II.4. RISK FACTORS OF
GASTROINTESTINAL INFECTIONS AMONG CHILDREN
II.4.1. Poor hygiene
The spread of an intestinal infection is ensured if public
health and hygiene are poor and if the parasites appear in high number. It is
estimated that worldwide, 2.6 billion lack adequate sanitation and in Rwanda,
62% of the population lack adequate sanitation (John, 2008).
II.4.2. Contact with
animals
Human can live in daily contact directly or indirectly with a
wide variety of animals. Contact with animals including their wastes can be a
source of intestinal parasites. Animals can also be a reservoir for the
parasites, such as reptiles, fishes, dogs, cats, pigs and rodents which can
infect human who handle them. Dog, cats, and pigs are the commonest
domesticated animals and all are reservoir of infections. For example, dog can
transmit 65 different parasites and cat about 40 (Lippnicott, 2006).
II.4.3. Contaminated
water
Water bodies are still the main cause of intestinal parasites
due to poor sanitation and unboiled water that many people take up and cause
long suffer from diarrhea and related diseases. According to national library
of medicine, swimming a creek, river or lake may cause infection with
intestinal parasite such as Giardia, Schistosoma and working through
mud or puddle without proper food can allow worms to enter the body through the
skin which then infect intestine. In Rwanda, 31% of the rural population is
lacking access to safe water and expose themselves to gastrointestinal
infections (John, 2008).
II.4.4. Contaminated
soil
Soil that is fertilized with human or animal wastes may
contain parasites, such as hook worms which can enter the skin and affect the
intestine. Walking with bare foot can result in small cut or abrasion that can
allow parasites' egg or cyst to enter the body and intestinal infections (TRAC
PLUS, 2008).
II.4.5. Malnutrition
Malnutrition is the condition that results from taking an
unbalanced diet in which certain nutrients are lacking, in excess (too high an
intake), or in the wrong proportions. A number of different nutritional
disorders may arise, depending on which nutrients are under or overabundant in
the diet. Lack of major dietary items, essential amino acids, essential fatty
acids, vitamins or minerals leads to a group of diseases collectively known as
malnutrition.
ll.5.1. Different types of malnutrition
Two major kinds of protein-energy malnutrition (PEM) are
classified as marasmus and kwashiorkor, or a combination of both. Marasmus
condition is characterized by extreme wasting of the muscles and a daunt
expression due to complete absence of food; whereas kwashiorkor is identified
as swelling of the extremities and belly, which is deceiving to their actual
nutritional status. Those child don't eat enough protein source and given
instead an almost pure carbohydrate energy source such as sweet potatoes and
cassava (WHO, 2005).
ll.5.2. How malnutrition is calculated
Weight loss is often the first clue to an underlying cause of
malnutrition. The loss of more than 10% of the patient's usual weight
necessitates a thorough nutritional assessment. Recent unintentional loss of
10% to 20% of the patient's usual weight indicates moderate PEM, and loss of
more than 20% indicates severe PEM.
Malnutrition is diagnosed by anthropometric measurements and
physical examination. Correlation of malnutrition and growth retardation allows
assessment of the individual nutritional state.
II.5.2.1. Z-score method and malnutrition
characterization
The Z-score is used to describe how far a measurement is from
the median, or average. For instance, a weight for height (W/H) Z-score
calculated for an individual tells us how an individual's weight compares to
the average weight of an individual of the same height in the WHO Growth
Standard (GS).
For example, a positive W/H Z-score means that the
individual's measurement is higher than the median weight value of an
individual of the same height in the WHO GS, while a negative W/H-Z score means
that the individual's weight is lower than the average weight of an individual
of the same height in the WHO GS (WHO, 2005).
Method of percentage in calculation of malnutrition is done by
the percent of median. This is merely the weight, height, age of child
relative to the average weight of the comparable children in the reference
population, expressed as a percentage. This can be calculated from a table
giving information about the reference population.
For instance, the percentage of reference W/H is the children
weight for a given height over reference W/H (Table A5.4) X100. The percentage
of reference height (length for children above 24 months) for age (H/A) is the
height (length) of a child over reference height (length) for age (Table A5.2)
X100. The percentage of reference weight for age (W/A) is the weight over
reference W/A (Table A5.1) X100 (Table A1,2.5 in annexes 2). As shown in table
11, the severity of malnutrition depends on the percentage obtained.
Table 1: CLASSIFICATION OF CHILDREN
MALNUTRITION.
|
Weight for height (length)
|
Height (length) for age
|
Weight for age
|
|
Acute malnutrition (wasting, undernourished)
|
Chronic malnutrition (stunted)
|
Underweight
|
|
Moderate undernutrition
|
Severe undernutrition
|
Moderate stunted
|
Severe stunted
|
Moderate underweight
|
Severe underweight
|
|
<70% to <80%
|
<70%
|
>85% to <90%
|
<85%
|
>60% to <80%
|
<60%
|
Source:
http://www.the-ecentre.net/toolkit/Nutrition/NTM-1(b).doc
| 
