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American Journal of Epidemiology Advance Access published online on October 5, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi312
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received January 31, 2005
Accepted June 14, 2005

ORIGINAL CONTRIBUTIONS

Nutritional Status and Diarrheal Illness as Independent Risk Factors for Alveolar Pneumonia

Christian L. Coles 1*, Drora Fraser 2, Noga Givon-Lavi 3, David Greenberg 4, Raphael Gorodischer 5, Jacob Bar-Ziv 6, and Ron Dagan 4

1 Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; S. Daniel Abraham International Center for Health and Nutrition, Beer Sheva, Israel; Current affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; S. Daniel Abraham International Center for Health and Nutrition, Beer Sheva, Israel; Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
3 Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
4 Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
5 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Pediatrics, Soroka University Medical Center/Ben-Gurion University of the Negev, Beer Sheva, Israel
6 Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel

* To whom correspondence should be addressed.
Christian L. Coles, E-mail: ccoles{at}jhsph.edu


  Abstract

Community-acquired alveolar pneumonia (CAAP) is typically associated with bacterial infections and is especially prevalent in vulnerable populations worldwide. The authors studied nutritional status and diarrheal history as risk factors for CAAP in Bedouin children <5 years of age living in Israel. In this prospective case-control study (2001-2002), 334 children with radiographically confirmed CAAP were compared with 529 controls without pneumonia with regard to nutritional status and diarrhea history. Controls were frequency matched to cases on age and enrollment month. Logistic regression models were used to evaluate associations of CAAP with nutritional status and recent diarrhea experience. Anemia (adjusted odds ratio (AOR) = 3.32, 95% confidence interval (CI): 2.24, 4.94; p < 0.001), low birth weight (AOR = 2.16, 95% CI: 1.32, 3.54; p = 0.002), stunting (AOR = 2.22, 95% CI: 1.31, 3.78; p = 0.004), serum retinol concentration (AOR = 1.03 per µg/dl, 95% CI: 1.02, 1.05; p < 0.001), and having ≥1 diarrhea episodes within 31 days prior to enrollment (AOR = 2.30, 95% CI: 1.26, 4.19; p = 0.007) were identified as risk factors for CAAP. Results suggest that improving antenatal care and the nutritional status of infants may reduce the risk of CAAP in Bedouin children. Furthermore, they suggest that vaccines developed to prevent diarrhea may also lower the risk of CAAP.

Keywords: anemia; diarrhea; micronutrients; nutritional status; pneumonia; risk factors.
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