Diarrhea, Environment, and Poverty
Diarrheal disease affects rich and poor, old and young, and those in developed and developing countries alike, yet a strong relationship exists between poverty, an unhygienic environment, and the number and severity of diarrheal episodes—especially for children under five.
Poverty is associated with poor housing, crowding, dirt floors, lack of access to sufficient clean water or to sanitary disposal of fecal waste, cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food—all of which increase the frequency of diarrhea. Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care. Thus, the young suffer from an apparently never-ending sequence of infections, rarely receive appropriate preventive care, and too often encounter the health care system when they are already severely ill.
Although the presence of blood in the stool is a recognized danger signal, prompting more urgent care seeking, even these patients either are not treated early or receive poor medical care. Ironically, the poor spend considerable amounts on inappropriate care and useless drugs purchased from local shops and untrained practitioners. If antibiotics are properly prescribed, poverty often limits the purchase of a full course of treatment or leads to cessation of treatment as soon as symptoms improve, even though the infection has not been cured.
