There is a strong linkage connecting diarhhoea, breastfeeding and underfive deaths in Nigeria
Watching from afar, Layi’s mother takes him off her back and places the 4-month old boy on her laps. He is floppy, weak and finds it difficult to open his deeply sunken eyes to look at the unfamiliar environment.
He moans and tries to cry as the discomfort becomes unbearable.
What’s wrong with him, the doctor asked.
According to the account of his mother, Layi started excreting watery stool a week earlier.
They started noticing something was wrong when he was producing mucous-stained stool between six to eight times daily. This was followed by frank liquid which according to the mother was “as if a tap was in his stomach pouring out water”.
Ab initio, the parents gave the little boy some herbal concoctions to stop the downpour of the gastrointestinal canal. The concoctions did not work. They then switched to various medications.
The name of the last one we administered is Diastop and it was given to us by our neighbor, the mother said.
Diastop is a suspension that is orally administered to arrest mild to moderate diarrhea. In Nigeria, it is sold over-the-counter and doctor’s request is required before it is sold.
The doctor described Layi as irritable, skinny and chronically ill. He was dressed in torn oversize faded shirt and wanted to be left alone but not until his mother was able to clean up the latest stream of watery stool emanating from Layi that trickled down the mother’s legs and onto the floor of the hospital.
Amid the drama that followed, the healthcare service providers.
This is something they see on a daily basis in this particular hospital and several others across rural and urban areas of Nigeria.
According to the World Health Organization, diarrhea is the passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual. Layi was a perfect patient.
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.
Diarrhea could lead to fluid loss, and may be life-threatening, particularly in young children like Layi and people who are malnourished or have impaired immunity.
Diarrhea and breast feeding
Without doubts, Nigerian mothers are unanimous regarding the burdens of exclusive breastfeeding which they said requires extra energy and strong will since with or without a job, mothers have to go the extra mile to maximally breastfeed their babies.
The US Center for Disease Control and Prevention, CDC stated that breast milk alone is sufficient to support optimal growth and development for approximately the first 6 months after birth.
For these very young infants, the American Academy of Pediatrics said water, juice, and other foods are generally unnecessary. Even when babies enjoy discovering new tastes and textures, the academy advised solid foods should not replace breastfeeding, but merely complement breast milk as the infant’s main source of nutrients throughout the first year.
“Beyond one year, as the variety and volume of solid foods gradually increase, breast milk remains an ideal addition to the child’s diet.”
WHO also recommends continued breastfeeding up to 2 years of age or beyond.
According to experts, creepy diseases like diarrhea arise often times when mothers introduce another source of food other than breast milk.
This is because any other alternative requires high level of hygiene to keep the feeding apparatus and containers free of germs that could cause infections, which in reality, considering the frequency of feeds that infant consumes on a daily basis, could be practically impossible.
Moreover, several Nigerian mothers believe an infant’s feces are not dangerous hence they are inappropriately disposed thus compromising the level of hygiene.
It also increases the risk of feeding an infant with contaminated fingers whenever food is prepared other than breast milk which does not require direct touch by the mother during its preparation.
There is also the myth angle.
According to Layi’s mother, the reason behind her son’s diarrhea is teething.
This is a typically popular belief. Most children are introduced to complementary foods around their teething periods. When contamination arises, it would be presented as sign of teeth development.
It has been well documented that diarrhea is a leading cause of infant death in Nigeria as a result of poor practice of exclusive breastfeeding and high level of poverty.
Nigeria ranks high on the global poverty index and people below poverty line source for free medications from neighbors and only go to health facilities after trying all possible free treatments, or when the condition might have either degenerated or with bad prognosis.
While the treatment of diarrhea is cheap, knowledge on its management is lacking among the traditional birth attendants who are the first point of contact in the community where children survive most times with a stroke of luck, according to the African Development and Empowerment Foundation.
Medical experts agreed that exclusive breastfeeding for the first six months of life and adequate complementary feeding and continued breastfeeding from six months up to two years, vitamin A supplementation, immunization, Safe drinking water, sanitation and hygiene are critical in the prevention of diarrhea.
They also recommended hand washing with soap which alone can cut the risk of diarrhea by at least 40 per cent and significantly lower the risk of respiratory infections since almost 60 per cent of deaths due to diarrhea worldwide are attributable to poor hygiene and sanitation as well as unsafe drinking water.
“Clean home environments and good hygiene are important for preventing the spread of diarrhea, and safe drinking water and proper disposal of human waste, including child feces, are vital to stopping the spread of diarrheal disease among children and adults,” said WHO.