Haiti: "Children are more vulnerable to cholera"

January 8, 2011

Haiti: "Children are more vulnerable to cholera" © Aurelie Baumel/MSF

The physiological characteristics of young children weaken them in the face of this disease. Sergio Cabral, a pediatrician at the Sarthe cholera treatment center (CTC) in Port-au-Prince, explains the specifics involved in treating cholera in children.

Why do we need to pay particular attention to children?

They are growing. Because they have a smaller body surface area, the cholera vibrio can settle in the intestine faster and the illness spreads more quickly. By way of comparison, the same quantity of vibrio will have a much less severe effect on an adult. In addition, a child's immune system is not fully developed so he or she is more vulnerable to cholera and will have a harder time fighting the infection.

Also, children do not yet have proper hygiene habits, which can promote their infection. This can be an additional factor of vulnerability, but is not hard and fast rule because adult behavior is quite similar.

Do you offer specific treatment for children?

The treatment is identical to that of adults. We provide oral rehydration for simple cases and intravenous rehydration for severe ones. The key difference is calculating the dose and flow of solution based on age, nutritional status and any related illnesses. When extreme amounts of liquids are lost, we also give antibiotics along with rehydration, based on weight, to children over one year.

The staff must have extensive pediatric experience because dehydration dries the veins, which makes it difficult to put a child on a drip. Sometimes, we can't inject in the arm so we try the hand, the leg and, then, the head. As a last result, we give an intra-bone injection. This is a delicate procedure but must be performed quickly as time is critical when dealing with a child who presents with severe dehydration.

Because children require careful attention and experienced medical staff, they are treated in an area set aside for pediatric patients. Our Sarthe cholera treatment center has a 336-bed hospitalization capacity (14 24-bed tents) and 72 of them are assigned to pediatrics. This figure varies because we are continually changing our response as the course of the epidemic evolves.

What are the specific problems related to children?

First, there is the issue of related illnesses, including pneumonia and asthma, which complicate treatment and further weaken the child. We treat the cholera on a priority basis because it's the life-threatening emergency and then address the other illness with appropriate treatment. In the case of malnutrition, which involves treatment that is incompatible with cholera treatment, we transfer the children who have recovered from cholera to MSF facilities that specialize in nutrition.

We also deal with children who do not have a parent or other adult responsible for them. Some children arrive alone, either because the parent (or parents) is (are) ill or because there are other children to be cared for at home. Sometimes, the child is abandoned because cholera still frightens people. Once the child recovers, the social service agencies take over. However, thanks to information and education efforts, that has become increasingly rare.

Since the epidemic began in mid-October 2010, MSF teams have treated 84,500 patients in nearly 50 cholera treatment centers and units across the country. This represents 57% of the total number affected by cholera, based on the latest figures provided by Haiti's Ministry of Health, which report 147,787 patients and more than 3,330 deaths.

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