Diarrhoea is the second leading cause of death for children in Western Province. Yet a child with diarrhoea is sometimes considered to be bewitched.
Many suspect the child has bhikumba (a combination of bones and sand) in his stomach, and that certain people with ‘evil eyes’ had placed them there.
Such attitudes might seem laughable, if only the consequences were not so deadly. Nationwide, diarrhoea kills about one million children yearly, and is the third leading cause of death in children under five, after malaria and pneumonia.
Breaking deadly cycle
In western alone, one in every six children under five succumbs to diarrhoeal diseases daily, yet it can be controlled by simple measures. In developing countries like Kenya, most public health resources are prioritised to other diseases like malaria and HIV/AIDS.
But a proactive policy decision by public health officials has already begun to yield significant health benefits.
Guided by the work of PATH (Programme for Appropriate Technologies in Health) and its partners, the Division of Child and Adolescent Health has endorsed a new treatment strategy.
The newly-endorsed strategy is based on the revival of Oral Rehydration Therapy (ORT) corners in hospitals, designed to quickly and economically improve the care of children with diarrhoeal diseases.
Generally just a small room or designated space in a busy hospital ward, the tiny ORT corner provides low-cost treatment and education that can save thousands of young lives.
As a practice, most Kenyan children with diarrhoea are routinely admitted and placed on intravenous therapy (IV). An average of five drips per child costs around Sh1,000.
Mothers often stay with their hospitalised children, incurring equipment, food and water costs at facilities. Fathers travelling back and forth to visit sick children increase the financial burden for families.
The revival of ORT corners allows most children to be assessed and treated with low-cost Oral Rehydration Salt (ORS) and zinc sulphate, in a process that averages about four hours.
The low-dose glucose and saline ORS solution is meant to replace bodily fluid loss during diarrhoea, while zinc tablets reduce the severity and duration of diarrhoea episodes.
During this process, medical staff can teach mothers how to administer the two therapies.
“These mothers are encouraged to bring their children to hospital promptly, give more fluids to the children and observe basic hygiene to prevent the disease,” says Western provincial pediatrician Oduro Kidaha. “The mothers are then given the zinc soluble tablets and enough sachets of ORS on discharge.”
Dr Kidaha says the mothers are also encouraged to give a lot of fluids, including milk, safe water and soup to their children.
Breastfeeding is also strongly encouraged.
Clearly, government support for the ORT approach arrives at a critical time. A 2006 ministry of Health Facility Survey showed that only 55 per cent of the children with diarrhoea were correctly assessed and treated.
Basic hygiene practices
In 2008, only 39 per cent of children diagnosed with diarrhoea were given an ORS solution. Another 28 per cent received no treatment.
At Webuye District Hospital, Salome Nafula, mother of seven-month-old Wellington Wekesa, praised the training.
“When we go home, we are going to practice what we are taught and try our level best to keep diarrhoea at bay,” she said.
Nafula said she had learned basic hygiene principles like hand washing, covering food, proper disposal of faeces, using and cleaning the toilets, and drying of utensils.
Another mother, Metrine Shiundu, had brought her already seriously dehydrated infant to hospital.
“My child is now receiving an IV drip, which I would have avoided if I’d came earlier,” she said.
The ORT approach is projected to reduce child death and illness from diarrhoea by more than two thirds by 2015.
PATH’s Enhanced Diarrhoeal Disease Control Programme officer Alfred Ocholla said Western has 37 ORT corners.
Dr Ocholla said the hospital medical staff were also encouraged to avoid the use of antibiotics in children who have diarrhoea caused by rotavirus.
“The only time that antibiotics should be administered is when the child has cholera or dysentery,” he said.
Dr Ocholla said most health care providers treat children with malaria with malarial drugs and ignore diarrhoea symptoms.
“We are training them to critically assess children suffering from malaria, because a combination of malaria and diarrhoea sends the child’s body to severe malnutrition, which kills children very fast,” Ocholla added.
Still, Ocholla acknowledges the challenges in tackling the problem. Where superstitions prevail, a traditional medicine man is the only one believed to be powerful enough to reverse the diarrhoea-causing ‘spell.’
Some parents avoid hospitals because they believe an injection can kill a child who has been bewitched with bhikumba.
Some mothers even refrain from feeding or giving fluids to children with diarrhoea, a dangerous practice that increases the threat of dehydration and malnutrition.
Local health officials hope the government’s introduction of the policy will increase resource allocation for child health programmes, so that the policy can achieve its objectives.