Megan Smith

Megan Smith - U82952842

Diarrheal diseases in the Democratic Republic of the Congo
From: Secretary of Health, Democratic Republic of the Congo
To: Minister of Finance, Democratic Republic of the Congo
Introduction
Diarrheal diseases are a serious problem in the Democratic Republic of the Congo. These
diseases primarily affect children under five, but also most people living in rural areas.8 Studies
have revealed that lack of access to improved water sources, sanitation, and malnutrition feed
this problem.3 As a result, there is a need for more education on diarrheal diseases, an increased
availability of treatments, a program encouraging hand washing with soap and dedication to
improving access to drinking water and sanitation facilities.8,11 Evidence to support the
effectiveness of these approaches is seen in numerous studies conducted by WHO, and other
reputable health organizations. Diarrheal diseases account for nearly 20% of our childhood
mortality and morbidity rate.4 The government needs to dedicate funding to help lower the
prevalence of diarrheal diseases. If money and resources are dedicated to education, preventative
efforts and cost-effective treatments we can drastically improve our nations health and the result
will be lower childhood mortality rates and a brighter future with a stronger promise of more
prosperity, as a healthy nation.
Nature and Magnitude of the Problem
Globally, Diarrheal disease is the second leading cause of death for children under five
years old.8 Diarrhea is typically caused by an infection in the intestinal tract as a result of
bacteria, viral or parasitic organisms and is then spread through contaminated food, drinking
water or person-to-person as a result of poor hygiene.11 Diarrheal disease is one of the main
causes of mortality and morbidity along with malaria, tuberculosis and HIV in the Democratic
republic of the Congo.9 Home to roughly 1% of the global population, the Democratic Republic

Megan Smith
of the Congo has the third highest diarrheal morbidity among children under five.8 One of the
specific diarrheal diseases that is contributing tremendously to these statistics is cholera.1 In
2011, there were 21,700 reported cases of cholera.7 Currently in the Democratic Republic of the
Congo 52.6% of children under five with diarrhea are receiving oral rehydration therapy, yet this
is still a large problem.7
Affected Populations
Diarrheal diseases are indiscriminate and can affect anyone. However, the population in
which it is most prevalent and most dangerous is children under five years old. A 2010 health
statistics report said that diarrheal diseases accounted for 19% of the causes of death among
children in the Democratic Republic of the Congo.4 This is higher than deaths caused by malaria
in children, at 13%, and nearly as high as the 20% caused by pneumonia.4 In a 2010 study, it was
reported that 60,450 children died from having diarrhea.8 Children are more susceptible and at a
greater risk for diarrheal diseases, although since it is something caused by contaminated food,
water, and lack of hygiene, no one is exempt. Others that are more likely to get diarrheal diseases
are those living in poverty, which is currently 71% of the total population of the Democratic
Republic of the Congo, or those without access to water and sanitation.2 In general, rural areas
have the highest rate of deaths from diarrheal diseases.4
Risk Factors
As stated above, children under five years old are most susceptible to diarrheal diseases,
and therefore are the most at risk population in the Democratic Republic of the Congo. Diarrhea
is also a leading cause of malnutrition in children under five years old.11 For children who die
from diarrhea, malnutrition is usually an underlying factor, which makes them more vulnerable
to diarrhea, and each episode of diarrhea worsens their malnutrition.11

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The biggest risk factor for everyone living in the Democratic Republic of the Congo is
not having access to clean water. In 2012 it was reported that only 39% of people in the
Democratic Republic of the Congo had access to an improved water source, and this is a very
slowly improving statistic.2 An improved water source is defined as a source of drinkable water
that could either be the presence of a piped water source on premises or sources such as public
taps, boreholes, rainwater collection or protected springs and dug wells.2 Since 2002 the access
to clean water has only risen 7%; less than a 1% increased access to clean water each year. If
only 39% of people have access to an improved water source, that means that 61% of the
population does not, which means that they do not even have access to collected rainwater as a
water source. The MDG target is that 73% of the population would have access to an improved
drinking water source by 2015. Clearly there is much progress to be made. Living in rural areas
is a risk factor itself because of the almost inherent lack of access to water, where as in urban
areas 96% of people have access to an improved water source, and this rate has been consistent
since 2005.2 Majority of people, 66%, live in rural areas while 34% of people in the Democratic
Republic of the Congo live in urban areas. Therefore, roughly one-third of people have access to
clean, drinkable water.2 A 2010 health statistics report on the Democratic Republic of the Congo
reported that specifically in the rural areas only 28% of people of access to an improved drinking
water source.4
The second major risk factor is poor sanitation, which is again linked to poverty. The
same 2010 health statistics report found that only 23% of the population has access to an
improved sanitation facility.4 The MDG target is that 55% would have access by 2015, which
also is drastically optimistic and unrealistic based on the current progress, or lack there of.

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Not having access to improved water source and sanitation facilities are two major risk
factors for diarrheal disease. It affects everyone, while children under five are still hit the hardest
as poor sanitation, lack of access to clean water and inadequate personal hygiene are
responsible for an estimated 90% of childhood diarrhea.8
Economic and Social Consequences
This health issue in the first place is attributed to economic and social factors such as
high levels of poverty, displacement and limited access to health services.5 However, diarrheal
diseases themselves also have a negative toll on the Democratic Republic of the Congos
economy and society as well. In a WHO health profile, they documented a drop in the national
growth rate, partially attributable to the large number of childhood mortalities from diarrheal
diseases.5 These diseases are affecting the livelihood of the Democratic Republic of the Congo,
which in turn effects the economy as the country is loosing people who have the potential to be
able-bodied workers to help prosper the nation. As with many illnesses, diarrheal diseases also
prevent children from being able to attend school and prevents adults from working, which is a
detriment to the prosperity of the nation as it inhibits people from health, education and taking
part in the economy. Diarrheal diseases are a burden on families as a whole, especially those
living in rural areas with an acute lack of access to health facilities.8 If a family member needs to
take someone into a clinic for treatment of diarrheal disease it causes them to miss days from
work, as well as pay money for treatment which causes financial hardships especially because
nearly 60% of the population is living on less than one dollar a day.7 The WHO said, access to
drinking water and improved sanitation is a fundamental need and a human right vital for the
dignity and health of all people. The health and economic benefits of improved water supply to
households and individuals (especially children) are well documented.7 It is important that we

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improve water and sanitization to protect children from diarrheal diseases and to improve the
Democratic Republic of the Congos health and economy.
Priority action Steps
A quick and cost effective way to treat diarrheal diseases is through rehydration with oral
rehydration salts that include salt and sugar to replace both water and electrolytes lost; this only
costs a few cents per treatment.11 As a nation we need to invest in increasing access to safe
drinking water and improving sanitation, although this is a longer term project and as we address
these larger underlying issues, we also need to actively make treatments more readily available
and provide other preventative measures in the meantime. We need to actively educate families
about diarrheal diseases; how they get them and ways they can prevent it within their own
family. Although not many people have access to clean water, we can encourage the boiling of
water in order to drink it, as well as use it for hygiene purposes; namely hand washing.8 Hand
washing with soap is a behavior that needs to be promoted through both education and soap
provisioned by the government as a study has shown that hand washing with soap lowers the
incidence of diarrhea by 53%.10 Education, access to clean water, and hygiene are the top steps
we need to commit to as soon as possible to lower the prevalence of diarrheal diseases, diseases
which we have the capability to treat and prevent. In the end, changes in behavior and public
health policy are going to make the most impact.8 We need to devote funding to educating our
citizens so they can start making behavior changes, as well as provide them with soap for hand
washing and make treatments more accessible to families. All of this must take place while
increasing funding to support larger infrastructure projects to increase accessibility to clean water
and sanitation in order to create long term preventative measures for diarrheal diseases and many
other illnesses.

Megan Smith

Bibliography
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