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Undernutrition in relation to childhood infections: a prospective study in the Sudan

European Journal of Clinical Nutrition volume 54, pages 463–472 (2000)Cite this article

Abstract

Objective: The aim of the study was to examine the relationships between nutritional status and diarrhoea and respiratory infections.

Design: Prospective cohort study within the framework of a randomized double-blind placebo-controlled intervention trial.

Setting: In rural communities in the Khartoum and Gezira regions, in Northern Sudan.

Subjects: 28, 753 Sudanese pre-school children between 6 months and 6 y old.

Methods: Relative risks of subsequent diarrhoea and respiratory infections in relation to nutritional status measured by anthropometry (Z-scores of height-for-age (H/A), weight-for-height (W/H), and weight-for-age (W/A), which reflect stunting, wasting and underweight, respectively) were estimated using odds ratios from logistic regression adjusting for various covariates.

Results: H/A, W/H and W/A were significantly and inversely associated with subsequent diarrhoea and febrile diarrhoea (P for trend <0.001) with risks being 2.00 times higher (95% confidence interval, CI (1.64, 2.43)) among children with W/A Z-scores below −4 Z, and 1.75 times higher (95% CI (1.56, 1.96)) among those with a W/A Z-score between −4 and −3 Z compared with children having a W/A Z-score ≥1. Age, gender, region of residence and seasonality modified these associations. Also, febrile cough was inversely associated with W/A and W/H (P<0.03), with risks ranging from 1.41 times higher (95% CI (1.02, 1.97)) to 1.21 times higher (95% CI (1.04, 1.41)) in the group of underweight children with W/A Z-scores below −4 and between −2 and −1 Z, all compared with normally nourished children (≥−1 Z).

Conclusions: The reduction of severe but also mild and moderate undernutrition is necessary through nutrition, health and socio-economic improvement in order to prevent morbidity.

Sponsorship: This study was carried out under cooperative agreement no. DAN-00450G-SS-6067 of the Office of Nutrition, US Agency for International Development, Washington DC, and the Harvard Institute for International Development.

European Journal of Clinical Nutrition (2000) 54, 463–472

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Authors and Affiliations

  1. Harvard Institute for International Development, Cambridge, MA, USA

    J Kossmann, P Nestel & MG Herrera

  2. Department of Epidemiology and Nutrition Harvard School of Public Health, Boston, MA, USA

    MG Herrera & WW Fawzi

  3. Ministry of Health, Khartoum, Sudan

    AEl Amin

Authors
  1. J Kossmann
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  2. P Nestel
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  3. MG Herrera
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  4. AEl Amin
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  5. WW Fawzi
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Contributions

Guarantors: P Nestel, MG Herrera and WW Fawzi.

Contributors: JK contributed to the design of this analysis, prepared the drafts of the paper and did the statistical analysis. P Nestel designed and implemented the field study, MH and with WF initiated the study, and provided advice in data analysis and commented on the manuscript. A El-A contributed to the implementation of the study in the field.

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Kossmann, J., Nestel, P., Herrera, M. et al. Undernutrition in relation to childhood infections: a prospective study in the Sudan. Eur J Clin Nutr 54, 463–472 (2000). https://doi.org/10.1038/sj.ejcn.1600998

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  • DOI: https://doi.org/10.1038/sj.ejcn.1600998

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