Acute Gastroenteritis (Diarrheal illness) in Guyana
The Ministry of Health has received an unusual number of calls from the public relating to diarrheal illnesses. In addition, the media has also become very interested in the public health problem. The Ministry of Health believes if people are kept informed, they will be able to take necessary action to reduce the problem. It is a public health problem and largely can be stopped by good hygiene. The Ministry of Health has been active in promoting good hygiene. One of the reasons for this robust campaign to promote good hygiene is to reduce the number of diarrheal cases in Guyana.
Acute Gastroenteritis is not a new illness in Guyana. It is still a global public health problem in both developed and developing countries, although it assumes greater significance in developing countries. In Guyana almost 30% of deaths of children under 5 are caused by diarrheal illnesses.
Globally one in every four children experiences at least 2 episodes of diarrhea and vomiting each year. In Guyana, gastroenteritis occurs in every geographic region. For every 10,000 population in Guyana, about 800 episodes of gastroenteritis occur each year. For children under 5, the rate is about 1,200 episodes for every 10,000 children.
The occurrence of gastroenteritis is seasonal and the highest incidence occurs in the months of December, January, February and March. Because the Ministry of Health considers the occurrence of gastroenteritis as a major public health problem, we have been monitoring the incidence of diarrheal illnesses throughout the country. All health facilities in Guyana, including private doctors and private hospitals have to report incidences on a weekly basis to the Ministry of Health. One of the problems we have encountered is the unreliable reporting from health facilities around the country.
In 2009, only 55% of the facilities reported consistently and on a timely basis. For the past four epidemiological weeks in 2010, the reporting facilities rose to between 65 and 80%. The Chief Medical Officer has been instructed to write to all health authorities to ensure compliance to the Ministry of Health requirements.
Guyana recorded a total of 60,246 diarrheal cases in the 52 epidemiological weeks in 2009. Children under-1 year old accounted for 5,673 (9.4%) of cases in 2009. Children between 1 year and under 5 years old, accounted for 17,059 (28.3%) of diarrheal cases in 2009. For the age group 5 to 14 years old, there were 15,325 (25.4%) cases of diarrheal illnesses and for the age group older than 15 years, there were 22,191 (36.8) cases in 2009.
In the first four epidemiological weeks for 2010, 11,017 cases were reported to the Ministry of Health. The overall total for the first four weeks of 2010 is slightly increased from the 1st four weeks of 2009. The under-1 year old children accounted for 788 (7.2%) of the 2010 cases so far in 2010, the 1 year to 5 years old accounted for 3,202 (29.1%), the 5 to 14 years old children accounted for 3,070 (29.7%) and the over 15 years old accounted for 3,957 (35.9%) of all diarrheal cases so far in 2010.
Globally, more than 50% of the time, no specific cause is identified. However, around the world, contaminated water, food and poor hygiene have been identified as the major causes.
1. In Guyana, about 35% of all diarrheal cases in children are caused by rotavirus. It is the main reason why the Ministry of Health is ensuring most of our children are vaccinated against rotavirus. 2. There are also common bacterial infections that cause diarrheal diseases in Guyana. These include:
• Staphylococcus aureus can form a toxin that is the cause of symptoms. This is usually a common cause of food poisoning. • Escherichia coli commonly found in contaminated water. There are different kinds of E. coli. The E. coli O157:H7 is a serious infection and can cause serious diarrheal diseases with kidney complications. This was the causative agent for serious diarrheal illnesses in 2009 in Region 1. • Salmonella is usually contracted from handling poultry, eggs and other animal products • Shigella is typically spread from one person to another because of poor hygiene. This was one of the main causes of diarrhea during the 2005 flood • Clostridium difficle bacteria may overgrow in the large intestine after someone has been on antibiotic treatment for some other illness.
3. We have also identified common parasites and protozoan that cause diarrheal diseases. These include Giardia. This is the most common water-borne agent for diarrhea. Cryptosporidium is another agent that causes water-borne diarrheal diseases. Cryptosporidium-induced water-borne diarrheal diseases are found commonly in people immune-suppression diseases, such as HIV.
On an annual basis, these are the main causative agents for diarrheal diseases in Guyana. Which one of these causes might be responsible for diarrheal illnesses in 2010 so far? We are constantly being asked this question.
We are not yet in a position to identify which one, but it is possible that more than one of these agents are the causative factor for diarrheal illnesses at this time.
Good hygiene is the answer. Good hygiene will work all the time.
• Wash hands regularly • Always wash hands with soap or use hand sanitizers • Wash hands after going to the toilets • Boil water before using it for drinking purposes or • Use bleach to disinfect water • Cook food thoroughly • Wash all raw food before use, such as fruits and vegetables • Ensure all eggs and meats are washed before use. • Keep all containers of water closed
• For anyone, particularly children and the elderly or someone with another serious illness, visit the health centers or your doctor if you have diarrheal illnesses.
• Keep a supply of ORS (oral Rehydration solution) at home. If you don’t have a Supply of ORS, you can make your own (use half teaspoon of salt with two tablespoon of sugar in 8ozs of water. Remember to boil water first, then add salt and sugar after cooling of water. If there is no water, add sugar and salt to orange juice).
• Coconut water can be substituted for ORS.
• You should continue to eat easily digested food such as bananas, biscuits, soups, potato.
Dr. Leslie Ramsammy Minister of Health February 13, 2010
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