가난한 어린이 설사로 죽는다


5살 미만 어린이 사망 원인 2위,
기후변화가 설사 발병을 부추겨

한겨레 등록 : 2013.04.11 15:45
http://www.hani.co.kr/arti/international/international_general/582365.html

‘콜레라.’ 고열과 구토를 동반하는 전염성 감염 질환이다. 한 해 지구촌에서 300만 명가량이 감염돼, 이 가운데 10만 명 정도가 목숨을 잃는다. 빠른 전염력 탓에 특정 지역에서 콜레라가 창궐하면, 세계인의 관심을 끌기 마련이다. 그럼, 이건 어떤가?

한 해 전세계적으로 약 17억 명이 앓는 질병이 있다. 세계보건기구(WHO)의 자료를 보면, 1년에 지구촌 5살 미만 어린이 66만 명이 이 병으로 목숨을 잃는다. 5살 미만 어린이 사망 원인 1위(약 120만 명)인 폐렴에 이어 두 번째로 치명적인 질병이다. 관심을 가질 만한가?

에티오피아 14%, 독일 1%

오염된 물과 음식 섭취가 주요 감염 경로다. 일단 발병하면 극심한 탈수 증세를 보인다. 영양실조 상태에 있으면 이 병에 걸리기 쉬운데, 발병 이후 영양실조가 급속도로 악화하면서 숨을 거두는 경우가 많다.

예방 대책? 적절한 위생 상태를 유지하고 깨끗한 물을 마시면 된다. 이게, 생각보다 쉽지 않다. WHO 자료를 보면, 전세계적으로 25억 명가량이 비위생적인 환경에서 살아가고 있다. 깨끗한 마실 물을 구하지 못하는 인구도 7억8천만 명이나 된단다. 이 질병이 창궐하는 이유다. 뭘까? 설사다.

유니세프는 지난해 6월 펴낸 보고서에서 가난한 나라와 부자 나라 어린이들의 ‘생존율 격차’를 분석했다. 2010년을 기준으로 지구촌에서 5살 미만 어린이 사망률이 가장 높은 에티오피아와 가장 낮은 독일을 견줘본 게다. 그해, 에티오피아에선 5살 미만 어린이 27만7천 명이 목숨을 잃었다. 1천 명 가운데 106명꼴이다. 독일에선 2900명이 숨졌단다. 1천 명당 4명꼴이다.

에티오피아에선 사망한 어린이 가운데 14%가 설사로 목숨을 잃었다. 독일에서 설사로 목숨을 잃은 어린이는 전체의 단 1%로 나타났다. 설사는 가난한 나라의 어린이에게 더욱 치명적이란 얘기다. 해마다 지구촌에서 설사로 목숨을 잃은 어린이의 절반은 사하라사막 이남 아프리카 국가에서 나온단다.

사하라사막 저 아래, 짐바브웨·남아프리카공화국 등과 국경을 맞대고 있는 내륙국가 보츠와나가 있다. 그곳에서도 설사는 5살 미만 어린이 사망 원인 가운데 2위, 2살 이하 영유아의 영양실조 원인 가운데 1위란다. 캐슬린 알렉산더 미국 버니지아공과대학 교수(수의학) 연구팀은 1974년부터 2003년까지 30년 동안 보츠와나에서 설사 발병률과 ‘특정 요인’의 상관관계를 분석한 논문을 지난 3월28일 <환경연구·공중보건 저널>에 발표했다. 연구팀이 발병률과 견준 ‘특정 요인’은 기온과 강수량, 곧 기후다.

높고 건조한 기간 발병률 높은 이유

전형적인 아열대 기후를 보이는 보츠와나는 건기와 우기가 뚜렷하다. 연구팀의 분석 결과, 해마다 기온이 가장 높고 건조한 기간에 설사 발병률이 가장 높게 나타났다. 설사를 유발하는 미생물을 옮기는 파리의 활동이 이 기간에 가장 왕성하기 때문이란다. 알렉산더 교수는 논문에서 “기후변화가 진행되면서, 특히 건기에 기온은 갈수록 높아지고 강수량은 점차 줄어들고 있다”며 “이 때문에 우기에 견줘 건기에 설사 발병률이 20%나 높게 나타났다”고 밝혔다.

설사는 특히 가난한 아이들에게 치명적이다. 기후변화가 설사 발병을 부추기고 있다. 말하자면, 기후변화가 가난한 아이들의 목숨을 위협하고 있는 셈이다. 기후변화에 관심을 쏟아야 할 이유가 한 가지 늘었다.

정인환 기자 inhwan@hani.co.kr

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Diarrhoeal disease

http://www.who.int/mediacentre/factsheets/fs330/en/index.html

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Key facts

• Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.
  
• Each year diarrhoea kills around 700 000 children.
  
• A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.
  
• Globally, there are nearly 1.7 billion cases of diarrhoeal disease every year.
  
• Diarrhoea is a leading cause of malnutrition in children under five years old.

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Diarrhoeal disease is the second leading cause of death in children under five years old, and is responsible for killing around 700 000 children every year. Diarrhoea can last several days, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhoea.

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose, “pasty” stools by breastfed babies.

Diarrhoea is usually a symptom of an infection in the intestinal tract, 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.

Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce disease risk. Diarrhoea can be treated with a solution of clean water, sugar and salt, and with zinc tablets.

There are three clinical types of diarrhoea:

• acute watery diarrhoea – lasts several hours or days, and includes cholera;
  
• acute bloody diarrhoea – also called dysentery; and
  
• persistent diarrhoea – lasts 14 days or longer.

Scope of diarrhoeal disease

Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly results from contaminated food and water sources. Worldwide, 780 million individuals lack access to improved drinking-water and 2.5 billion lack improved sanitation. Diarrhoea due to infection is widespread throughout developing countries.

In developing countries, children under three years old experience on average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhoea.

Dehydration

The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced.

The degree of dehydration is rated on a scale of three.

• Early dehydration – no signs or symptoms.
  
• Moderate dehydration:
  
  
  
  • thirst
    
  • restless or irritable behaviour
    
  • decreased skin elasticity
    
  • sunken eyes
  
  
• Severe dehydration:
  
  
  
  • symptoms become more severe
    
  • shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin.

Death can follow severe dehydration if body fluids and electrolytes are not replenished, either through the use of oral rehydration salts (ORS) solution, or through an intravenous drip.

Causes

Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. Infection is more common when there is a shortage of adequate sanitation and hygiene and safe water for drinking, cooking and cleaning. Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.

Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause of malnutrition in children under five years old.

Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea.

Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation. Fish and seafood from polluted water may also contribute to the disease.

Prevention and treatment

Key measures to prevent diarrhoea include:

• access to safe drinking-water;
  
• use of improved sanitation;
  
• hand washing with soap;
  
• exclusive breastfeeding for the first six months of life;
  
• good personal and food hygiene;
  
• health education about how infections spread; and
  
• rotavirus vaccination.

Key measures to treat diarrhoea include the following:

• Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
  
• Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
  
• Rehydration: with intravenous fluids in case of severe dehydration or shock.
  
• Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well.
  
• Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.

WHO response

WHO works with Member States and other partners to:

• promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries;
  
• conduct research to develop and test new diarrhoea prevention and control strategies in this area;
  
• build capacity in implementing preventive interventions, including sanitation, source water improvements, and household water treatment and safe storage;
  
• develop new health interventions, such as the rotavirus immunization; and
  
• help to train health workers, especially at community level.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int