Currently in my pharmacy school curriculum, we are learning
about diarrhea. In class, it was mentioned that diarrhea is “the leading cause
of childhood illness and death in developing countries” according to the
Centers for Disease Control and Prevention.
As a matter of fact, the Centers
for Disease Control and Prevention (2013) have stated:
·
An estimated 801,000 children younger than 5 years of age perish
from diarrhea each year, mostly in developing countries. This amounts to 11% of
the 7.6 million deaths of children under the age of five and means that about
2,200 children are dying every day as a result of diarrheal diseases 4.
·
Unsafe drinking water, inadequate availability of water for
hygiene, and lack of access to sanitation together contribute to about 88% of
deaths from diarrheal diseases 1.
·
Water, sanitation and hygiene has the potential to prevent at
least 9.1% of the global disease burden and 6.3% of all deaths 1.The
impact of clean water technologies on public health in the U.S. is estimated to
have had a rate of return of 23 to 1 for investments in water filtration and
chlorination during the first half of the 20th century 5.
·
Water and sanitation interventions are cost effective across all
world regions. These interventions were demonstrated to produce economic
benefits ranging from US$ 5 to US$ 46 per US$ 1 invested 6.
·
Improved water sources reduce diarrhea morbidity by 21%; improved
sanitation reduces diarrhea morbidity by 37.5%; and the simple act of washing
hands at critical times can reduce the number of diarrhea cases by as much as
35%. Improvement of drinking-water quality, such as point-of-use disinfection,
would lead to a 45% reduction of diarrhea episodes 7.
In the United States, we think of diarrhea as
something that is insignificant and simply a nuisance. In reality, however, if
a small child has untreated diarrhea, it can be fatal. This can be explained by
the physiology of the gastrointestinal tract. Every day, the proximal small
intestine receives 9 liters of fluid. Only approximately 2 liters of fluid come
from the diet. The rest of the fluid comes from bile. If a child has diarrhea,
the extra fluid from the bile has no chance at being reabsorbed. The child then
can become dehydrated and have electrolyte imbalances. This is extremely
dangerous for a small child. Adults, on the other hand, are more resilient to
diarrhea because they have more total body water than a child.
In countries like the United
States, children do not commonly die from diarrhea. This is because there are
sanitation structures in place. Children that die in other countries due to a
lack of sanitation structures could be seen as structural violence. If the
conditions were more sanitary, they would not be experiencing such a high rate
of diarrhea. Similarly, if a child’s family was too poor to afford treatment
for their diarrhea, it could be seen a social suffering.
Looking at the problem from a
viewpoint of disease transmission, it is apparent that the bacteria are being
transmitted through the drinking water. There is an idea that, if mode of
transmission of the disease is destroyed, it will have to find another way to
be transmitted. Diseases that are transmitted through environmental factors are
known to be harsher than other diseases. Examples of this include malaria,
which is transmitted through mosquitos, and dysentery, which is transmitted
through water. They do not rely on being transmitted from person to person.
Diseases like the common cold, which do rely on being transmitted from person
to person, are not as harsh. This postulated because in order to be spread to
other people, it is advantageous for the disease to have milder symptoms so the
people can get into contact with other people. In theory, if we were to
completely remove the source of transmission of these diseases, they would have
to change in order to survive.
Similarly, as I learned in
microbiology, there is the idea of moderation of diseases over time. When a
virus or bacteria first evolves into a new strain, it starts out with harsh
symptoms. For example, new strains of flu, such as H1N1, are notoriously
dangerous. After a few years of moderation, however, their symptoms become less
harsh. The idea is that they can not survive for very long if you die. The
virons that mutate and do not kill you are ultimately the ones that are spread.
There is also the problem of
bacterial resistance to antibiotics. Instead of continually trying to create
new antibiotics that become resistant within a few years, what if we simply
made diseases that are as awful as dysentery as mild as the common cold? This
could potentially be done if their mode of transmission was removed completely.
This illustrates how diseases,
such as diarrhea, are a matter of global health. Not only do they directly
affect millions of people around the world, but they also have implications on
modern medicine and its effectiveness.
References
Centers for Disease Control and Prevention.
(2013). Global WASH fast facts. Retrieved from
http://www.cdc.gov/healthywater/global/wash_statistics.html.
Indeed! diarrhea is still a scourge for many undernourished children and contributes to the global IMR and U5MR
ReplyDeleteI think what Professor Lala mentioned in class on Monday is really compelling re: Oral Rehaydration Packets. The philosophy of Primary Health Care would suggest that if we strengthened the systems of health care, the sanitation issues would be resolved and thus most of the diarrhea. However, the SPHC model leaves Jim Grant walking through these communities with OR in his pocket as a panacea for treating diarrhea. You've exhibited here that were there systems in place to control for water quality, we wouldn't need OR in the first place. It's interesting to note that the structural violence you mention is caused by a lack of clean water, not a lack of rehydration salts. I'm wondering how this changes your approach as a pharmacist or where you place yourself in terms of the field when arguing for better structures that prevent diarrhea.
ReplyDeleteAs a pharmacist, I would always recommend prevention rather than treatment. This can be in the form of vaccinations, diet, exercise, water sanitization, or other things. Primary health care must be available to everyone in order to administer vaccines and to counsel people on their diet and exercise, among other things. At the same time, water sanitization systems should also be in place to reduce the spread of diarrheal and other diseases. Each component is important. If diarrheal disease is one of the leading causes of death in children around the world, I would argue that water sanitization should be the top priority. Recognizing that this takes a lot of effort and money to accomplish, we should be advocating for donors to be spending their money on this issue and speaking to governments of countries that need improved water sanitization about how to tackle the problem. We certainly do not want to make the situation worse by ignoring the situation that each country is in.
ReplyDeletePharmaceutical companies, however, have always had a focus on treatment rather than prevention or cures. This is because treatment over a long period of time is lucrative. With the current healthcare system based on neo-liberal theory, the focus has always been on profits. This is why we see pharmaceutical companies suing South Africa over intellectual property, when the people would be completely unable to afford the medication at all. While it is important to make the reward for creating a life saving medication worth the risk of losing billions of dollars, somehow there needs to be an incentive for allowing medication to be available to people who could never afforded it otherwise. I do not know a feasible way of doing this in terms of pharmaceutical companies. Possibly, the WHO could come up with an ethical agreement for pharmaceutical companies to follow, similar to the Declaration of Helsinki. This would be in addition to strengthened primary health care and sanitization efforts.
I thought that this topic was very interesting because my last blog post was concerned with water sanitation and hygiene. I looked on the World Health Organization website to see some of the prevention strategies that they suggested to try to eliminate diarrheal disease in developing countries. It was an interesting list of interventions that emphasized 5 main elements………
ReplyDelete• Rotavirus and measles vaccinations
• Promotion of early and exclusive breastfeeding and vitamin A supplementation
• Promotion of hand washing with soap
• Improved water supply quantity and quality (including treatment and safe storage of household water)
• Community-wide sanitation promotion
Since this is considered a new approach, it has some interventions that some might have not associated with the diarrhea issue. The WHO recognizes that rotavirus is estimated to cause roughly 40% of hospital admissions due to diarrhea among children under 5 worldwide. It is also estimated that around 88% of diarrhea related deaths are due to unsafe water and inadequate sanitation.
Shelby, these are important interventions and certainly, all these interventions would help with the issue. Things like rotavirus and measles vaccinations would reduce diarrhea morbidity and mortality. They do not get to the source of the problem, however, which is poor water quality and sanitation. As we discussed in class, providing water distribution infrastructure is a difficult task, especially in rural areas that do not have enough money to accomplish the task. My post is very idealistic and does not take into consideration the many obstacles that one would face when trying to provide quality water and sanitation to all those who need it.
DeleteI think that you bring up a great point on how to change the way to fight disease. However, I do have one question, how would one make "diseases that are as awful as dysentery as mild as the common cold"? Would that be through a vaccination? Since it is something that evolves overtime, how would one speed up the evolution process?
ReplyDeleteShelly, my post is certainly idealistic and not very realistic. It is more of an idea that if proper water infrastructure was in place, diseases like dysentery would have no mode of transmission. This is idealistic because there are so many obstacles to putting in proper water infrastructure. Of course, diseases do evolve over time. However, diseases evolve more rapidly than do other organisms because they reproduce so quickly. If you think about it, animals reproduce after decades of life, whereas bacteria and viruses reproduce ever minute. This allows their evolution to be expedited. If dysentery were unable to evolve to find a new way to be transmitted, it would die off. Because microbial organisms reproduce so quickly it is possible that it would find another method of transmission, which would likely have to include its host’s ability to get up and spread the disease.
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