Would control of childhood infectious diseases reduce malnutrition?

Abstract

Infectious diseases and especially diarrheal diseases have been noted to have an adverse effect on the growth of underprivileged children in developing countries. Diarrheal diseases have been estimated to account for 10-80% of growth retardation in the first few years of life, with the magnitude of effect possibly modified by other factors, such as the adequacy and source of dietary intake, treatment and feeding practices during and following illness and the opportunity for catch-up growth after illness. In the only study in which infectious diseases and routine dietary intake have been evaluated simultaneously, inadequate dietary intake rather than infectious diseases, was found to have the predominant role in growth faltering. Although reduction in infectious diseases is desirable for many reasons, the relative feasibility and cost of this approach to improve nutritional status must be compared with more direct nutrition interventions.

PIP: An analysis of a group of prospective community bases studies has revealed that diarrhea has the most effect on slowing growth of children 0-24 months old. On the other hand, respiratory infections did not generally influence growth. 1 study in the Gambia, however, revealed that lower, but not upper, respiratory infections significantly affected growth. In these studies, diarrhea accounted for 10-80% of growth retardation. Indeed 1 study in The Gambia had the highest magnitude of growth retardation due to diarrhea (101 g of 122 g deficit/month). In another study here, the magnitude was 50%. In a study in the Bangladesh, only enterotoxigenic Escherichia coli and Shigella species influenced growth while rotavirus and other enteropathogens did not. This review recognized that mitigating factors may have moderated the magnitude of diarrhea's effect on growth, however. For example, in 1 study in The Gambia, even the children with little to no diarrheal episodes gained almost no weight during the preharvest months of July and August. Moreover, high prevalence of diarrhea among the children in this study had little effect on growth. In a study in Bangladesh, researchers found that inadequate dietary intake played a more significant role in growth faltering than did infectious diseases. All the studies that looked at breast feeding showed that it did not adversely affect growth and/or reduced the severity and duration of diarrhea. Further, continued feeding during diarrhea and proper treatment including oral rehydration improved weight gain. In conclusion, nutritional interventions may be more cost effective than controlling infectious diseases. Other countries included Guatemala, Uganda, Mexico, Taiwan, and the Sudan.