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Does malnutrition predispose to diarrhoea during childhood? Evidence from a longitudinal study in Matlab, Bangladesh
M K Chowdhury1, V M Gupta, R Bairagi
1International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Insights
Previous diarrhoeal illness significantly increases the risk of subsequent diarrhea in children. This effect can mask the link between malnutrition and diarrhea, especially in older children.
Area of Science:
- Child Health
- Infectious Diseases
- Nutritional Epidemiology
Background:
- Diarrhoeal illness is a major cause of child mortality globally.
- The cyclical relationship between malnutrition and diarrhea is complex.
- Previous diarrhoeal episodes may influence subsequent illness patterns.
Purpose of the Study:
- To investigate the influence of previous diarrhea on subsequent diarrhoeal illness.
- To examine the association between malnutrition and diarrhea, considering the impact of prior infections.
- To analyze these relationships in different age groups of children.
Main Methods:
- Longitudinal community-based study in Matlab, Bangladesh (1262 children, 6-60 months).
- Analysis of cross-sectional anthropometry and longitudinal diarrhoeal morbidity data.
- Logistic regression models controlling for previous diarrhea, maternal illiteracy, and poverty.
Main Results:
- Diarrhoeal illness in a preceding 2-month period increased the risk of subsequent diarrhea by over threefold.
- Malnutrition was associated with increased diarrhea risk in children without prior diarrhea.
- Severe malnutrition (weight-for-age) was linked to longer diarrhoeal illness in children aged 24-60 months, but not in younger children.
Conclusions:
- Previous diarrhea is a significant risk factor for subsequent diarrhoeal illness.
- The impact of malnutrition on diarrhea risk is dependent on prior infection history and age.
- Public health interventions should consider the recurrent nature of childhood diarrhea.
Abstract:
It is posited that diarrhoeal illness during one period has influence on diarrhoeal illness in a subsequent period. This relationship may potentially mask the association between malnutrition and subsequent diarrhoea. To test this, we analysed data on cross-sectional anthropometry in combination with data on diarrhoeal morbidity collected longitudinally in a community-based study of 1262 children (aged 6-60 months) during March-December, 1976, in Matlab, Bangladesh. The results confirmed the posited relationship between diarrhoeal morbidities in two consecutive periods and showed that the risks of diarrhoeal attack and longer diarrhoeal illness increased more than threefold during the 2 months following diarrhoeal illness during the preceding 2 months (previous diarrhoea). Children with no previous diarrhoea indicated a positive association between malnutrition and subsequent diarrhoea, but the pattern found among children with previous diarrhoea was not understandable. Logistic regression analyses performed separately for younger and older children showed that controlling for effects of previous diarrhoea, maternal illiteracy and household poverty, severe malnutrition as assessed by weight-for-age was found to be strongly associated with the risk of longer diarrhoeal illness in a 2-month interval in the age group 24-60 months; in the same age group the association with the risk of diarrhoeal attack was significant at the 10 per cent level. No such association for malnutrition, however, was found in the age group 6-23 months.