These outbreaks result in 50 deaths among under-fives annually. National health initiatives and improving medical services are helping to combat the severity of the illness among children, but diarrhoea still remains one of the country’s leading child killers.
The main problem stems from unsafe water supplies. According to census data from 2011, nearly two-fifths of households have no proper sanitation, which allows traces of faeces to be washed into water sources. And though 85% of people supposedly have access to an ‘improved’ water supply, this doesn’t mean the water is necessarily safe. Therefore, apart from the high incidence of diarrhoea among children, Nepal’s population also suffers from other health dangers caused by water-borne diseases. For example, three years ago, a severe cholera epidemic affected over 70,000 people across 27 districts of the country.
Speaking to The Guardian, a spokesperson for the United Nation’s child agency (UNICEF) in Nepal, blamed the poor water situation on “too many government entities” being responsible for implementing water and sanitation projects, as well as inefficient spending. So for example, at least three different agencies, working under separate government ministries, are involved in water, sanitation and hygiene projects. This has led to inefficient spending and the fragmentation of efforts to improve the water system on the ground.
There are also many rural communities which have yet to be reached, particularly in mountainous regions. Outbreaks of diarrhoea therefore occur frequently in hill districts. The severity of outbreaks isn’t helped by cultural attitudes towards hygiene. For a long while, going to the toilet outdoors was seen as preferable to using indoor latrines – see 'Changing attitudes to sanitation in Nepal'. Attitudes are changing, as campaigns have focused on the necessity of toilets and there is more awareness among the population about the importance of good hygiene. However in a country where levels of poverty remain high, less than half the population have regular access to soap and clean water for hand-washing.
The key questions for government and development agencies are therefore how to ensure better and more focused spending on water systems and how to keep up the momentum of improvements in hygiene and attitudes towards sanitation moving forwards. The lives of many children depend on finding the right answers to these questions.