Rahman, M., Alam, A. N. & Rahman, N. (1988). Risk factors for persistent diarrhoea. British Medical Journal 297, 1036–8.CrossRefGoogle ScholarPubMed
Smithie, B. M. (1992). The aetiology of diarrhoea in Sierra Leonean children. Dissertation for M.Sc in Applied Parasitology and Medical Entomology, University of Liverpool.Google Scholar
Sommer, A., Djunaedi, E., Loeden, A. A., Tarwotjo, I., West, K. P., Tilden, R., Mele, L. & The ACEH Study Group. (1986). Impact of Vitamin A supplementation on childhood mortality: a randomised controlled community trial. Lancet 329, 1169–73.CrossRefGoogle Scholar
Sommer, A., Hussaini, G., Tarwotjo, I. & Susanto, D. (1983). Increased mortality in children with mild Vitamin A deficiency. Lancet 324, 585–8.CrossRefGoogle Scholar
Sullivan, P. B., Marsh, M. N., Phillips, M. B., Dewit, O., Neale, G., Cevallos, A. M., Yamson, P. & Farthing, M. J. G. (1991). Prevalence and treatment of giardiasis in chronic diarrhoea and malnutrition. Archives of Diseases in Children, 66, 304–6.CrossRefGoogle ScholarPubMed
UNDP (1991).Human Development Report 1991, pp. 121–3. Oxford: Oxford University Press.Google Scholar
Webster, J., Hodges, M., Crompton, D. W. T. & Walters, D. E. (1990). Intestinal parasitic infections in children from Freetown, Sierra Leone. Journal of the Sierra Leone Medical & Dental Association 5, 144–55.Google Scholar
White, P. T. (1977). Farmer Health Survey, p. 12. IADP Eastern Region, Kenema.Google Scholar
Whitworth, J. A. G., Morgan, D., Mande, G. H., McNicholas, A. M. & Taylor, D. W. (1992). A field study of the effect of ivermectin on intestinal helminths in man. Transactions of the Royal Society of Tropical Medicine and Hygiene 85, 222–4.Google Scholar
Williams, M. O. (1974). Intestinal animal parasites of man in Sierra Leone. Bulletin of the Sierra Leone Medical & Dental Association 2, 62–4.Google Scholar
Wilson, F., Lindsay, G., Crompton, D. W. T. & Hodges, M. (1991). Intestinal helminth infections in infants and their mothers in Sierra Leone. Journal of the Sierra Leone Medical & Dental Association 6, 22–30.Google Scholar
Wolfe, M. S. (1988). In Hunter's Tropical Medicine, 7th edn (ed. Strickland, G. T.), pp. 550–65. Philadelphia: W. B. Saunders/Harcourt Brace Jovanovich.Google Scholar
World Bank. (1980). World Development Report, 1980, August 1980. Oxford: Oxford University Press.Google Scholar
WHO. (1988 a). Diarrhoeal Disease Control Programme. Sixth Programme Report 1986–87, no. 88.28, p. 46. World Health Organisation, Centre for Diarrhoeal Diseases.Google Scholar
WHO. (1988 b). Persistent diarrhoea in children in developing countries: memorandum from a WHO meeting. Bulletin of the World Health Organisation 66, 709–17.Google Scholar
WHO. (1990). Diarrhoeal Disease Control Programme. Seventh programme report, no. 90.34, p. 61. World Health Organisation, Centre for Diarrhoeal Diseases.Google Scholar
WHO. (1991). Research priorities for diarrhoeal disease vaccines: memorandum from a World Health Organisation Meeting. Bulletin of the World Health Organisation 69, 667–676.Google Scholar
WHO. (1992). Diarrhoeal Disease Control Programme Eighth Programme Report no 92.38 p 53. World Health Organisation. Centre for Diarrhoeal Diseases.Google Scholar