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Nutritional status and delayed mortality following early exposure to measles
P Aaby1, M Andersen, K Knudsen
1Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen S, Denmark.
Insights
Early measles exposure in Guinea-Bissau is linked to later childhood mortality, but not growth faltering. Nutritional status did not explain this association, suggesting further research into delayed mortality mechanisms is needed.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Global child health
Background:
- Community studies in Guinea-Bissau indicate measles exposure before six months of age is associated with delayed mortality.
- The underlying mechanisms for this association, particularly the role of nutritional status, require further investigation.
Purpose of the Study:
- To examine the role of pre-exposure nutritional status in measles-associated delayed mortality.
- To assess the impact of measles exposure on child growth and subsequent mortality.
Main Methods:
- Analysis of community study data from Guinea-Bissau.
- Examination of anthropometric measurements (weight-for-age) and mortality data in children exposed and unexposed to measles.
- Statistical adjustment for age and nutritional status.
Main Results:
- Children exposed to measles were lighter but pre-exposure weight-for-age did not predict subsequent mortality.
- Measles exposure was strongly associated with excess mortality (Mortality Ratio = 3.70 for 6-17 months) but did not negatively impact growth.
- The association between weight-for-age and mortality differed significantly between exposed and unexposed children.
Conclusions:
- Growth faltering does not explain the excess mortality observed after early measles exposure.
- The relationship between nutritional status and mortality is altered by prior measles exposure.
- Further research is warranted to elucidate the mechanisms behind delayed mortality following early measles exposure.
Abstract:
Community studies in Guinea-Bissau have found that exposure to measles prior to 6 months of age is associated with delayed mortality later in childhood. In an attempt to understand the underlying mechanism, we examined the role of pre-exposure nutritional status and the impact of exposure to measles on growth and subsequent mortality in these outbreaks. Though exposed children were lighter than controls, there was no association between pre-exposure weight-for-age and subsequent mortality adjusting for age. Although exposure was strongly associated with excess mortality, it did not have a negative impact on growth. Adjustment for state of nutrition did not alter the mortality ratio (MR) between 6 and 59 months of age for exposed children and controls; exposed children examined anthropometrically between 6-17 months had a MR of 3.70 compared with controls. This trend was the same for anthropometric measurements obtained at 18-59 months of age. Among the controls, there was a significant association between weight-for-age and subsequent mortality to the age of 5 years. However, for exposed children there was no association; the relation between weight-for-age and subsequent mortality was significantly different for exposed children compared with controls (tests for interaction between exposure and anthropometric measurements at 6-17 months: P = 0.05). Growth faltering as a consequence of early exposure to measles does not explain the marked excess mortality among these children. Further studies of the process underlying delayed mortality after early exposure to measles are warranted.