Panacea for Under Five Deaths in Children

Globally, experts say diarrhoea remains the second leading cause of death among children under five. Yet, these untimely deaths can be prevented if proper domestic hygiene, adequate sanitary practice, safe-drinking water and food cleanliness can be strongly practiced. Rebecca Ejifoma, who spoke with four mothers, reports on the relevance of deworming infants as a panacea

At barely three years of age, David Ese had been caught in the web of cable television documentary series on Nat Geo World. He is also hooked on a few others. With the company of his grandfather, Mr. Emmanuel Brudu, whom the toddler lived with from birth in Ajeromi-Ifelodun area of Lagos, the little lad was always on a cruise of animal awareness.

At such a tender age, he could easily identify different sea creatures, such as the kings of the jungle; the preys, the hunters, the reptiles, the night crawlers, and the deadliest of the wilds.

For this pre-schooler, all he knows about television are just three features – cartoons, news, and Nat Geo Wild. This, according to his grandfather, began to reflect on his actions because he would often attempt to roar like a lion or recognise various animals.

“One Monday morning,” said the granddad, “little Ese suddenly leaped from the bed like one who had a nightmare and yelled Mummy,” and at the same time pointed at his bums and told her: “elephant in my bumbum”. You just needed to be there to watch us laugh hysterically. We understood at once that it could be he saw an elephant in his dreams or had watched more than necessary for his age the previous day or so.”

Then his mom, Mrs. Esther Ese, a primary school teacher and caterer, chipped in, “These were among the several assumptions that, I presume, tried to bury his distress wailings.”

She hinted that as she checked his buttocks that day, she obviously did not see any elephant there or in her house. So, she simply handled his alarm call with kid’s gloves, like most mothers do according to medical reports.

It was the grandfather, who, a little later, sensed the little lad could be alerting them about worm possibly playing around his anus. He said it suddenly occurred to him that a possible reason children put hands in their bumbum is when they feel any kind of uncomfortable movements.

According to the grandpa, he felt Ese would continue to be traumatised by his delusive screams, if they didn’t do anything to calm him. Then, the old man bent to look when he saw the tiny, white, thread-like creature trying to crawl out of his little grandson’s anus.

NDHS on Children’s Health and Statistics

As statistics cited by the Nigerian Demographic Survey (NDHS) 2018 shows, 13 per cent of children under age five had diarrhoea in the two-week period before the survey. It was thus likely that little Ese’s incident could have been added to that figure which represents a 10 per cent increase between 2008 and 2013.

Also, the World Health Organisation (WHO), in its description, says diarrhoea is a form of gastrointestinal infection caused by a variety of bacterial, viral and parasitic organisms.

The agency adds that diarrhoea can be gotten through inadequate sanitation, contaminated food or drinking water, or from person-to-person as a result of poor hygienic practices, among others. WHO also affirms that diarrhoea is the second leading cause of death in children under five years whereas it is both preventable and treatable.

Despite the fact that it is preventable and treatable, the NDHS still maintains that nearly 1.7 billion cases of childhood diarrhoea are recorded annually with it killing about 525,000 children under five globally every year.

Mothers Narrate Experience

A Human Resource Personnel, Mrs. Chinasa Ibeneme, is a mother of four residing at Abule-Ado in Amuwo Local Government Area. One of her daughters, Ugochi, is five-years old. She had experienced stooling as a result of picking and eating food crumbs from the floor and chewing her fingernails.

“It was really very shocking,” the mother lamented. “Ugochi has never complained of worm infections because I always deworm her and my other two children ages nine and seven every three months.” On the advice of her own mother, a teacher, Ibeneme first dewormed her little girl at a year-and-six-months old.

“And when I asked my children’s paediatrician, he told me that as long as a child is healthy, the child doesn’t really need deworming. But my mom has a contrary opinion. She argued that little children often pick things from the floor; and with such an habit, any improperly cooked meat would add to the children being prone to having worms,” she emphasised.

Ibeneme said from what she experienced with her child, she would really harp on the importance of oral solution deworming because, “it makes children healthy”. She also adds that it is ideal to clean the environment; adding, “I’m an advocate of hygiene”.

The HR personnel also pointed out that surroundings of several residential areas are no longer as clean as they used to be since Lagos State government stopped the environmental sanitation exercise. She said it is sad that many children in the same age group with her five-year-old may also delight in picking food scraps from the floors. She further cautioned parents to be alert so they can use positive reinforcements to stop their children picking their noses and putting the boogers into their mouths.

She also added that another factor of concern is the situation in which househelps handle the children’s food flasks with laxity when washed. She then recalled how her househelp washed her children’s food flask, yet, it was still very dirty when checked.

Ibeneme recalled: “At first, I didn’t know what led to my children always vomiting no matter what they ate. Then, one day on impulse, I just took their food flasks and checked. You can’t imagine the loads of dirty, left-over particles I found in the corners and edges of the food flasks.

“I asked the help and she said she didn’t know they were left there. Promptly, I put adequate measures in place to ensure proper washing of the food flasks and that helped solve that problem.”

To a very large extent, she continued with emphasis, “I now handle the basic chores as sweeping, mopping the living room tiled floor; keeping their clothes clean; cut their nails every Saturday, change their toothbrushes every three months and douse their cutleries in warm water.”

Ibeneme said she also went as far as acquainting herself with the NDHS 2018 findings which enlightened her that pneumonia, diarrhoea and malaria claim most lives of children between ages one month and five years. “And this knowledge has equipped me in knowing ways to preserve my children’s lives,” she said.

Whereas for Mrs. Elemonuwa Innocent, the fear of diarrhoea puts her on the red alert to safeguard the lives of her broods. This mother of three says she pays rapt attention to them because they are still within ages three years, one year, and one-month range respectively.

According to Innocent, when she took them for immunisation, those that attended to mothers told them “not to deworm any of our children until they are age one”. She disclosed that religiously, she follows this instruction without any question.

But the moment her first two children crossed age one, she said she has been deworming them every three months. And this is why she doesn’t understand why, despite deworming, diarrhoea still finds its way into children’s system. Hence, she is holding excess sugar guilty for worms in children after a mother had taken other precautionary measures.

“In my home for instance, rather than buy or use sugary substances for my children, I do more of homemade fruit juice. I know that worms cause illnesses in children. I had even heard how some children, after consuming certain foods, developed stomach troubles which made them to be vomiting and pooing out worms. I got truly scared and that is why I’m doing my motherly best to help prevent my little children from the pangs of diarrhoea.”

Now, despite being a full time event planner and caterer, Mrs. Esther Ibe, still makes her children’s health a top priority.

“I started deworming my five-year-old son since he was seven months old. I needed to make him stay healthy, so I do required deworming for him four times in a year.”

Knowing the role safe water plays in the life of children and despite its cost, Ibe said she began using clean and certified sachet water for them since each of them marked age one. “In addition to sachet water, I often boil water for the three of them when going to school because of germs.

“To some extent, I have read up on worms and know that when in children, they could have shortage of blood, make them become pale, makes their bums itch, they keep stooling and as well, have loss of appetite and few other health issues. That’s why I do my utmost part in ensuring that my children are kept worms-free in their bodies,” she noted.

Unlike many mothers who have garnered experiences in raising children, a young mother of one, Zainab Danmole, is a new entrant in the trade.

She admitted, “I’m quite unaware about worm in infants. In fact, I was never informed of deworming until my two-year old son began to spit constantly, lose weight and lost his appetite refusing to eat even his favourite foods.”

As she told THISDAY: “My elder sister, whose child was two years old, rushed to get some worm expellers for my child at a nearby clinic. If not, I would have remained in the dark of my son’s illness. When I told her my baby was always spitting and doesn’t eat well and that when I had never given him any worm expeller before, my sister just shouted.”

But after giving him some oral solutions, the first-time mum said it totally eluded her again until he became age three in the new year 2021. Happily, for her, she said the young lad has been growing up fine since his deworming experience.

Expert’s Perspective

Proffering a paediatric expert’s perspective to the issue in focus, the Medical Director, GTAK Health Clinic, Ikeja, Lagos, Dr. Goke Akinrogunde, stressed that poor hand cleanliness or food hygiene, especially when handling raw uncooked meals and other foods are usually responsible for worms in children.

Expert’s Perspective

The Medical Director, GTAK Health Clinic, Ikeja, Lagos, Dr. Goke Akinrogunde, stressed that poor hand cleanliness or food hygiene, especially when handling raw uncooked meals and other foods are usually responsible for worms in children.

The paediatrician, who is a sub-Committee on Medical Negligence, Nigerian Medical Association (NMA), said another factor is to prevent or caution against children walking about barefooted.Akinrogunde, who is a sub-Committee on Medical Negligence, Nigerian Medical Association (NMA), said another factor is to prevent or caution against children walking about barefooted.

He noted that some of those larva that hatches from the eggs of the worms can penetrate through the sole of the foot or even through the skin, especially ones with open sores.”

Akinrogunde also stressed a point by the WHO, which states that the chances of children in the upper or middle class getting infected or infested is very low. He said this is not to claim that worms in children is a matter of life’s social status as too much consumption of sugary foods or other pastries also have its own effects.

Diarrhoea in Africa

From medical records, Nigerian children are not the only ones grappling with diarrhoea. Perhaps, this is due to the short distance between the two countries.

Whilst diarrhoea is the second largest killer of under five children in Nigeria, in Ghana, it is the third cause of deaths among children under five. Reports have it that Ghana records 1.7 billion cases annually leading to deaths of 14,000 under-five children whereas Nigeria records 18.8 per cent with about 26 per treated with Oral Dehydration Salts (ORD). Only 10 per cent of under-five deaths were recorded in Nigeria in 2016.

According to research, diarrhoea is deemed a menace in sub-Saharan Africa including some parts of West Africa with an estimated 150,000 cases yearly among children under-five due to poor hygienic and sanitary practices.

In 2011, diarrhoea was said to have peaked in Ghana with estimated cases at 113,786 among children under-five years. It was also noted that approximately 2,318 cases were from severe dehydration leading to 354 deaths within the same year.

A 2019 submission by the WHO describes diarrhoea as ‘the passage of three or more loose or liquid stools per day or more frequent passage than is normal for the individual. The condition, if persistent, and/or without intervention, may lead to several complications and even death, particularly among under five children.

Globally, it is estimated that about 1.7 billion episodes of childhood diarrhoea disease occur annually, and over 700,000-800,000 of these cases result in preventable deaths. WHO states that global evidence has recently recorded a vast decline in diarrhoea cases and deaths within the last two decades; the reverse remains the scenario in sub-Saharan Africa where the situation has continued to be unacceptably high.

On the other hand, the United Nations Children’s Fund (UNICEF) has it that diarrhoea deaths has slightly declined to about 76,980 representing 15 per cent in 2016. In 2017 alone, diarrhoea accounted for 8 per cent of all deaths, which translates to over 1,300 children per day or 480,000 per year among children under five worldwide, despite the availability of a simple treatment.

The agency noted, however, that between the year 2000 and 2018, a huge progress was made during which the total annual number of deaths from diarrhoea among children under five decreased by 64 per cent. UNICEF also disclosed that most deaths from diarrhoea occur among children below the age two living in South Asia or sub-Saharan Africa.

Furthermore, as of 2013 in Sierra Leone and Congo, UNICEF findings show that about 15 per cent and 18 per cent respectively of under five deaths were due to diarrhoea.

How Worms Get into Humans

According to the Centre for Diseases Control (CDC) research on soil-transmitted helminth, it refers to the intestinal worms infecting humans through polluted soil. Its infections are among the most common infections in humans caused by a group of parasites known as worms. They are also known as parasitic worms.

Helminth worms are also transmitted via accidental ingestion through infective eggs while others have larvae that actively penetrate the skin such as hookworms, schistosomes, strongyloides and a few others.

Its infections are mostly found mainly in areas with warm and moist climates where sanitation and hygiene are poor, including in temperate zones during warmer months. They live in the human intestines while their eggs pass into the faeces of the infected person. Sadly, when the infected person defecates in the open field and such is used as fertilizer; those soiled eggs are re-deposited into the soil.

People then get infected when the mature hookworm gets ingested either through dirty, contaminated hands or via vegetables that have not been thoroughly washed, peeled and cooked. While they also hatch in the soil, they release larvae, immature worms that can penetrate the human skin while on the open field.

Already across the world, figures on hookworm infections range from 576 to 740 million, and in another instance, an estimated 807 to 1,222 million people are said to be infected by it globally; altogether accounting for a major burden of the disease worldwide.

The consequence of this, experts say, is the heavy harm of infections the worms do to the human body in multiple ways. Some of the harms include impairing the nutritional status of its host, feeding of its host’s tissues and blood, which leads to a loss of iron and protein.

Hookworms also cause chronic intestinal blood loss leading to anaemia. In children, it causes internal bleeding leading to loss of iron and anaemia; intestinal inflammation and obstruction; diarrhoea; and impairment of nutrient intake, digestion and absorption.

Precautions

Living healthy has always been recommended for everyone as the overall lifestyle. Sadly, not many people take that into practicable cognizance. Yet, in the bid to combat worms, living healthy lifestyle has been mooted by experts as one of the ways to help prevent chronic diseases and long-term illnesses, especially as it relates to diarrhoea to curb worm infestations.

In particular, Akinrogunde notes that “if you have good food, environmental and hand decontaminations, and make sure you prevent uncooked food to some extent, one can really knock off worms’ infestation.

He opposed to the idea of quarterly deworming, adding that it is not for every child. For instance, he said: “I don’t expect the parents of a child that stays in the upper-middle level where you can hardly see filthy environment to say they are deworming their children. It is just not necessary.”

He shared an experience he had in the paediatric ward of a general hospital in Lagos. He narrated that a child had been brought in for scan. And at first, he had thought there was a mast in the lad’s tummy, quite full. “As the paediatric surgeon, I had the responsibility of operating on him.” He said: “If you saw the amount of worms this child passed out over the weekend that was causing terrible obstruction in his system, you would marvel.”

Akinrogunde noted that he shared that to let readers know the level of damages worms can cause in the human body. He said: “Among others, worms can generally cause diarrhoea just as hookworms can reduce blood level because it sucks blood. Then, tape worms can make a child to grow abnormally.”

Solutions

The expert stressed on the importance of keeping under-five children healthy, alive and free from worms. He prescribed access to safe drinking-water, well-cooked meal, hand hygiene, constant footwear, washing of foods such as fruits, vegetables, seafood, raw meat, environmental hygiene, and proper sanitation as diverse panacea to helping the toddlers grow healthy.

The pediatrician noted that with these practices in place, it is certain that mortality and morbidity in children age zero to five years will reduce in Lagos State in particular, and in Nigeria in general.