By Nayak Paudel, Kathmandu, Apr. 30: Acute Gastro-Enteritis (AGE), also known as stomach flu, has been a major public health problem in Nepal. It is a viral or bacterial infection, caused most commonly by rotavirus and norovirus, which is marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever.

According to the Weekly Bulletins of the Early Warning and Reporting System (EWARS) under the Epidemiology and Disease Control Division (EDCD), AGE is the leading cause of morbidity across Nepal.

The 15th epidemiological week bulletin, which was published on April 25, shows that 284 cases of AGE were reported last week. Similarly, 349 and 343 cases were reported in the 14th and 13th week respectively.

EDCD officials informed that the cases of AGE were reported throughout the year and the major reason behind it is the lack of proper hygiene.
“Eating improperly prepared food, drinking contaminated water or coming in close contact with an infected person can spread the disease. The viruses and bacteria which enter the human body through different means of poor hygiene cause AGE,” said Dr Amrit Pokhrel of the Epidemiology and Outbreak Section under EDCD.

With the disease spreading to a mass population over the years, the government had also brought a “National Preparedness and Response Plan for Acute Gastro-Enteritis/Cholera Outbreaks in Nepal” in 2017. It was a five-year national plan.

The major objectives of the plan were to prevent the spread of AGE/Cholera and also to eliminate mortality because of it. Similarly, the plan focuses on a coordinated and collaborative preparedness and response during an outbreak of AGE/Cholera.

Among several interventions, which the plan suggested, the government has been targeting a mass population to generate awareness on preventive water, sanitation and hygiene (WASH).

“The major focus should be made on children because they often get dirty by playing outdoors. Similarly, they touch a number of things, which can be infected with virus and bacteria, and most probably don’t wash their hands. Nevertheless, people from all age groups are at risk of the disease,” said Dr Pokhrel.

Nevertheless, in a bid to reduce the burden of AGE cases among children, the Nepal government introduced the Rotavirus vaccine against diarrhoea in children on July 2, 2020. It was stated as a new milestone for Nepal in the reduction of child mortality from vaccine-preventable diseases by the World Health Organisation (WHO).

As per the Child Health and Immunization Service Section, around 42 per cent of under-five children suffer from diarrhoea every year in Nepal.
However, with the vaccination drive started and the government raising awareness regarding the prevention, there are still several steps to be taken to control the increasing spread of the disease.

One of the major struggles, which the experts at EDCD stated, was the lack of clean drinking water.

“Testing of several samples of drinking water shows that many were found infected with coliform bacteria. It triggers dysentery and diarrhoea disorders and diseases such as cholera and typhoid. Since bacteria are found in water due to contamination, we are well aware of the quality of drinking water across the country,” said Dr Krishna Prasad Paudel, director at EDCD.

Experts argued that AGE is an easily preventable disease. However, in case one gets infected, medical professional treat with medicines and antibiotics. But since the AGE’s symptoms contradict with other diseases, experts argue that people must have them diagnosed properly before asking for prescriptions.

Meanwhile, the EDCD informed that the recent COVID-19 pandemic has facilitated the prevention of AGE.

“People use masks, wash their hands regularly and don’t come in close contact with others due to the COVID-19 pandemic. It has taught people of the importance of hygiene. The cases of AGE are reported almost daily but they are fewer this year than the previous ones,” said Dr Pokhrel.
Nevertheless, experts at EDCD requested the public to follow the basics of personal hygiene and cleanliness properly.

“AGE is not the only disease caused by poor hygiene, unsafe drinking water and rancid food. If one is to abide by the measures of cleanliness and healthy habit, it is possible to keep several diseases at bay,” said Dr. Paudel.