Characteristics of and Predictors of Inflammation Among 6–23 months old Children in Nepal

Abstract

Inflammation in children reflects immune response to an insult. A population based representative micronutrient survey was conducted among 2,549 children 6–23 months in two districts of Nepal. It included indicators of inflammation because they can mask micro nutrient deficiencies and affect their assessment. The purpose of this analysis is to examine characteristics and predictors of inflammation among young children in Nepal. Inflammation was assessed using elevated C‐reactive protein (CRP>5mg/L) and α‐1‐acid glycoprotein (AGP>1 g/L). Afour stage inflammation variable was calculated as both normal CRP and AGP(non‐inflamed); high CRP and normal AGP (incubation); high CRP and high AGP (acute);and normal CRP and high AGP (chronic). Analyses were weighted and accounted for complex survey design. Four stepwise adjusted generalized logistic regression models were used to examine predictors of inflammation for Model 1) elevated AGP or CRP; Model 2)only elevated AGP; Model 3) only elevated CRP; and Model 4) the four stages of inflammation with non‐inflamed as thereferent. Predictor variable domains included sociodemographic, recent morbidity, and nutritional variables. The prevalence of inflammation was 43% by either CRP or AGP, 39% by only AGP, and 18% by only CRP. Overall prevalence of inflammation by the four stages was 41% distributed as follows: 3% incubation; 15% acute; and 23% chronic. Variables associated with an increased odds of having either an elevated AGP or CRP (model 1) included anemia, underweight, and fever (last two weeks), while higher household wealth ranking was associated with lower odds. In all the four models, anemia and fever predicted inflammation while other predictors varied by models. The prevalence of any inflammation was high among children and the predictors differed by inflammation category.Support or Funding InformationThe Government of Nepal, Ministry of Health and Population, and UNICEF Nepal Country Office supported the implementation of the Survey.