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WHO|Diarrhoealdisease

Mediacentre
Diarrhoealdisease
FactsheetN330
April2013

Keyfacts
Diarrhoealdiseaseisthesecondleadingcauseofdeathinchildren
underfiveyearsold.Itisbothpreventableandtreatable.
Eachyeardiarrhoeakillsaround760000childrenunderfive.
Asignificantproportionofdiarrhoealdiseasecanbeprevented
throughsafedrinkingwaterandadequatesanitationandhygiene.
Globally,therearenearly1.7billioncasesofdiarrhoealdisease
everyyear.
Diarrhoeaisaleadingcauseofmalnutritioninchildrenunderfive
yearsold.

Diarrhoealdiseaseisthesecondleadingcauseofdeathinchildren
underfiveyearsold,andisresponsibleforkillingaround760000
childreneveryyear.Diarrhoeacanlastseveraldays,andcanleavethe
bodywithoutthewaterandsaltsthatarenecessaryforsurvival.Most
peoplewhodiefromdiarrhoeaactuallydiefromseveredehydrationand
fluidloss.Childrenwhoaremalnourishedorhaveimpairedimmunityas
wellaspeoplelivingwithHIVaremostatriskoflifethreatening
diarrhoea.
Diarrhoeaisdefinedasthepassageofthreeormorelooseorliquid
stoolsperday(ormorefrequentpassagethanisnormalforthe
individual).Frequentpassingofformedstoolsisnotdiarrhoea,noristhe
passingofloose,"pasty"stoolsbybreastfedbabies.
Diarrhoeaisusuallyasymptomofaninfectionintheintestinaltract,
whichcanbecausedbyavarietyofbacterial,viralandparasitic
organisms.Infectionisspreadthroughcontaminatedfoodordrinking
water,orfrompersontopersonasaresultofpoorhygiene.
Interventionstopreventdiarrhoea,includingsafedrinkingwater,useof
improvedsanitationandhandwashingwithsoapcanreducedisease
risk.Diarrhoeacanbetreatedwithasolutionofcleanwater,sugarand
salt,andwithzinctablets.
Therearethreeclinicaltypesofdiarrhoea:
acutewaterydiarrhoealastsseveralhoursordays,andincludes
cholera
acutebloodydiarrhoeaalsocalleddysenteryand
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persistentdiarrhoealasts14daysorlonger.

Scopeofdiarrhoealdisease
Diarrhoealdiseaseisaleadingcauseofchildmortalityandmorbidityin
theworld,andmostlyresultsfromcontaminatedfoodandwater
sources.Worldwide,780millionindividualslackaccesstoimproved
drinkingwaterand2.5billionlackimprovedsanitation.Diarrhoeadueto
infectioniswidespreadthroughoutdevelopingcountries.
Indevelopingcountries,childrenunderthreeyearsoldexperienceon
averagethreeepisodesofdiarrhoeaeveryyear.Eachepisodedeprives
thechildofthenutritionnecessaryforgrowth.Asaresult,diarrhoeaisa
majorcauseofmalnutrition,andmalnourishedchildrenaremorelikelyto
fallillfromdiarrhoea.

Dehydration
Themostseverethreatposedbydiarrhoeaisdehydration.Duringa
diarrhoealepisode,waterandelectrolytes(sodium,chloride,potassium
andbicarbonate)arelostthroughliquidstools,vomit,sweat,urineand
breathing.Dehydrationoccurswhentheselossesarenotreplaced.
Thedegreeofdehydrationisratedonascaleofthree.
1.Earlydehydrationnosignsorsymptoms.
2.Moderatedehydration:
thirst
restlessorirritablebehaviour
decreasedskinelasticity
sunkeneyes
3.Severedehydration:
symptomsbecomemoresevere
shock,withdiminishedconsciousness,lackofurineoutput,
cool,moistextremities,arapidandfeeblepulse,lowor
undetectablebloodpressure,andpaleskin.
Deathcanfollowseveredehydrationifbodyfluidsandelectrolytesare
notreplenished,eitherthroughtheuseoforalrehydrationsalts(ORS)
solution,orthroughanintravenousdrip.

Causes
Infection:Diarrhoeaisasymptomofinfectionscausedbyahostof
bacterial,viralandparasiticorganisms,mostofwhicharespreadby
faecescontaminatedwater.Infectionismorecommonwhenthereisa
shortageofadequatesanitationandhygieneandsafewaterfordrinking,
cookingandcleaning.RotavirusandEscherichiacoliarethetwomost
commonetiologicalagentsofdiarrhoeaindevelopingcountries.
Malnutrition:Childrenwhodiefromdiarrhoeaoftensufferfrom
underlyingmalnutrition,whichmakesthemmorevulnerabletodiarrhoea.
Eachdiarrhoealepisode,inturn,makestheirmalnutritionevenworse.
Diarrhoeaisaleadingcauseofmalnutritioninchildrenunderfiveyears
old.
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Source:Watercontaminatedwithhumanfaeces,forexample,from
sewage,septictanksandlatrines,isofparticularconcern.Animal
faecesalsocontainmicroorganismsthatcancausediarrhoea.
Othercauses:Diarrhoealdiseasecanalsospreadfrompersonto
person,aggravatedbypoorpersonalhygiene.Foodisanothermajor
causeofdiarrhoeawhenitispreparedorstoredinunhygienic
conditions.Watercancontaminatefoodduringirrigation.Fishand
seafoodfrompollutedwatermayalsocontributetothedisease.

Preventionandtreatment
Keymeasurestopreventdiarrhoeainclude:
accesstosafedrinkingwater
useofimprovedsanitation
handwashingwithsoap
exclusivebreastfeedingforthefirstsixmonthsoflife
goodpersonalandfoodhygiene
healtheducationabouthowinfectionsspreadand
rotavirusvaccination.
Keymeasurestotreatdiarrhoeaincludethefollowing:
Rehydration:withoralrehydrationsalts(ORS)solution.ORSisa
mixtureofcleanwater,saltandsugar.Itcostsafewcentsper
treatment.ORSisabsorbedinthesmallintestineandreplacesthe
waterandelectrolyteslostinthefaeces.
Zincsupplements:zincsupplementsreducethedurationofa
diarrhoeaepisodeby25%andareassociatedwitha30%reduction
instoolvolume.
Rehydration:withintravenousfluidsincaseofseveredehydrationor
shock.
Nutrientrichfoods:theviciouscircleofmalnutritionanddiarrhoea
canbebrokenbycontinuingtogivenutrientrichfoodsincluding
breastmilkduringanepisode,andbygivinganutritiousdiet
includingexclusivebreastfeedingforthefirstsixmonthsoflifeto
childrenwhentheyarewell.
Consultingahealthprofessional,inparticularformanagementof
persistentdiarrhoeaorwhenthereisbloodinstoolorifthereare
signsofdehydration.

WHOresponse
WHOworkswithMemberStatesandotherpartnersto:
promotenationalpoliciesandinvestmentsthatsupportcase
managementofdiarrhoeaanditscomplicationsaswellasincreasing
accesstosafedrinkingwaterandsanitationindevelopingcountries
conductresearchtodevelopandtestnewdiarrhoeapreventionand
controlstrategiesinthisarea
buildcapacityinimplementingpreventiveinterventions,including
sanitation,sourcewaterimprovements,andhouseholdwater
treatmentandsafestorage
developnewhealthinterventions,suchastherotavirus
immunizationand
helptotrainhealthworkers,especiallyatcommunitylevel.

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Formoreinformationcontact:

WHOMediacentre
Telephone:+41227912222
Email:mediainquiries@who.int

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Integratedglobalactionplanfor
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pneumoniaanddiarrhoea
Waterrelateddiseases:diarrhoea
Documentsondiarrhoea
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