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Multicenter Study
. 2009 Jun;38(3):766-72.
doi: 10.1093/ije/dyp159. Epub 2009 Mar 11.

Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years

Wolf-Peter Schmidt  1 , Sandy Cairncross, Mauricio L Barreto, Thomas Clasen, Bernd Genser
Affiliations
Multicenter Study

Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years

Wolf-Peter Schmidt et al. Int J Epidemiol. 2009 Jun.

Abstract

Background: Children in low-income settings suffering from frequent diarrhoea episodes are also at a high risk of acute lower respiratory infections (ALRI). We explored whether this is due to common risk factors for both conditions or whether diarrhoea can increase the risk of ALRI directly.

Methods: We used a dynamic time-to-event analysis of data from two large child studies in low-income settings in Ghana and Brazil, with the cumulative diarrhoea prevalence over 2 weeks as the exposure and severe ALRI as outcome. The analysis was adjusted for baseline risk of ALRI and diarrhoea, seasonality and age.

Results: The child population from Ghana had a much higher risk of diarrhoea, malnutrition and death than the children in Brazil. In the data from Ghana, every additional day of diarrhoea within 2 weeks increased the risk of ALRI by a factor of 1.08 (95% CI 1.00-1.15). In addition, we found a roughly linear relationship between the number of diarrhoea days over the last 28 days and the risk of ALRI. In the Ghana data, 26% of ALRI episodes may be due to recent exposure to diarrhoea. The Brazilian data gave no evidence for an association between diarrhoea and ALRI.

Conclusion: Diarrhoea may contribute substantially to the burden of ALRI in malnourished child populations.

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Figures

Figure 1
Figure 1
Exposure to diarrhoea. Shown is the distribution of the number of diarrhoea days in the 14 days for all individuals and days under observation
Figure 2
Figure 2
The risk of ALRI depending on diarrhoea over a 14-day window at different lag times for (a) Ghana and (b) Brazil. The index day 0 is the day on which ALRI presence or absence was ascertained. The first estimate on the right (1.08 for Ghana) denotes the increase in the risk (hazard) of ALRI with every additional day with diarrhoea during the 14 days preceding the index day starting from Day −1. The next estimate (1.05 for Ghana) denotes the increase in the risk of ALRI with every additional diarrhoea day during the 14 days from Day −8 to Day −21, and so on
Figure 3
Figure 3
The risk of ALRI in Ghana depending on the number of diarrhoea days during (a) the last 14 and (b) the last 28 days prior to the index day (time window closest to the index day). To avoid convergence problems, the number of diarrhoea days during the 28-day window was collapsed into groups of four
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Comment in

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