Running head: MARGINILIZATION ESSAY
Emily Schneider
Systems Essay: Marginalization
Western Washington University
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How does the experience of marginalization affect the prevalence of diarrheal
disease in present day Tanzania? This is the question I am going to be examining through
out this essay. The first thing that should be addressed is what is diarrheal disease.
“Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be
caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through
contaminated food or drinking-water, or from person-to-person as a result of poor
hygiene” (World Health Organization, 2013, Key Facts Section). Each year, diarrhoea
kills around 760,000 children under five years old, making it the second leading cause of
death of children under five (World Health Organization, 2013). Additionally, diarrhoea
can be linked to a cause in malnutrition in children under five (World Health
Organization, 2013).
According to Graham Land (2010), 1.5 million children in Africa die every year
from diarrhoeal diseases. Even though diarrhoeal disease is a global issue, it is most
prevalent in Africa due to the unclean drinking water. “In the developing world, poor
access to safe drinking water and inadequate sanitation are important contributors to the
risk of diarrheal diseases, which cause an estimated two million deaths per year in
children under 5 years old” (Land, 2010, paragraph 4). If the diarrhea doesn’t lead to
death, then there are a number of other symptoms associated with it. “Diarrhea can have a
detrimental impact on childhood growth and cognitive development” (Center for Disease
Control, 2013, Diarrhea: What we know). Additionally, diarrhea depletes body fluids,
causing dehydration (Center for Disease Control, 2013).
Despite the fact that diarrheal disease can affect any person in Africa, children are
especially prone to getting this disease. Thea et al. (1993) completed a study to examine
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the prevalence of diarrheal disease among HIV-1 infected Zairian children. The study
looked at 429 Zairian children, and included cases of Acute Diarrhea, Recurrent
Diarrhea, Persistent Diarrhea, and Mortality from Diarrhea. In the case of Acute
Diarrhea, Thea et al. (193) explain, “The early introduction of either milk formula or
solid food correlated with the occurrence of Acute Diarrhea regardless of HIV status” (p.
1698).
Additionally, Thea et al. (1993) explain that episodes of acute, recurrent, or
persistent diarrhea occurred more frequently among HIV infected infants than among
uninfected controls. Of the 429 infants studied, diarrhea accounted fro 36% of
mortalities, and when HIV-1 was present, the mortality rate from diarrhea increased 11fold (Thea et al., 1993). To take this study further, Thea et al. (1993) explain that the
presence of pathogens within the community and the susceptibility of the infants to these
pathogens adds to the probability of diarrheal disease in HIV-1 infected children and noninfected children.
Grohmann et al. (1993) explain that the cause is often unknown regarding the link
between HIV infection and diarrheal disease. To examine this link, a study was
conducted where stool and serum specimens were obtained from HIV-infected patients
Grohmann et al., 1993). Fecal specimens were collected from patients with diarrhea and
control patients without diarrhea were screened (Grohmann et al., 1993). After the study
was conducted, Grohmann et al. (1993) came to the conclusion that, “Novel enteric
viruses such as astrovirus and picobirnavirus may be more important etiologic agents of
diarrhea in HIV infected patients than previously recognized and may be more common
than either bacterial or parasitic enteropathogens (p. 14).
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Although Grohemm et al. (1993) can’t provide a definite answer regarding why
children with HIV and more susceptible to diarrheal disease, they can provide an
informed suggestion. After much research through a study, the authors conclude that,
“viruses may be more common agents in HIV-infected patients than has been previously
suspected” (Grohemm et al., 1993, p. 17). Astrovirus and picobirnavirus each contributed
significantly to the association of diarrhea and HIV-infection. This information can be
used in the future to better understand diarrheal disease in children in Africa.
In conclusion, diarrheal disease is common in children in Africa, and the exact
reason remains unknown. Through much research and studying Thea et al. (1993) explain
that children with HIV-1 infection are more likely to get diarrheal disease. They conclude
that the introduction of milk formula and solid foods can contribute to this. Additionally,
the presence of pathogens in a community can increase the chance of diarrheal disease
(Thea et al., 1993). Grohemm et al. (1993) add to the research by saying that viruses can
be a more common agent in people with HIV getting diarrheal disease.
When examining my references, one thing that comes up for me is the date of two
of the references. Both of the references are from 1993, and although they provide very
useful information, I am wondering if the information is outdated. Are there more recent
studies out there with different information? Also, these two studies both have a
significant amount of authors. I am wondering if all of the authors are reliable and
provide trustworthy information. Why are there so many authors? For instance, one of the
studies I looked at has 12 authors, and that just seems a little excessive to me. One other
thing I am wondering about with my references is when is the last time the website was
updated? Two of my references are WHO and the center for disease control, and I am
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curious if the websites for each of these were recently updated. Finally, for my two
references that are studies, I am wondering how they went about selecting their
participants, and if they are a good representation for the study. Also, was the instrument
they used the best possible instrument for this study?
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References
Diarrhoeal disease. (2013, January 1). Retrieved April 12, 2015, from
http://www.who.int/mediacentre/factsheets/fs330/en/
Global water, sanitation, & hygiene (WASH). (2013, January 24). Retrieved April 12,
2015, from http://www.cdc.gov/healthywater/global/diarrhea-burden.html
Grohmann, G.S., Glass, R.I., Pereira, H.G., Monroe, S.S., Hightower, A.W., Weber,
R…Bryan R.T. (1993). Enteric viruses and diarrhea in hiv-infected patients. The
New England Journal of Medicine, 329(1). Retrieved May 7, 2015, from
http://www.nejm.org/doi/pdf/10.1056/NEJM199307013290103
Land, G. (2010, April 20). In Africa, diarrhea kills 1.5 million children every year.
Retrieved April 12, 2015, from http://www.greenfudge.org/2010/04/20/in- africadiarrhea-kills-1-5-million-children-every-year/
Thea, D. M., St. Louis, M.E., Atido, U., Jankjinga, K., Kembo, B., Matondo,
M.,…Keusch, G.T. (1993). A prospective study of diarrhea and hiv-1 infection
among 429 zairian infants. The New England Journal of Medicine, 329(23).
Retrieved May 7, 2015, from
http://www.nejm.org/doi/pdf/10.1056/NEJM199312023292304