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September 19,2013

Diarrheal disease is one of the leading killers of young children in Africa. While more countries are using vaccines to help prevent outbreaks, health officials are often unable to track down the source of outbreaks when they do occur. Now, researchers believe they can change that.

Map of Botswana, Africa

In Botswana’s Chobe District – about 1500 kilometers north of the capital Gaborone – there are only five doctors for 23,000 people.

So when there’s an outbreak of diarrheal disease, doctors and nurses spend most of their time treating the sick, not learning the epidemiology of the outbreak – the who, what, when, where, why and how of the disease.

Kathleen Alexander is an associate professor at Virginia Tech’s College of Natural Resources -- and has worked in Africa for more than 20 years. She said usually in diarrheal outbreaks health officials have little information.

“Outside of numbers – the number of children that are affected – we generally know very little if anything at all about why they have diarrhea, which agent is responsible. What are the socio-economic circumstances? I mean there have been studies that link certain factors to diarrheal disease broadly, but when you start talking about Namibia, Botswana, many places in Africa, and trying to look at why certain diarrheal outbreaks were thought to have occurred, there won’t be any information on the patients – other than sex, age and outcome. Were they discharged or did they get hospitalized? Did they die?”

But Alexander and her colleagues have discovered that a few simple questions can yield a lot of information – information that can save lives. They developed a short questionnaire for patients at Chobe District’s Kasane Primary Hospital, a 29-bed facility built in 1962.

“Understanding where the exposure to water borne pathogens is occurring, or food, or is it flies. There are so many contributing factors that if you can’t get to more of that patient-related data you won’t really understand where the risk is and then what to do about it,” she said.

If there’s a disease outbreak in the United States, the CDC, Centers for Disease Control and Prevention, has experienced staff and the best equipment to locate the source and recommend action. Alexander said things are different in remote, rural Botswana.

“There’s this big push to go towards hi-tech tools,” she said, “but at the end of the day they’re not going to work in these types of environment. And that’s the place that we really need to understand. This place where lots of disease is happening, lots of diarrheal disease, in particular, and we still know nothing about it because we’re waiting for more sophisticated studies to happen.”

But if you simply ask patients if they drank water from the river and they say no, then odds are the river water is not the source of the pathogen. If you ask whether they’ve seen many standing pools of dirty water and they say, yes, that can be a vital clue. Do villages use pit latrines or running water? Are only children affected or adults, too? Have there been water shortages? The patients can provide that information and more.

Alexander said, “In places in Africa where we have larger issues with water quality, those infections can be quite significant. So, for example, in 2006 there was a lot of rain in Botswana and in a period of less than three months over 500 children died related to a diarrheal disease. That’s a lot.”

Alexander said using a simple patient survey is an “important starting point”… that “does not require “increased human or economic resources or outside researchers.” She added, “It can give immediate insight into public health threats and disease outbreaks.”

What’s more, Alexander said waiting for complex health studies in remote areas only widens the health gap between developing and developed nations.