D

espite improvements in preventive care, the nation still suffers from high incidences of diarrhea an a high infant mortality rate — conditions one expert blames on a lack of skills among health workers in the country.

Badriul Hegar, Indonesia Pediatric Society chairman, said severe dehydration was responsible for most deaths among diarrhea victims.

“The [diarrhea] infection is quite mild actually; but the question is, whether we are able to cope with the critical phase so that the children do not suffer from severe dehydration,” he told a press briefing.

In many cases, he said, diarrhea patients died from severe dehydration due to a lack of skills and knowledge among health workers on how to properly treat acute diarrhea.

“Rehydration remains the heart of therapeutic approach of diarrhea,” Badriul said Wednesday.

Globally, diarrheal diseases remain a leading cause of both morbidity and mortality. They top the list of five common causes of death worldwide. Most cases of diarrhea occur in developing countries in which poor hygiene and sanitation, widely recognized as indirect causes of gastrointestinal infections, remain a problem.

In Indonesia, diarrheal diseases place a heavy burden on public health costs as the fatality rate they cause stands at 7.8 per 1,000 people per year, making them one of leading causes of death among infants in the country.

“Our infant mortality rate has improved a lot, partly thanks to progress in combating diarrhea. Yet, we haven’t been able to achieve the
desired results,” said Rini Sekartini, a pediatrician from the University of Indonesia’s School of Medicine.

The 2007 Basic Health Survey (Riskesdas) showed that diarrhea accounted for 15 percent of deaths among infants after neonatal problems, which accounted for 46.2 percent. Other causes of infant mortality included pneumonia (12.7 percent), congenital anomalies (5.7 percent), meningitis (4.5 percent), and tetanus (1.7 percent), while 3.7 percent remained unknown.

Diarrhea also ranked as the second-highest cause of death among children under five years old, claiming 17.2 percent of deaths in the category, while neonatal problems topped the list.

The infant mortality rate currently stands at 34 per 1,000 live births.

Badriul said intestinal infections caused most cases of diarrhea, and poor hygiene, sanitation, eating habits and bad housing also played key roles in spreading such diseases.

Citing hospital surveillance on diarrhea cases in children under five years old conducted by the Health Ministry and the NAMRU 2 study of 2005, he said that 84 percent of diarrheal infections were caused by rotavirus and only 16 percent came from bacterial factors.

“Therefore, only equal to or less than 16 percent of diarrheal infections need antibiotics,” he said.

Studies show that several big cities in Indonesia have high incidences of severe rotavirus diarrhea, including Bandung (47 percent), Denpasar (59 percent), Jakarta (67 percent), Mataram (63 percent), Palembang (60 percent), and Yogyakarta (35 percent).

Rotavirus infections, Badriul said, adhere to and destroy the absorptive tissues in gastrointestinal tract. As the intestines lose their ability to absorb water, dehydration and electrolyte imbalances could cause vomiting and diarrhea in patients he said.

To cope with serious cases of diarrhea in children, the Health Ministry has introduced the “Lintas Diare” program, which delivers five key treatment approaches: rehydration, proper nutrition, zinc supplementation, selective use of antibiotics and education on healthy and clean living habits.