Diarrhoea

Diarrhoeal disease is the second leading cause of death in children under five years old, and was responsible for the deaths of 370,000  children in 2019. The most severe threat posed by diarrhoea is dehydration. During an episode of diarrhoea, water and electrolytes including sodium, chloride, potassium and bicarbonate are lost through liquid stools, vomit, sweat, urine and breathing. A person with diarrhoea becomes dehydrated when these losses are not replaced. In addition, diarrhoea is a major cause of malnutrition, making the person more susceptible to future bouts of diarrhoea and to other diseases.

There are three clinical types of diarrhoea, each with its specific treatments:

• Acute watery diarrhoea, which may last several hours or days, and includes cholera.
• Acute bloody diarrhoea, also called dysentery.
• Persistent diarrhoea, lasting 14 days or longer.

In the past, for most children, severe dehydration and fluid loss were the main causes of dying from diarrhoea. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths. 

Exclusive breastfeeding is protective and prevents diarrhoea from occurring in young children. Breastfeeding also reduces the severity of diarrhoea.

Innovative activities and demand creation are important for achieving behaviour change and sustaining long-term preventive practices to combat preventable morbidity and mortality from diarrhoeal diseases. 

Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person to person as a result of poor hygiene.

Key measures to prevent diarrhoea include the following:

• access to safe drinking-water.
• use of improved sanitation.
• hand washing with soap.
• exclusive breastfeeding for the first six months of life.
• good personal and food hygiene.
• health education about how infections spread.
• rotavirus vaccination.

Key measures to treat diarrhoea include the following:

• Rehydration with oral rehydration salts (ORS) solution: ORS, particularly the low osmolarity formula, are a proven life-saving commodity for the treatment of children with diarrhoea.
• Rehydration may require intravenous fluids in case of severe dehydration or shock.
• Zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
• Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well.
• Consulting a health professional, in particular for management of persistent diarrhoea, or when there is blood in the stool, or if there are signs of dehydration.
• Adequate nutrition is key to improving natural defenses, starting with exclusive breastfeeding for the first 6 months of life.