Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Diarrhea · Nutrition · Children

Key Messages

• Diarrhea remains one of the leading causes of mor-
  tality among children under 5 years of age


• Risk factors for diarrhea include those related to
  poverty, undernutrition, poor hygiene, and under-
  privileged household conditions making children
  more at risk of developing infectious diarrhea


• Recent evidence suggests that if a range of existing
  interventions are scaled up, diarrhea burden can be
  significantly reduced © 2015 S. Karger AG, Basel

Introduction

In 2011, 6.9 million children under 5 years of age
died; 4.4 million (58%) of these deaths were at-
tributable to infectious diseases, of which pneu-
monia and diarrhea were the leading ones [1].
The incidence of diarrhea has decreased from 3.4
episodes per child-year in 1990 to 2.9 episodes per
child-year in 2010; however, it still remains one of
the most common reasons for hospital admis-
sion, with an estimated 1,731 million episodes of
childhood diarrhea reported in 2011 [2]. There

are three clinical types of diarrhea: (1) acute wa-

tery diarrhea that lasts several hours or days and

includes cholera; (2) acute bloody diarrhea, also

called dysentery, and (3) persistent diarrhea that

lasts 14 days or longer. Risk factors for diarrhea

include those related to poverty, undernutrition,

poor hygiene, and underprivileged household

conditions making children more at risk of devel-

oping infectious diarrhea. Lack of breastfeeding is

a single independent risk factor for diarrhea, and

it is estimated that not breastfeeding is associated

with a 165% increase in diarrhea incidence among

0- to 5-month-olds, a 47% increase in diarrhea-

related mortality among 6- to 11-month-olds,

and a 157% increase among 12- to 23-month-

olds. Overall, lack of breastfeeding is found to be

associated with a 566% increase in all-cause mor-

tality among children aged 6–11 months and a

223% increase in mortality among those aged 12–

23 months [3]. Despite these figures, the rates of

exclusive breastfeeding (EBF) remain unaccept-

ably low worldwide, especially in low- and mid-

dle-income countries. In this chapter, we will dis-

cuss the preventive and therapeutic strategies and

nutrition interventions pertaining to acute and

persistent diarrhea among children along with

the delivery strategies to increase access to these

interventions.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 168–172
DOI: 10.1159/000367878

3.6 Reducing the Burden of Acute and Prolonged

Childhood Diarrhea

Jai K. Das  Zulfiqar A. Bhutta