Multi-country analysis of the effects of diarrhoea on childhood stunting
Multi-country analysis of the effects of diarrhoea on childhood stunting
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DOI：
10.1093/ije/dyn099
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发表时间：
2008-08-01
影响因子：
7.7
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Checkley, William;Buckley, Gillian;Black, Robert E.
腹泻是发展中国家儿童死亡和患病的一个重要原因;然而，腹泻是否会导致发育迟缓仍有争议。我们对9项研究进行了汇总分析，这些研究收集了每日腹泻发病率和纵向人体测量，以确定24个月前腹泻的纵向病史对24个月时发育迟缓的影响。数据涵盖20年期间和5个国家。我们使用逻辑回归来模拟腹泻对发育迟缓的影响。24个月时发育迟缓的患病率因研究而异（范围为21-90%），24个月前腹泻的纵向病史也是如此（发病率范围为3.6-13.4次/儿童年，患病率范围为2.4-16.3%）。然而，腹泻对发育迟缓的影响在各项研究中相似。24个月大时发育迟缓的几率随着每次腹泻发作和24个月之前每天腹泻而成倍增加（所有P < 0.001）。发育迟缓的校正几率每5次增加1.13（95%CI 1.07-1.19），纵向患病率每增加5%单位增加1.16（95%CI 1.07-1.25）。在这个24个月大的儿童样本中，24个月前腹泻发作≥ 5次导致发育迟缓的比例为25%（95% CI 8-38%），24个月前腹泻发作≥ 2%导致发育迟缓的比例为18%（95% CI 1-31%）。这些观察结果与腹泻累积负担增加发育迟缓风险的假设一致。
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 >= 5 diarrhoeal episodes before 24 months was 25% (95% CI 8-38%) and that attributed to being ill with diarrhoea for >= 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.