Diarrhoea remains a leading cause of morbidity and mortality among under-five children in Nigeria, primarily driven by fluid and electrolyte loss. Clinically defined as the passage of three or more loose or liquid stools per day, it disrupts normal intestinal transport mechanisms. Pathophysiologically, acute diarrhoea is categorized based on its mechanism and duration:
In Nigerian primary health care settings, diarrhoeal episodes stem from a mix of viral, bacterial, and parasitic pathogens. Rotavirus is the predominant cause of severe dehydrating gastroenteritis in infants. Bacterial agents such as Escherichia coli, Shigella, and Vibrio cholerae frequently present with high fever or bloody stools. Parasites like Cryptosporidium contribute significantly, especially in immunocompromised children.
Transmission dynamics are heavily influenced by local environmental and socio-economic determinants:
A systematic clinical assessment of a child with diarrhoea requires evaluating general appearance, eye condition, skin turgor, and thirst. The World Health Organization classifies dehydration into three distinct clinical categories to guide immediate fluid management.
| Clinical Sign | No Dehydration | Some Dehydration | Severe Dehydration |
|---|---|---|---|
| Condition | Alert, normal | Restless, irritable | Lethargic or unconscious |
| Eyes | Normal | Sunken | Very sunken and dry |
| Skin Pinch | Goes back immediately | Goes back slowly | Goes back very slowly (>2 seconds) |
| Thirst | Drinks normally, not thirsty | Drinks eagerly, thirsty | Drinks poorly or not able to drink |
Oral Rehydration Therapy (ORT) remains the cornerstone of treating children with no or some dehydration. Low-osmolarity Oral Rehydration Salts (ORS) solution optimizes the sodium-glucose cotransporter mechanism in the intestinal mucosa, enhancing water absorption even during active diarrhoeal fluid loss. Nurses must teach caregivers how to prepare and administer ORS correctly, using small, frequent sips from a cup rather than a feeding bottle to prevent contamination and aspiration.
Alongside ORS, daily zinc supplementation (10 mg for infants under six months, 20 mg for older children for 10-14 days) is mandatory. Zinc shortens the duration of the illness, reduces stool volume, and prevents future episodes over the subsequent two to three months by supporting mucosal cell regeneration and immune function.
Starving a child with diarrhoea is an outdated and harmful practice that worsens malnutrition and delays intestinal mucosal repair. Feeding must continue during the illness, and an extra meal should be given daily for at least two weeks after the diarrhoea stops to catch up on lost growth.
While ORS manages most cases, children with severe dehydration or specific complications require urgent intravenous (IV) fluid resuscitation and secondary facility care. Nurses must recognize these danger signs promptly to prevent hypovolemic shock and death.
Controlling diarrhoeal diseases requires targeted public health interventions aimed at interrupting transmission cycles within communities. Nurses play a central role in health education during antenatal visits, immunization clinics, and community outreaches.