The occurrence of diarrheal diseases in children in Nigeria is about the same as everywhere in the world. Virus and bacteria cause diarrhea. Most diarrhea diseases are transmitted feco-orally. 

I will give a brief outline of the causes of diarrhea and then speak more on preventive measures, prevention and treatment.  

Rota Virus is the most common cause of diarrhea in children less than 2 years old. Ecoli bacteria, Salmonella and Shigella, follow it closely.  Shigella and Salmonella are a lot more common in older children, and tend to be more involved in food poisoning.  We cannot forget to mention Cholera. This disease occurs in out breaks. Finally there is Dysentery, which is caused by amoeba. 

The core relevance of this lecture as it pertains to diarrhea, is in essence the imperative of good and clean water supply. Most of these disease, if not all are transmitted feco-orally, which in plain language means from stool to mouth.  

The prevalence of diseases in Nigeria can be traced to that fact that most human waste is disposed of by unsanitary means and frequently under conditions where they contaminate water used for domestic purposes –especially for cooking and drinking.  All that is required to infect the drinking or cooking water is the stool of an infected person coming in contact with such water, and also by the water not being properly purified before use or consumption.  

Containment of transmission can be achieved in two ways; proper hand washing and sanitary conditions, and clean and available drinking water.  This goes to show just how much solution can be achieved by that simple measure of having clean portable water. 

Children, especially those less than two years of age, are inherently more susceptible to the complications of diarrhea.  When diarrhea occurs in children, the severity of the vomiting and diarrhea can be quite devastating. It can quickly lead to dehydration.  Some of these children can have as much as 5 to 6 bowel movements (stooling) within an hour, and the occurrence could last for a span of 24 to 48 hours. 

The solution, usually, is the replacement of the lost fluid. This is done either intravenously (drip) or by oral rehydration. The WHO has used oral rehydration successfully in developing countries. The only setback or problem is that the rehydration powder has to be mixed with clean water before being administered.  

As I mentioned earlier, Salmonella and Shigella infections are more commonplace in older children. It is usually associated with food poisoning.  The symptoms include abdominal pain and bloating. Vomiting is also present. In some instance, the bloodstream might be infected with the bacteria.  While the resulting diarrhea is not usually as severe, it is occasionally bloody.  Transmission is also feco-oral. One of the complications of Salmonella diarrhea is the carrier state.  This happens when the infected person gets treated with antibiotics indiscriminately. This leads to the resolution of the diarrhea, whereas the stool still retains the bacteria. This person walks around, not sick, but the stool can easily infect others at any time. If hands are not clean or stool comes in contact with water. 

Ameobiasis is not as common, but does occur especially in older children. It causes mild but prolonged and intermittent diarrhea. Abdominal pain and bloating are also present in these children. The bacteria can migrate to the liver and reside there.  Similarly, it could present as jaundice. It is usually treated with antibiotics (Flagyl). Like in the other forms of diarrhea, use of clean portable water is necessary to prevent infection or its reoccurrence.  

Having dealt with the medical information about diarrhea, I will now turn to the solution as it pertains to problems solving.  

Most of the diarrheas can be prevented or reduced by the availability of clean and accessible portable water. In a community where there is lack of a water treatment facility, if borehole is sunk deep enough and water accessed through pipes, the water can be boiled for decontamination.  

Improving sanitary condition is also another way of decreasing the incidence of diarrhea. In small rural communities, where water supply means reliance on a common stream, river or lake, we cannot use that common source of water supply for cooking, drinking, bathing and dumping human waste (defecating) without risking the incidence of diarrhea and contamination.  In the event that providing toilets facilities proves impossible, then we must at least strive to provide drinking water from taps or faucets. 

Use of intravenous fluids is the quickest way to correct the dehydration that children have, but there is a lot involved for countries like Nigeria.  The availability of the fluids and other supplies, as well as prohibitive costs will make it difficult for most parents of infected children to afford the required treatment.  Likewise hospitalization is expensive. But expensive as it may be, administering intravenous fluids is sometimes unavoidable. 

Simple measures like hand washing reduces the incidence of transmission and carriage of most, if not all of the diarrheal illnesses. In developed countries like the United States, on some rare occasions, contamination may occur when there is sewage spill into local rivers and reservoirs. But these are frequently dictated by the Public health Departments and precautionary measures taken. However, those who go against such public health advice and swim in contaminated waters risk infection. 

Aside from this feco-oral transmission is the most prevalent. Hand washing, is therefore, of a paramount importance in the prevention of transmission of viruses and bacteria that cause diarrhea.  Antibiotics have a small role to play in diarrheal diseases in children. It is usually needed more in diarrhea associated with older children. If there is a proven presence of Shigella, or Ameobiasis, then the use of the appropriate antibiotics id needed.   

I have deliberately used the term “appropriate” because as I alluded earlier, the indiscriminate use of antibiotics in certain diarrhea diseases, namely Salmonella, will only increase the carrier state. What this means is that you have a perfectly healthy looking individual walking around with this bacteria, ready to spread it to unsuspecting hosts in the event of unsanitary conditions. This could mean a food vendor who uses the bathroom, but does not wash his or her hands, before serving food to the next customer.  I know that this is more common than most of us would like to imagine, believe or acknowledge.  

In conclusion, there are lots of causes of diarrheal illnesses in children The most common is due to Rota Virus, which as the name suggest, is a virus that can be controlled and incidence reduced dramatically by the use of simple measures, like hand washing, and appropriate disposal of infected stool.

The need for clean and accessible water cannot be overemphasized. The availability of clean water can solve a lot of the problems that is associated with diarrheas. We can with the limited resources achieve a measure of success in the control, of spread of diseases as well as cut down on the high incidence by providing portable water.  The paradox of water borne diseases is well captured by a popular Nigerian musician, Fela Anikulapo Kuti, who once sang “water has no enemy”. True as that may be, untreated water can be a very deadly enemy. 

I thank you for you attention.