Multi-country analysis of the effects of diarrhoea on childhood stunting

Abstract

Diarrhoea is an important cause of death and illness among children in developing countries; however, it remains controversial as to whether diarrhoea leads to stunting. We conducted a pooled analysis of nine studies that collected daily diarrhoea morbidity and longitudinal anthropometry to determine the effects of the longitudinal history of diarrhoea prior to 24 months on stunting at age 24 months. Data covered a 20-year period and five countries. We used logistic regression to model the effect of diarrhoea on stunting. The prevalence of stunting at age 24 months varied by study (range 21-90%), as did the longitudinal history of diarrhoea prior to 24 months (incidence range 3.6-13.4 episodes per child-year, prevalence range 2.4-16.3%). The effect of diarrhoea on stunting, however, was similar across studies. The odds of stunting at age 24 months increased multiplicatively with each diarrhoeal episode and with each day of diarrhoea before 24 months (all P < 0.001). The adjusted odds of stunting increased by 1.13 for every five episodes (95% CI 1.07-1.19), and by 1.16 for every 5% unit increase in longitudinal prevalence (95% CI 1.07-1.25). In this assembled sample of 24-month-old children, the proportion of stunting attributed to >or=5 diarrhoeal episodes before 24 months was 25% (95% CI 8-38%) and that attributed to being ill with diarrhoea for >or=2% of the time before 24 months was 18% (95% CI 1-31%). These observations are consistent with the hypothesis that a higher cumulative burden of diarrhoea increases the risk of stunting.

Relationship Between Growth Rate and Different Types of Infection in Children Under 5 Years on West Papua

“…7,9,18 For the specific factor of growth rate, some studies have shown a relationship between growth faltering and gastroenteritis. [11][12][13] A combined analysis of data from nine studies in five countries (Bangladesh, Brazil, Ghana, Guinea-Bissau and Peru) shows that 25% of stunting at 24 months of age was associated with five or more episodes of gastroeneteritis in the first 2 years of life. 12 Less clear is the relationship between growth rate and respiratory infections.…”

“…[11][12][13] A combined analysis of data from nine studies in five countries (Bangladesh, Brazil, Ghana, Guinea-Bissau and Peru) shows that 25% of stunting at 24 months of age was associated with five or more episodes of gastroeneteritis in the first 2 years of life. 12 Less clear is the relationship between growth rate and respiratory infections. Some studies have associated growth faltering and febrile respiratory infections.…”

“…[7][8][9][10] However, few studies have tried to link the problem of growth rate itself with the prevalence of different types of infection beside gastroenteritis. [11][12][13] A province in the eastern Indonesia, West Papua, hold the distinction of having the lowest population density in Indonesia. 14 The aforementioned low population density makes it replete with problems such as inadequate infrastructure and low economic prowess.…”

Sanitation and child health in India

“…Diseases have been linked to stunting (Checkley et al [2008]) but have also shown direct associations with short (Nokes et al [1992], Nokes et al [1998], Walker et al [2011]) and long-term effects on human capital (Almond and Currie [2011], Bozzoli et al [2009]). Understanding the potential of improving the disease environment that children live in is hence of direct policy relevance.…”

Modeling the Complexities of Water, Hygiene and Health in Limpopo, South Africa

“…is a major cause of these deaths which can also lead to serious problems such as stunting (Checkley et al , 2008), long-term cognitive deficits (Niehaus et al , 2002) and lower performance in school (Lorntz et al , 2006). Finally, poor access to water and sanitation technologies disproportionally a↵ects women and children who are primarily in charge of water resources in most developing nations.…”