American Journal of Epidemiology Vol. 137, No. 3: 355-365
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health
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Malnutrition, Cell-mediated Immune Deficiency, and Diarrhea: a Community-based Longitudinal Study in Rural Bangladeshi Children
1Community Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka, Bangladesh
2Department of International Health, School of Hygiene and Public Health, The Johns Hopkins University Baltimore, MD
Reprint requests to C. Abdullah H. Baqui, Community. Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh
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 momths. 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.
anthropometry; diarrhea, infantile; gastroenteritis; immunity; nutrition disorders; nutritional status
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