Malnutrition
Malnutrition is a major health problem, especially in developing countries. Water supply, sanitation and hygiene, given their direct impact on infectious disease, especially diarrhoea, are important for preventing malnutrition. Both malnutrition and inadequate water supply and sanitation are linked to poverty. The impact of repeated or persistent diarrhoea on nutrition-related poverty and the effect of malnutrition on susceptibility to infectious diarrhoea are reinforcing elements of the same vicious circle, especially amongst children in developing countries.
The disease and how it affects people
Malnutrition essentially means “bad nourishment”. It concerns not enough as well as too much food, the wrong types of food, and the body's response to a wide range of infections that result in malabsorption of nutrients or the inability to use nutrients properly to maintain health. Clinically, malnutrition is characterized by inadequate or excess intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result.
People are malnourished if they are unable to utilize fully the food they eat, for example due to diarrhoea or other illnesses (secondary malnutrition), if they consume too many calories (overnutrition), or if their diet does not provide adequate calories and protein for growth and maintenance (undernutrition or protein-energy malnutrition).
Malnutrition in all its forms increases the risk of disease and early death. Protein-energy malnutrition, for example, plays a major role in half of all under-five deaths each year in developing countries (WHO 2000). Severe forms of malnutrition include marasmus (chronic wasting of fat, muscle and other tissues); cretinism and irreversible brain damage due to iodine deficiency; and blindness and increased risk of infection and death from vitamin A deficiency.
Nutritional status is compromised where people are exposed to high levels of infection due to unsafe and insufficient water supply and inadequate sanitation. In secondary malnutrition, people suffering from diarrhoea will not benefit fully from food because frequent stools prevents adequate absorption of nutrients. Moreover, those who are already experiencing protein-energy malnutrition are more susceptible to, and less able to recover from, infectious diseases.
The cause
Individual nutritional status depends on the interaction between food that is eaten, the overall state of health and the physical environment. Malnutrition is both a medical and a social disorder, often rooted in poverty. Combined with poverty, malnutrition contributes to a downward spiral that is fuelled by an increased burden of disease, stunted development and reduced ability to work. Poor water and sanitation are important determinants in this connection, but sometimes improvements do not benefit the entire population, for example where only the wealthy can afford better drinking-water supplies or where irrigation is used to produce export crops. Civil conflicts and wars, by damaging water infrastructure and contaminating supplies, contribute to increased malnutrition
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CAGAYAN DE ORO, Philippines - A leptospirosis outbreak has been declared in Cagayan de Oro after 200 people were diagnosed to have the disease.
Two of the victims, Wildon Bacan and Raffy Chavez, have been confined at the hospital for 4 days due to leptospirosis.
The 2 survived the floods in Barangay Bulalang in Cagayan de Oro but they could not escape the disease, which is transmitted through floodwaters contaminated by urine from rats and other animals.
"I had a fever after 2 days. The fever goes away and comes back. I had a headache and I vomited," Bacan said.
The Cagayan de Oro City Health Office has already recorded 200 cases of leptospirosis infection, with 5 deaths.
Dr. Jaime Bernadas, regional director of the Department of Health (DOH), said 99% of the patients failed to get enough medicine.
The disease has an incubation period of 5 to 21 days.
CAGAYAN DE ORO – The increasing number of people infected with leptospirosis could be associated to complacency or indifference of people to take prescribed medicine, a Health official said Tuesday.
The Department of Health (DOH) in Northern Mindanao declared Monday an outbreak of leptospirosis in Cagayan de Oro City after five persons died while more than 200 were infected with the disease.
The DOH said confirmatory tests on 128 patients out of the suspected 200 cases proved to be positive.
The outbreak was spurred by flash floods that ravaged villages in the city last December 17 due to Tropical Storm Sendong (international codename: Washi).
The DOH said many of those affected by the flash floods received Doxycycline, a prophylactic medicine and antibiotic against leptospirosis, but did not take it.
Dr. David Mendoza, head of the DOH’s Regional Epidemiology, Surveillance and Disaster Response Unit, said Doxycycline is always available in clinics set up by the DOH and the City Health Office (CHO) at the evacuation centers.
But it seems the people failed to take the medicine because of “inadequacy and insufficient information” on leptospirosis, Mendoza said.
CAGAYAN DE ORO. Nurses at the Northern Mindanao Medical Center (NMMC) are busy attending patients suffering from leptospirosis. There are more than 200 individuals confined at the government hospital and most of them are victims of Tropical Storm Sendong last December 17. (Joey P. Nacalaban)
“Many people, especially those living outside the evacuation centers, came only for food and relief goods, but not for medical consultations,” he said.
At the Northern Mindanao Medical Center (NMMC), 122 children are confined while more than a hundred adults are also hospitalized due to leptospirosis, some of whom are already staying in hallways and in open spaces due to the lack of available rooms.
A nurse at the NMMC, who requested not to be named, said they gave antibiotics and other medicines like pain killers to the infected patients for free.
Among the medicines given to the patients are Penicillin G (Pen G), Omeprazole (40mg) for stomach pain, Doxycycline and Benzylpenicillin.
She said among the symptoms they assess before giving the medicines include fever, malaise, headache, chills, muscle and joint pain, diarrhea, abdominal pain, nausea/vomiting, cough, jaundice, hemoptysis (vomiting/coughing of blood), dyspnea (difficulty in breathing), decrease in urine output, hematuria (blood in urine) and discoloration of skin.
“The number of patients with leptospirosis will still increase since it will probably take at least five days before the symptoms will be visible,” the nurse said.
One of the patients, Judith Sumalpong, 47, a resident of Igpit in Opol town, Misamis Oriental, said she might have gotten the disease after she drank contaminated water at the height of the flash flood.
“I thought I was drinking clean water,” Sumalpong said.
She said she got the water from a container of mineral water that was floating in flood waters.
Sumalpong said she was later brought to the hospital after experiencing frequent vomiting, difficulty in breathing and lack of appetite.
On Tuesday, DOH assistant secretary Romulo Busuego said at least 208 leptospirosis patients have been recorded both in Cagayan de Oro and Iligan cities.
But Buseugo said some patients have already been discharged from the hospitals.
DOH regional director Dr. Jaime Bernadas earlier said they are hoping that cases of leptospirosis will go down with the distribution of medicines to affected residents who are staying inside and outside of the evacuation centers.
Councilor Dante Pajo, chairperson of the City Council’s committee on health and sanitation, has called on the public not to be careless and complacent since leptospirosis is fatal.
