title: Malnutrition, cell-mediated immune deficiency and acute upper respiratory infections in rural Bangladeshi children.
abstract: A community-based longitudinal study conducted in rural Bangladesh investigated the association between nutritional status, cell-mediated immune status and acute upper respiratory infections (URI). A total of 696 children aged 0-59 months was followed prospectively for 1 y yielding 183,865 child-days' observation. Trained field workers visited each child every 4th d and collected morbidity data on symptoms suggesting URI (cough, fever, nasal discharge) for the preceding 3 d by recall. On the day of visit they examined each child reporting cough and/or fever to record the temperature, presence of nasal discharge, rate of respiration and presence of chest indrawing. Anthropometry for all children was conducted monthly. Cell-mediated immune competence was assessed by a multiple antigen skin test at baseline and thereafter every 3 months. The incidence of URI was 5.3 episodes per child-year observed. Approximately three-quarters of the study children were below -2 Z-score weight for age and height for age, and a quarter below -2 Z-score weight for height. During different test periods 9-21% of the study children did not respond to any of the test antigens. In a regression model children < -2 Z-score for weight for height had 16% [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.03-1.31, p = 0.01] higher risk of developing URI. Anergic children had 20% higher risk (OR 1.20, CI 1.05-1.38, p = 0.009) of URI than immunocompetent children. The study demonstrated that wasting and depressed cell-mediated immunity (CMI), but not stunting, were associated with the incidence of URI among rural Bangladeshi children.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh.
authors.forename: K
authors.initials: K
authors.lastname: Zaman
authors.forename: A H
authors.initials: AH
authors.lastname: Baqui
authors.forename: M
authors.initials: M
authors.lastname: Yunus
authors.forename: R B
authors.initials: RB
authors.lastname: Sack
authors.forename: H R
authors.initials: HR
authors.lastname: Chowdhury
authors.forename: R E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000886:Anthropometry; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007111:Immunity, Cellular / Q000276:immunology*; D007153:Immunologic Deficiency Syndromes / Q000453:epidemiology* / Q000276:immunology; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009749:Nutrition Surveys; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000453:epidemiology* / Q000276:immunology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000276:immunology; D012306:Risk; D012424:Rural Population / Q000706:statistics & numerical data*