LAHORE, 13 May 2008 (IRIN) - With the advent of hot weather and the increased consumption of water that comes with it, gastroenteritis has begun to spread across southern Pakistan, officials said.

Sindh Province is the worst-hit, but outbreaks of the water-borne stomach disease have also been reported in towns in southern Punjab, including Vehari.

Sajjid Maqbool, one of the country's leading paediatricians, told a seminar in Islamabad last year that 25,000 children died each year from gastroenteritis, caused by infection by the rotavirus.

The worst-hit area has been Nawabshah, in central Sindh, a four-hour drive north of Karachi. Over 200 people have come in to the Nawabshah Medical College Hospital, the largest medical facility in the area, over the past week, stricken by the disease. At least 20 patients have been admitted for treatment.

"We have a shortage of beds and doctors. That creates problems at times like these," Gulshan Ali Memon, a medical superintendent at the hospital, said.

Those who fail to reach hospital, often because they live in remote areas, face the biggest risk. Early in May, the death of six-year-old Muhammad Farooq of Dorai Mahar village in Nawabshah District was reported. He had been taken to the Rural Health Centre, Qazi Ahmed, in critical condition with acute gastroenteritis, but doctors said he was dead on arrival.

Water-borne diseases cause most illnesses in the country, according to official data.

According to the US Agency for International Development (USAID), which is supporting a range of health programmes across Pakistan, the mortality rate for children under five is 94 deaths per 1,000 live births. Water and sanitation-related diseases are responsible for 60 percent of child deaths in Pakistan, with diarrhoea estimated to kill 230,000 children under five each year [http://www.usaid.gov/pk/health/index.htm].

A February 2007 World Wide Fund for Nature (WWF) report said 20-40 percent of "people in hospitals [in Pakistan] are suffering from water-borne diseases - gastroenteritis, typhoid, cholera, dysentery… and other serious diseases". The report said every third Pakistani "drinks unsafe water". According to the WWF, 250,000 child deaths each year are a result of water-borne diseases.

The fact that less than 60 percent of the rural population, according to the UN Children's Fund (UNICEF), has access to adequate sanitation contributes to this. There have been major epidemics of gastroenteritis over the past two years, mainly in Sindh, but also in the Punjab and Balochistan.

Boiled water

While awareness about the need to boil water has spread, there are still significant difficulties involved. "I try to boil water, but with four children to look after, only one small kerosene stove and all the household chores to manage, I sometimes let my older children just drink from the tap," said Sumera Ahmed, 30, who lives on the outskirts of Lahore.

She also points out that in summer - when the risk of gastroenteritis is greatest - it is difficult for families without refrigerators to cool water.

"We often add ice brought from the market," she says. Although Sumera knows this ice is made from unboiled water, she shrugs and says: "We have no choice. My husband and kids all want cool water to drink."

Herbal drinks, iced drinks and other items commonly sold by roadsides pose an additional hazard, say health specialists.

Gastroenteritis can usually be successfully treated. But in acute cases, dehydration poses an enormous risk, especially to small children, when fluids cannot be retained due to vomiting and diarrhoea. Those factors reportedly lead to the high death toll from gastroenteritis each year. Many deaths go unreported because they take place in remote villages and hamlets.

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