Clean hands, healthy children

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Clean hands, healthy children

Written by Sade Oguntola Monday, 03 October 2011

Many illnesses, particularly diarrhea, can be prevented with proper hygiene and sanitation practices. Experts warn that contaminated hands are one of the main ways diarrheal disease spread, arguing that hand washing with soap is an effective way to interrupt the transmission path of diarrhea and remain healthy. Sade Oguntola reports.

Concerned about Abel’s condition, Mrs Haruna carried him to the nearest health clinic, journeying on foot from their home. Because the two medical officers at the clinic served a community of more than 100,000 people and many people were usually on queue to be attended to at the clinic, she decided to take Abel to see a traditional healer, who treated Abel with herbs.

Mrs Haruna’s experience, sadly, is not unique. In fact, her neighbour, Mrs Ebun Nwankwo, lost her nephew to diarrhea when he was six. Mrs Nwankwo had five children of her own, and her three-year-old daughter nearly died when she became severely dehydrated from diarrhea.

Sadly, Abel and Mrs Nwankwo’s nephew are just two of more than one million children whose lives are lost each year to diarrheal disease. Their excruciating experiences, shared by millions of parents around the world, is an indication that whether a child survives a diarrhea episode or not may depend on where he or she lives as well as awareness of and access to existing life-saving interventions like washing hands with soap and water.

Today, the leading causes of death among children under the age of five, particularly in the developing world, are pneumonia and diarrhea. Diarrhea, the passage of three or more loose or liquid stools per day, or more frequently than is normal for an individual, is a leading cause of childhood ill health and death in developing countries.

According to World Health Organisation (WHO) estimates, diarrheal disease kills 2 million children in developing countries each year, making it the second most serious killer of children worldwide. The tragedy of these deaths is that diarrhea is both preventable and treatable.

Caused by the intake of water and food contaminated by bacteria, viruses or parasites (often from faeces), diarrhea can easily spread through contaminated food and drinking water or from person to person as a result of poor hygiene and sanitation. Unfortunately, diarrhea is especially risky for malnourished children who are more likely than adults to become dehydrated quickly, as well as adults who have weakened immune systems.

One of the most commonly recommended measures for preventing diarrheal diseases is washing hands with soap and water. Although the problem of implementing this intervention in areas that lack basic infrastructure such as a clean water supply still needs to be addressed, the immense importance of hand washing explains why Unilever Nigeria Plc in conjunction with the Lagos State Ministry of Health, launched a hand-washing campaign to prevent diarrhea and other diseases in the country.

Dubbed “Pledge to Defeat Diarrhea in Nigeria”, the campaign seeks to mobilise the public in hand-washing activities, in a bid to prevent the disease, which is the cause of over 3.5 million deaths of children in the country annually.

“Statistics indicate that only one out of every 10 children washes their hands properly with soap and water and only 10 per cent of the population know how to wash hands properly. Mothers need to instill habits of washing hands in children so that it becomes a daily habit,” Mr Thambo Mabe, Unilever’s Managing Director, said.

Why should mothers instill habits of washing hands in children? Children are more vulnerable to diarrhea because their bodyweight has higher amounts of water than that of adults and, as such, have a greater risk of life-threatening dehydration. Their kidneys are less capable of conserving water and children in poor state of nutrition or health are more susceptible to diarrhea and dehydration,” explained Dr Babayemi Osinaike, a consultant Paediatrician and Head, Olikoye Ransome Kuti Children Emergency Room, Lagos University Teaching Hospital (LUTH).

Although diarrhea is a major cause of death during natural disasters and other population emergencies, he said, “Prevention of diarrhea through hand washing with soap is one of the most cost-effective public health interventions. Studies have shown that hand washing with soap can reduce the incidence of diarrheal disease by over 40 per cent.”

The most critical times to clean hands are before and after meals and snacks; before caring for a young children; after touching a public surface; before and after preparing food, especially raw meat, poultry, or seafood; after using the restroom; when hands are dirty; after touching animals, or when one or someone around one is ill.

But washing hands with water alone is significantly less effective than washing hands with soap in terms of removing germs. According to Dr Osinaike, “the promotion of hand washing with soap is an intervention that appears to be both highly effective, reducing diarrhea incidence by between 27 and 89 per cent. Effective hand-washing with soap takes between eight and 15 seconds and is followed by thorough rinsing with running water.”

Paradoxically, the quality of water used in washing hands also matter. “Malawians have better access to safe water and soap than most other Africans. Yet diarrhea continues to be a major cause of sickness and death among young children in that country. This is because many use contaminated water and maintain unhygienic practices in food preparation. There is also poor waste disposal,” Dr Osinaike pointed out.

Still, Dr. Mobolanle Balogun, a consultant public health physician, stated that hand washing is one of a range of hygiene promotion interventions that can interrupt the transmission of disease-causing germs including diarrheal and respiratory tract infection- causing germs. It is both cost-effective and applicable across a broad range of disease-causing germs.

Ironically, many people are not aware of the need for hand washing in the prevention of diseases. According to him, “a study carried out by the Nigerian Infection Control Association (NICA) between March and May 2011, which measured the level of hand washing knowledge and practice, handling and storage of water as well as perceptions of the prevalence and causes of diarrheal and upper respiratory infections in Karamu beach community, a sprawling urban slum on the coastline of Lagos, found that the link between a dirty environment, the hands and disease is not understood by many people in the studied community.”

Only 3.6 per cent of the sample population linked diarrhea to dirty hands and faeces, but they did not see hand washing as a preventive measure. Although many respondents knew that soap should be used to wash hands, less than 50 per cent washed their hands with soap. Still, many people in the community could not recognise poor hygiene as one of the causes of upper respiratory infections. In addition, many thought cough was due to bad air, smoking, eating coconut and dust, while higher education was directly correlated with higher rates of hand washing practice and this was a statistically significant finding.

Certainly, diarrheal disease has many different causes and infections respond differently to different intervention methods. So, successfully combating diarrheal disease requires a coordinated approach that includes both prevention and treatment methods to effectively address and treat all of the possible causes and effects of diarrhea. These include improving water quality, sanitation, and hygiene. Similarly, exclusive breastfeeding can prevent and mitigate the effects of diarrhea in infants under six months of age.

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