American Journal of Epidemiology Vol. 128, No. 1: 93-105
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health
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ASSOCIATION OF MALNUTRITION AND DIARRHEA IN CHILDREN AGED UNDER FIVE YEARS
A PROSPECTIVE FOLLOW-UP STUDY IN A RURAL SUDANESE COMMUNITY
1The Faculty of Medicine, University of Khartoum Khartoum, Sudan
2Departments of Epidemiology and Biostatistics, Harvard School of Public Health Boston, MA
Reprint requests to Dr. Walter Willett, Department of Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115
Results are reported from a one-year follow-up study conducted in 1983 and 1984 of 445 Sudanese children aged under five years that was designed to address the hypothesis that malnutrition increases the incidence of diarrheal disease. Children were weighed and measured at two-month intervals ("child intervals") and diarrhea incidence was ascertained during biweekly house visits. During child intervals that followed a prior episode of diarrhea, underweight (weight-for-age <90% of expected) was associated with a higher incidence of diarrhea after adjusting for the potential confounding effects of age and socio-economic factors (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1–2.8). During child intervals with no history of diarrhea in the preceding interval, the association with underweight was less (OR = 1.2, 95% Cl = 0.9–1.6); among these children, stunting (height-for-age <95% of expected) was significantly associated with diarrhea (OR = 1.4, 95% Cl = 1.0–1.8). Moderate malnutrition (weight-for-age <75% of expected) was associated with a twofold increased risk of multiple episodes of diarrhea during a follow-up interval whether or not diarrhea had occurred in the preceding interval (OR = 2.0, 95% CI = 1.2–3.5) after adjusting for age, socioeconomic factors, and diarrhea in preceding interval. Age, rainy season, and history of diarrhea in preceding interval were found to be strongly associated with incidence of diarrhea. These data are consistent with the hypothesis that malnutrition increases the risk of childhood diarrhea.
diarrhea; diarrhea; infantile; nutrition disorders
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