Changes over time in the epidemiology of diarrhea and malnutrition among children in an Urban Brazilian Shantytown, 1989 to 1996

Abstract

Background: Endemic diarrhea and its associated malnutrition remain leading causes of childhood morbidity and mortality in developing countries. This study was undertaken to describe changes in the incidence of diarrhea and prevalence of malnutrition among children in an urban Brazilian shantytown from 1989 to 1996. A secondary purpose was to examine associations between malnutrition and increased incidence and duration of diarrhea. Methods: From August 1989 through December 1996 a dynamic birth cohort of 315 children was followed for surveillance of diarrhea and nutrition. Study homes were visited twice or thrice weekly to assess the occurrence of diarrhea. Length and weight of the subjects were measured quarterly. Poisson regression was used to test for associations between prior nutritional status and subsequent diarrhea during a quarter. Multiple regression was used to test for an association between nutritional status and episode duration. Results: Declines in both age-adjusted attack rates (6.0 episodes/child-year in 3-year-olds to 2.5 episodes/child-year in 8-year-olds) and days with diarrhea per child-year (30.8 days/child-year in 3-year-olds to 8.5 days/child-year in 8-year-olds) were highly correlated with yearly improvements in mean nutritional status (R 2 = 0.84, P < 0.05, for mean length-for-age with mean number of episodes/child-year). Both length- and weight-for-age were significant predictors of diarrhea incidence, including persistent episodes (≥14 d), but not duration. Conclusions: These results demonstrate marked changes over time in the diarrhea burden and nutritional status of children in this population and provide further evidence of a significant association between malnutrition and increased incidence of diarrhea.