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Randomized Controlled Trial
. 2015 Oct;20(10):1320-8.
doi: 10.1111/tmi.12557. Epub 2015 Jul 15.

Stunting is associated with poor outcomes in childhood pneumonia

Peter P Moschovis  1 , Emmanuel O D Addo-Yobo  2 , Salem Banajeh  3 , Noel Chisaka  4 , David C Christiani  1 , Douglas Hayden  1 , Prakash Jeena  5 , William B MacLeod  6 , Greta Mino  7 , Archana Patel  8 , Shamim Qazi  9 , Mathuram Santosham  10 , Donald M Thea  6 , Patricia L Hibberd  1
Affiliations
Randomized Controlled Trial

Stunting is associated with poor outcomes in childhood pneumonia

Peter P Moschovis et al. Trop Med Int Health. 2015 Oct.

Abstract

Objective: Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials.

Methods: We analysed data from two WHO and USAID-sponsored inpatient treatment trials, the Severe Pneumonia Evaluation Antimicrobial Research study (n = 958) and the Amoxicillin Penicillin Pneumonia International Study (n = 1702), which enrolled children aged 2-59 months across 16 sites in LMICs. We assessed the effect of stunting (height-for-age Z score < -2) on treatment outcome and time to resolution of hypoxaemic pneumonia.

Results: Among 2542 (96%) children with valid data for height, 28% were stunted and 12.8% failed treatment by 5 days. The failure rate among stunted patients was 16.0% vs. 11.5% among non-stunted patients [unadjusted RR = 1.24 (95% CI 1.08, 1.41); adjusted RR = 1.28 (95% CI 1.10, 1.48)]. An inverse relationship was observed between height and failure rates, even among non-stunted children. Among 845 patients with hypoxaemic pneumonia, stunting was associated with a lower probability of normalisation of respiratory rate [HR = 0.63 (95% CI 0.52, 0.75)] and oxygen saturation [HR = 0.74 (95% CI 0.61, 0.89)].

Conclusions: Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.

Keywords: desnutrición; fallo terapéutico; global health; malnutrition; neumonía; pneumonia; pneumonie; salud global; santé mondiale; treatment failure; échec du traitement.

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Figures

Figure 1
Figure 1
Study Population * The APPIS and SPEAR studies were based on the pre-2013 WHO classification scheme for pneumonia. The classification has been revised in the latest edition of the WHO guidelines.(21)
Figure 2
Figure 2
Mean respiratory rate by stunting
Figure 3
Figure 3
P for trend (Cochran-Armitage) <0.0001 Error bars represent 95% confidence intervals
Figure 4
Figure 4
Time to normal respiratory rate among stunted vs. non-stunted children with severe pneumonia
Figure 5
Figure 5
Time to normal oxygen saturation among stunted vs. non-stunted children with severe pneumonia
See this image and copyright information in PMC

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