Malnutrition, cell-mediated immune deficiency, and diarrhea: a community-based longitudinal study in rural Bangladeshi children.
A community-based longitudinal study was conducted in Matlab, a rural area of Bangladesh, from May 1988 to April 1989 to examine the associations among malnutrition, cell-mediated immune deficiency, and the incidence of diarrhea in children under age 5 years. A cohort of 705 children was followed for a year; illnesses were ascertained every fourth day by home visits, anthropometric status was evaluated monthly, and cell-mediated immune status was assessed by a multiple antigen skin test at baseline and every 3 months. The diarrhea incidence rate was 4.6 episodes per year. Approximately three quarters of the children were below -2 z score weight for age and height for age, and about a third were below -2 z score weight for height. There was a modest association between undernutrition and the incidence of diarrhea. About 10-20% of the study children were anergic, and these children experienced a 50% increased incidence of diarrhea compared with their immunocompetent counterparts. This association persisted after controlling for the effects of age, nutritional status, socioeconomic status, and history of diarrhea in the previous 3 months. Malnutrition and cell-mediated immune deficiency were important independent risk factors for the occurrence of diarrhea and must both be considered in the design of interventions for the control of this condition.
Baqui
A H
AH
Community Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Black
R E
RE
Sack
R B
RB
Chowdhury
H R
HR
Yunus
M
M
Siddique
A K
AK
D001459:Bangladesh / Q000453:epidemiology; D015362:Child Nutrition Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007153:Immunologic Deficiency Syndromes / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D012307:Risk Factors; D012424:Rural Population; D012882:Skin Tests; D012959:Socioeconomic Factors