Diarrhoea in African Children: Causes and Symptoms


By Ibironke Taiwo. Datelinehealth Africa Volunteer and Freelance Writer, with medical review and editorial support by The DLHA Team

Black toddler with diarrhoea

Black toddler with diarrhoea. Click on image to enlarge. Credit: IYCF image bank





Diarrhea is a serious problem for children globally but more so in sub-Saharan Africa, where a bout of diarrhoea can quickly result in death or other serious disabilities. According to the WHO, diarrhoea accounts for 7.7% of deaths in under five year olds in Africa yearly. (1)


As at 2009, the WHO estimated that African children had five episodes of diarrhoea per year and that 800,000 children die each year from diarrhoea and dehydration.


In Nigeria as in most other countries in sub-Saharan Africa, diarrhoea was identified as the second biggest killer of children and as 2009, it was responsible for about 16% of child deaths every year. This amounted to a yearly estimated death of 151,700 (WHO, 2009).


Due to governmental and multiple stakeholder interventions, the last two decades have witnessed a drop in child deaths and disabilities from diarrhoea in Africa (2), but more advocacy, public health education and joint stakeholders (co-produced) health interventions are needed in order to reduce the burden of the condition in sub-Saharan African.


The purpose of this blog is to provide accurate and basic information about the causes and symptoms of diarrhoea in children in sub-Saharan Africa so that parents, other child caregivers and public health managers can quickly identify moderate to severe diarrhoea situations and take prompt and informed actions to address it.





The causes of diarrhoea in children under the age of 5 years and older can be either infectious or non-infectious. In most cases, it is mainly caused by an infection in the gastrointestinal tract due to exposure to germs such as bacteria, viruses and parasites (rarely).


According to the World Health Organization, the two most common causative infective agents of moderate to severe diarrhoea in low income countries (like sub-Saharan Africa) are Rotavirus and Escherichia coli. (2)


Other infectious diarrhoea causing agents in children include (3):

  • Clostridium botulinum (Botulism )
  • Campylobacter jejuni (Campylobacter gastroenteritis)
  • Vibrio cholerae (Cholera)
  • Salmonella serovars (Salmonellosis, Typhoid)
  • Shigella spp.(Shigellosis)
  • Staphylococcus aureus enterotoxins (Staphylococcal food poisoning) 
  • Giarda duodenalis (Giardiasis)
  • Entamoeba histolytica (Amebiasis)


The commonest route of infection is by mouth, i.e., from drinking contaminated water and hand to mouth contact with food and objects contaminated by human fecal or animal waste as well as floor germs (3, 4)


Non-infectious causes of childhood diarrhoea include:

  • Food intolerance e.g. lactose intolerance.
  • Food poisoning from oral ingestion of metal (.e.g., lead, and arsenic)
  • Adverse effects of medications.
  • Poor absorption of food.
  • Inflammatory bowel disease (IBD).





The risk factors for diarrhoea disease in sub-Saharan African children include:



What children eat and drink can put them at great risk of having diarrhea as certain foods cause or aggravate the occurrence of diarrhea. Examples include:

  • Sugar and artificial sweeteners due to their laxative effect.
  • Caffeine-contacting foods such as chocolate, coffee, soda, tea, etc, These increase the movement of food in the intestine. 
  • Fatty foods cause digestive difficulties.
  • Spicy foods cause irritation of the lining of the stomach and intestine and may provoke diarrhoea.
  • Dairy products 




Young children are prone to picking up objects and putting them in their mouth. In this way, they may pickup germs (microbes) that cause diarrhea from contaminated surfaces, objects, food, and water. For this reason, it is essential to teach young children how to wash their hands regularly and especially after visiting the toilet, as well as before and after eating. It is also important for adult caregivers to wash their hands after changing baby diapers, as well as before and after cooking.




Food poisoning can be caused by improper handling of food. Therefore, it is very important that you keep your cooking utensils clean, limit cross contamination between food items prior to cooking and preserve your both raw and cooked foods appropriately.




The social factors that put many African children at risk of diarrhoea disease have been covered here in details. They include

  • Household poverty
  • Being male and within age 7- 24 months
  • Being weaned from breast milk earlier than 6 months
  • Being born to working mothers with low educational status
  • Poor access to potable water
  • Living in household with traditional latrine, and non-washable flooring, etc.


Awareness of these social risk factors are needed by public health managers so that they can promptly identify and target interventions to communities and children who are more likely to be impacted by diarrhoea disease the most.





The symptoms of diarrhoea may vary from child to child. The generally common ones include: 

  • Passing loose and watery stools about three or more times a day.
  • An urgent need to use the bathroom (older children)
  • Complaints of abdominal cramping (older children)
  • Excess bowel movement or frequent soiling of diapers (infants and toddlers).
  • Nausea 
  • Bloating
  • Excessive crying and irritability due to abdominal pain


Children with underlying infection may also have: 

  • Blood or mucus in stools
  • Fever 
  • Dizziness
  • Vomiting


As diarrhoea may cause dehydration and malabsorption in children, the following symptoms may also be present:


Dehydration related symptoms include:

  • Thirst
  • Urinating less than usual (lack of wet diapers in infants for 3 hours or more)
  • Passing dark coloured urine
  • Weakness and fatigue
  • Lack of tears despite crying


Malabsorption related symptoms include:

  • Foul smelling and greasy stool
  • Weight loss or poor weight gain
  • Poor appetite
  • Bloating
  • Gas





Awareness of the common causes, risk factors and symptoms of diarrhoea in children is crucial for guiding African parents to seek help promptly for a child with diarrhoea. It is also important for other child caregivers and public health managers in providing appropriate interventions to reduce the current level of deaths and disabilities associated with the condition.




1. World Health Organization. Diarrhoea: Why are children still dying and what can be done. [Published Jan. 1 2009]. Available from: https://www.who.int/publications/i/item/9789241598415. Accessed, July 30, 2023.

2. World Health Organization. Diarrhoea disease. May 2 2017]. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease Accessed, July 30, 2023.

3. G.A. Tarr, L. Chui, B.E. Lee, X.L. Pang, S. Ali, A. Nettel-Aguirre, et al. Performance of stool-testing recommendations for acute gastroenteritis when used to identify children with 9 potential bacterial enteropathogens. Clin Infect Dis. 2019 Sep 13;69(7):1173-1182. doi: 10.1093/cid/ciy1021

4. Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities. Glob Health Action. 2016 May 11;9:30166. doi: 10.3402/gha.v9.30166.






Published: August 3, 2023

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