Association between nutritional status, cell-mediated immune status and acute lower respiratory infections in Bangladeshi children

Objective: To investigate the association between nutritional status, cell-mediated immune status and the incidence of acute lower respiratory infections (ALRI). Design: Community-based longitudinal study. Setting: Three villages in rural Bangladesh at Matlab. Subject: 696 children aged 0-59 months were followed up for a year. Methods: Trained field workers visited all children every fourth day and collected morbidity data for the preceding three days by recall. To determine the type and severity of respiratory infections, the field workers physically examined each child reporting a cough. Anthropometric status was determined monthly and cell-mediated immune status by skin tests was assessed at the beginning of the study and thereafter every 3 months. Results: The incidence of ALRI was 23 episodes per 100 child-years. A total of 73-78% of the children were below -2 z score weight for age, 15-30% were below -2 z score weight for height, and 68-76% were below -2 z score height for age. In logistic regression models, malnutrition as assessed by weight-for-height status [odds ratio (OR) 0.66, 95% confidence interval (CI) 0.45-0.96, P = 0.03] or weight-for-age status (OR 0.64, 95% CI 0.45-0.92, P = 0.02) was significant predictor of ALRI. Anergic children had a higher risk of ALRI which approached to be statistically significant (OR 1.81, 95% CI 0.92-3.55, P = 0.08). Conclusions: Improvement of nutritional and cell-mediated immune status in rural Bangladeshi children should reduce the incidence of ALRI.