It is summer and the sun is already scorching the earth with its punishing rays. With the blistering cold giving way to the heat, most people are engrossed in their daily activities.
But Dikeledi Ontheetse is not at work because she has to attend to her youngest child, aged 18 months, who has a bout of diarrhea. The young mother is worried and helpless. Her little boy, Mothusi, looks weak and dejected. When her mother rushes her to the clinic yet again, his situation has worsened. Although he was given an oral treatment a few days earlier, he is not showing marked signs of improvement. Ontheetse takes the advice the nurses gives her, and after the child is
observed and medication administered, the two bound off for home.
“I have been up for most of the past nights. I know how dangerous diarrhea can be because my sister’s child died from it two years ago,” she says with a defeated sigh. The mother of three says she always ensures that their living area is clean and the children’s eating utensils are thoroughly washed and sterilized.
According to the World Health Organization, diarrhea is the leading cause of child mortality of children under five years of age globally, and is estimated to claim the lives of a whopping 760 000 babies annually, across the world. Of these, 1.7 billion cases of diarrhea infection among children are reported. Botswana has seen many children dying from diarrhea. In 2011, 183 children died in a space of three months, forcing government to declare war against the infection. In the periods 2008-2012, there have been more than 200 diarrhea related deaths among children every year.
171 280 cases of diarrhea were reported between 2006 and 2011. Of that number, about 1820 children succumbed to the disease. The cases vary between the clinical types, which include acute watery diarrhea (cholera), bloody diarrhea (dysentery) and persistent diarrhea. Medical experts have eluded the importance of availing safe drinking water, as well as adequate sanitation and hygiene, to fight diarrhea infections. The Ministry of Health has asserted that diarrhea disease is a health challenge accounting for majority of childhood deaths globally, and the second highest in Botswana.
In 2006, coinciding with heavy rains, Botswana health facilities reported increase in diarrhea, mortality and acute malnutrition among young children across the country. Of the approximately 540 children sampled for a cluster survey, one third of those aged less than fiver years old had experienced an episode of diarrhea. Although breastfeeding was found to be protective, it wasn’t paramount. This highlights the need for safe infant feeding, treatment of malnutrition and risk factors of diarrhea in young children.
A health practitioner at the Tsopeng clinic in Lobatse, Mmilo Keemang asserts that diarrhea is more rampant during the summer dry season. “We always encourage parents to pay attention to hygiene and bring children in for medical consultation as soon as they experience more than three watery stools per day. At this point, we mostly ascribe oral dehydration sachets. It’s best to seek professional intervention and be advised accordingly,” she explains.
Diarrhea outbreak among young children is a familiar pandemic in Botswana. Almost every single year, scores of children develop diarrhea, which is a symptom of infection in the intestinal tract caused by bacterial, viral and parasitic organisms. Diarrhea is often said to spread through contaminated food or drinking water, or poor hygiene. Researchers have established that in northern Botswana, seasonal, acute diarrhea has occurred across the country, coinciding with major hydrological phenomena occurring in the area (e.g. rainfall). Earlier this amidst fears that our tap water was unsafe to drink the Minister of Minerals, Energy and Water Resources Kitso Mokaila rubbished the claims, asserting that Botswana tap water was among the safest to drink among developing countries. He said this was made possible by the state of the art treatment facilities that the Water Utilities has established to meet the quality standards; therefore there was no possibility or need for fear of contracting waterborne diseases. This despite that many infants had been dying from regular diarrhea outbreaks, suspected to be caused by the water.
Interesting developments however spin that there could be coloration between diarrhea outbreaks and climate change.
Kathleen Alexander, an Associate professor of wildlife, natural resources and environment at the United States of America’s Virginia Tech college, says climate change is likely to worsen public health threat of diarrhea disease in arid countries like Botswana. This is her conclusive stance after more than two decades of studying diarrhea infection among children in Botswana. She conducted household surveys of North Botswana communities around the Kasane areas, to comprehend the link between environment, water quality and human diarrhea disease. Her findings established that climate drives a large part of diarrhea disease and increases the threat of climate change on vulnerable communities. After independence in 1966, Botswana set up health surveillance programmes.
However, it’s uncommon to find information on studies of climate and health interactions in the country. Alexander has however pointed out that it’s critical to identify climate health interactions across the country. She claims climate change will increase the burden of diarrhea disease in the country, in the coming months and years. “Analysis suggests that forecasted climate increase in temperature and decreases in precipitation for the region likely to increase dry season diarrhea incidence, while it declines during the wet season. Diarrhea case incidence is 20% higher on average during the dry season because the dryness increases density and fly activity. Flies are major contributors tin the transmission of diarrhea disease-causing microorganisms,” her research paper states.
Research by the Nature Climate Change journal has indicated that waterborne bacteria can cause stomach upset. It also states that vibrio infections rise with peaks in sea surface temperature.
This means that the warmer the ocean, the more food poisoning people in surrounding areas will experience. Vibrio is a group of bacteria mainly found in warm marine environments. Since Botswana is a landlocked and semi arid country, the cause may be similar but slightly different. Experts will point to dirty water as the main cause of diarrhea but there appears to be more exacerbating factors like dry weather. This dry weather attracts flies, and these flies bring contamination.
This is common in areas with subtropical climate of distinct wet and dry seasons, of which Botswana is among. Climate change in Botswana is expected to have wide-ranging effects on key sectors such as water, agriculture (food security) and human health. The country’s fragile arid environments make it more exposed and vulnerable to spells of drought and inconsistent floods. The country is anticipated to experience temperature rise of 2 degrees Celsius in 2015, and a 13 percent decline of river flow. There is obvious need for escalated public health focus on controlling diarrhea disease in Botswana. In her report, Alexander further pointed out that government must also understand the potential health implications of climate change, to ensure proper development of mitigation and adoptive strategies to protect vulnerable communities. She explained that it’s crucial to understand climate variability as a determinant of infectious disease, and note that it’s a cornerstone of climate change preparedness. Unfortunately, from the conclusions of her research spanning several decades, it’s the poor who suffer the most; they who are most dependent on the environment for their livelihood, and are least able to adapt to system changes.
The Botswana government has recently emphasized commitments to safeguard the lives of Batswana through a holistic approach to addressing climate change challenges through carbon development strategies, national adaptation plans, mitigation actions, public awareness and technological developments.
