Diarrhoeal diseases in the Gelukspan Health Ward 1983-94

Diarrhoeal diseasesin the
Gelukspan Health Ward
1983-94

Paulo Ferrinho

Part one of a three-partarticle

Summary ABBREVIATIONS

This arti.cleis diuid,edinto 3 parts. In ANC - Ante-Natal Clinics
Part I a generalintroductionto the BF - Breast feeding
Health Seruicesin the Gelukspan DD - Diarrhoeal Diseases
Distrfutis giuenwith thereasonsfor FP - Family Planning
sucha suruey.The datafrom children HDD - Household where at least one of the underfive children
admittedwith dinrrhoealdiseasesto
our ward ouera period of 7 months has had diarrhoea over the study period
are armlysedu, tithregardto seasonal, NDD - Households where none of the underfive children
age,sqcualand nutritional factnrsas
well as mortalifu.Thenthe 70 ORS - had diarrhoea over the study period.
qrrcstionnairecsompletedwith the PNC - Oral rehydration solution
caretakersof theabouechildrenare SSS - Poshratal Clinic
discussedand analysed UFC - Salt-Sugar Solution
Under{ive children
Part II representstheresulfsof a
communitysurueyon Diarrhoeal
Diseasescondurtedin 1984,including
theattitudesand knowledgeof the
caretakersconceningthis diseaseand
aspectsof domestfulrygi.erle.
In Part III thefi,ndingsare
discussedin relationto othersurueys
in tuytrWto understandwhat is
happenirryregardirryDiarrhoeal
Diseasesin the Gelukspanarea^Some
conclusionasnd recommendationasre
made.

Dr Paulo Ferinho MB ChB
Gelukspan Community Hospital
Private BagX21
RADITHUSO
2746
Republic of Bophuthatswana

SAFAMILYPRACTICEAPRIL1985 IO7 SA HTIISARTSPRAKTYK APRIL 1985

Dianhoeal diseasesin the Gelukspan Health lVard

INTRODUCTION death in pre-school children according to hospital
statistics.
HEALTH SENWCES IN THE GELUKSPAN DISTRICT
The Gelukspan Community Hospital servesa This fact, together with the fact that we already had a
population of 72 458 people (calculated, 1983), most of successful nutrition program initiated by Dr M Bac,
Tswana origin, living either in long-established brought out the need to complement the nutrition
haditional villages or in more recently established project with a special intervention directed at diarrhoeal
resettlements as a result of the political policy in diseases. The first steps were taken when in 1981 a
Southern Africa sruvey was conducted on water and diarrhoeal diseases;
health education by all our teams always emphasized
Agriculture and cattle farming are the main occupations the need for oral rehydration But it was not until last
of the population; migr:ant labour is the major source of year that the diarrhoeal project became a project on its
income; the hospital is the main employer in the region own The first steps were directed at irnproving in-
patient care and developing teaching materials (songs:
The health status of the population has been Appendix 1, and teaching posters) addressing this
extensively studied in community surveyst'z'r'r'sc, arried particular problem. The second step \ryas the
out by Dutch students under the guidance of Dr M Bac. assessment of the knowledge of our clinic staff
It was in response to the finding of these surveys that concerning the management of diarrhoeal diseases and
our system of health care has evolved with general the subsequent development'of a flow chart for the
emphasis on primary health care and parbicular management of DD. The third step was to study the
emphasis on childhood malnutrition. The description characteristics of children with DD admitted to the
and the successes of this intervention program have ward, to find out what caretal<ers had done for children
been published6. before admission and to do a community based shrdy of
DD. The results of these studies are presented and
We have one hospital, seven clinics (fixed points), 8 discussed in this tlreepart article.
mobile clinic points, a mobile underfive team, a
psychiatric community teanrq a TTI team, an Eye team, Children admitted
a school nurse, social workers, an environmental health with diarrhoeal
team and a dental team involved in community work diseasesbetween lst
Every one is supposed to provide preventive services October 1983 and
and, with the exception of the school nurse and the lst May 1984
social workers, to provide curative services also.
SEASONAL DISTRIBUTTON AND STUDY GROI.IP
Both the hospital out-patients deparhnent and all the As seen from Graph 1.1, diarrhoeal diseases tend to
clinics have special clinic days for ANC, FP, UFC, occur over the hot, rainy season and that is the reason
PNC, Psychiatry and TB cases.We try where possible why 306 (44,15%) of all the 693 children admitted to
to combine PNC/UFC/FP in a single visit to the clinic. our infectious disease ward during the study period had
The mobile clinic tries to attend to the villages where DD; of these only 217 originated from our health ward
there is no fixed clinic and its points are selected so and it is the data from this group that we will analyse.
that the whole population has access to our health
workers within a distance of 15 kilometres at least once AGE DISTRIBUTTON
a month" The mobile underfive team reaches 90% of The majority (59%) of the children admitted with DD
the pre-school children in the district and prornotes are in the first year of life and 86% n the first 24
health education, immunizations, simple curative months of life. In 4 cases the children were over five
services and at the same time screens them for years and in 15 casesthe precise age was unknown The
malnutrition, putting these children that are at risk on highest incidence was between the ages of 5 and 10
food supplements, and admitting the ones with severe months (Graph 1.2).
malnutrition
SEX DISTRIBUTION
In the hospital we have 70 maternity beds, 270 TB There was a predominance of 121 males over 96
beds and 225 generalbeds (of the gereral beds 3/5 are females, although in the district, in the same age group,
paediatric beds), one general paediatric ward, one there is a slight female predominancea.
nutrition rehabilitation ward, a paediatric ward for
infectious diseaseswhere all children with diarrhoea are CARETAKERSADMITTEDWITH THE
admitted. We still have an extra 440 beds shared CHILDREN
between an Old Age Home and an Institution for the
Crippled. There are seven doctors and about 180 We encourage caretakers, preferably the mother or the
nurses in the hospital and 25 nurses in the distuict
clinics. This means about 1 doctor per 11 500 people
and 1 nurse per 250 peoplea.

TIIE DIARREOEAPNOJECT
In all the surveys already mentioned and in our arurual
reports on the district, malnutrition and diarrhoeal
diseasesalternate year after year as the major causesof

SAFAMILYPRACTICEAPRIL1985 l08 SA HUSARTSPRAKTYI{ APRIL 1985



Diarrhoeal diseasesin the Gelukspan Health Ward

GRAPH 1.3

fist yasr Ue?rt t'4 Third yqr Feurth ymr Fitth y6ar Eialh yssf
[4ilk prwdsr
lmn S*eond yBsr g{hene
VilemiF
btta 606pt Drtr d9{ bw aoept
Hb
I &s
He6d
Cirsum- M ?4
ftrencF
I "M
in cm,
h&
b l 16 21
*--a t*o &W zfi
a 1C
: 14 W Y*t 1E
.* 17
YT TT 15
*+-.. \5

9uc I _* *T::& 13

c lt 12
i1
9rr I

1*

k

ie

E

&z
&

5

ahid'e 7 {, ' .
bnh tn ? -4*

ure,g. Wmdr3-4
Jui€75
Sitsalore 1 min- I walk6 l0 stepo Sern6m6 {34 wfld$i
1s12

,T a , 9 p ll r* r5 tx ry u It w ia fi t

ega ifr

* Undenaeight means weight for age less thnn 80% for the mean
Haruard stondard
** A child wos consi.d.eredseuerely molnourised if she had either
ffuTrasmus or knashinrkor (Wellcome classification) or an arrn
circumferenceof lessthan 13cnt
*** Dehydration means cliniral dehydration as assessed by the
admitting doctor.

We see from Table 1.1 that electrolyte imbalancesare
more common in patients that used a salt-sugar solution
at home. The incidence of dehydration is equally
common in both groups; dehydration is the indication
for admission only in one third of all cases.From Graph
1.4 it can be seen that dehydration is most common
before the age of one year.

MORTALITY
Parenteral infections are a common concomittant
finding in children admitted with DD. Of all the DD

SAFAMILYPRACTTCAEPRIL1985 rlo SA HUISARTSPRAKTYI( APRIL 1985