Malnutrition, cell‐mediated immune deficiency and acute upper respiratory infections in rural Bangladeshi children

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Abstract
A community‐based longitudinal study conducted in rural Bangladesh investigated the association between nutritional status, cell‐mediated immune status and acute upper respiratory infections (URI). A total of 696 children aged 0–59 months was followed prospectively for 1 y yielding 183 865 child‐days' observation. Trained field workers visited each child every 4th d and collected morbidity data on symptoms suggesting URI (cough, fever, nasal discharge) for the preceding 3 d by recall. On the day of visit they examined each child reporting cough and/or fever to record the temperature, presence of nasal discharge, rate of respiration and presence of chest indrawing. Anthropometry for all children was conducted monthly. Cell‐mediated immune competence was assessed by a multiple antigen skin test at baseline and thereafter every 3 months. The incidence of URI was 5. 3 episodes per child‐year observed. Approximately three‐quarters of the study children were below ‐2 Z‐score weight for age and height for age, and a quarter below ‐2 Z‐score weight for height. During different test periods 9–21 % of the study children did not respond to any of the test antigens. In a regression model children < ‐2 Z‐score for weight for height had 16% [odds ratio (OR) 1. 16, 95% confidence interval (CI) 1. 03–1. 31, p= 0. 01] higher risk of developing URI. Anergic children had 20% higher risk (OR 1. 20, CI 1. 05–1. 38, p= 0. 009) of URI than immunocompetent children. The study demonstrated that wasting and depressed cell‐mediated immunity (CMI), but not stunting, were associated with the incidence of URI among rural Bangladeshi children.