ygiene and sanitation play a key role in preventing gastrointestinal infections. The most common gastrointestinal illnesses present in health services as indigestion, upper abdominal pain and diarrhoea.

Adults usually complain of heartburn, acid brash, upper abdominal pain with meals or on an empty stomach and bloating. Patients may also complain of nausea, vomiting and regurgitation. When investigated for stool H.pylori bacteria, many of them turn out to be positive. Enquiry about their eating habits reveals that a majority are using tap water or direct groundwater supply. The consumption of street food too seems to be a frequent culprit. We all know food and drinks are handled with bare hands, and many vendors do not even bother to cover food. Poor hygiene contributes to the spread of H.pylori in the community.

A meta-analysis shows that the prevalence of H.pylori is 44.3 percent worldwide. H.pylori infection causes gastric and duodenal ulcers. H. pylori are found in 90-95 percent of individuals with duodenal ulcers and 50-70 of individuals with gastric ulcers. The infection contributes to gastric cancer in the long run.

In 1994, the WHO and the International Agency for Research on Cancer (IARC) categorised Helicobacter pylori as a Class 1 human carcinogen due to its prevalence association with gastric carcinoma. Hygiene and handling of food and using safe water for drinking can help prevent acquiring this infection.

Poor hygiene in children makes them susceptible to getting worms, viruses and bacterial infections leading to diarrhoea. Rotavirus and Escherichia coli are the two most common etiological agents of moderate-to-severe diarrhoea in low-income countries. Diarrhoea is the second leading cause of childhood morbidity and mortality. A WHO report from 2017 states that diarrhoea kills many under-five children every year. The chief reasons for acquiring these infections are inadequate hand washing after using the toilet and not showering regularly, especially after getting exposed to dirt and sucking of objects and thumbs in children. Bottle feeding also transmits bacteria and can be a source of infection in infants and toddlers.

Diarrhoea can last several days and can leave the body without the water and salts that are necessary for survival. In the past, for most people, severe dehydration and fluid loss were the main causes of diarrhoea deaths. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths. Also, each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea is a leading cause of malnutrition in children under five years of age and malnourished children are more likely to fall ill from diarrhoea again.

Diarrhoea is the second leading cause of childhood morbidity and mortality. A WHO report from 2017 states that diarrhoea kills many under-five children every year. The chief reasons for acquiring these infections are inadequate hand washing after using the toilet and not showering regularly, especially after getting exposed to dirt and sucking objects and thumbs in children. Bottle feeding also transmits bacteria and can be a source of infection in infants and toddlers.

Maternal literacy plays an important role here. An educated mother can well understand the importance of hygiene, appropriate diet for her child and identification of signs of illness. Through education and awareness, many illnesses can be prevented. This can be done through counselling sessions in maternity clinics, print media, social media and television. Mothers need to avoid bottle feeding, trim their children’s nails regularly, give them daily showers and provide them with safe drinking water and food. Mothers need to know when to take the child to the doctor. Eagerness for drinking fluids, sunken eyes and lethargy are warning signs of dehydration that need to be addressed promptly. Exclusive breastfeeding in the first six months of life and rotavirus vaccination for babies can help prevent diarrhoea.

Adults also transmit infections like typhoid and cholera due to poor food handling. Long dirty nails harbour bacteria; cooking and serving with unwashed hands spreads infections at home and community outside. Use of a head cap while cooking and gloves when needed can help prevent the spread of infection. Flies and mosquitos carry bacteria and viruses and are a source of transmitting infections by contaminating food. Polluted air carries dust and germs too. Therefore, it is important to cover food and drinks appropriately.

Meat and poultry must be refrigerated and properly cooked. Unpasteurised dairy and juices should not be taken. Vegetables and fruits must be properly washed before eating. Many parasitic infections are likely to be acquired by contacting soil contaminated with human or animal faeces. These include giardiasis, cryptosporidiosis and toxoplasmosis. Swimmers also tend to acquire gastrointestinal infections as faecal contamination of pools can be harmful.

Drinking water may contain various impurities – physical, biological and chemical. The most dangerous contaminants are of biological nature. These cause human health problems, often leading to death. Poor treatment facilities cause the spread of waterborne diseases. Worldwide, 780 million individuals lack access to improved drinking water, and 2.5 billion lack improved sanitation. In Pakistan, the drinking water system and drainage lines run in parallel, which causes leakages and mixing results in deterioration of water quality. In most cities of Pakistan, groundwater supply contains various pathogens, including many viral, bacterial, and protozoan agents causing 2.5 million deaths from the endemic diarrhoeal disease each year. Water contaminated with human or animal faeces, such as sewage, septic tanks and latrines, is of particular concern. Tap water is not safe for drinking. Drinking water must be made safe by chlorination, boiling, using filter membranes or alternative standard methods. It is the responsibility of the educated community members to spread awareness among their contacts. Hand hygiene and safe drinking water practice should be encouraged at homes, schools and workplaces.

Travellers can acquire diarrhoea if they are not careful with the food and drinks they are taking. It is advisable to use bottled water for drinking and teeth cleaning and avoid ice and raw foods. Meat and eggs should be thoroughly cooked before eating. Salads should be avoided as they are a rich source of bacterial growth. Travellers should also avoid contact with people suffering from gastrointestinal infections as a precautionary measure.

The writer is the    senior registrar, family medicine, Baqai Medical University