Abstract
.Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95% confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23, 95% CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0–6 months was protective against diarrhea (0–2 months: RR 0.39, 95% CI 0.32, 0.49; 3–5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3–5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.
Highlights
Children in low-income countries are exposed to numerous infections in early life either concurrently or within a short timeframe because of high rates of infectious diseases and pathogens in their environments, poor nutritional status, and immune function, and lack of access to health care
Nineteen children from the cohort died during the follow-up, and the suspected causes of death included neonatal disorders, respiratory infections, and diarrhea
The majority of illness symptoms (80%) were concentrated in around half of the children and the distribution of diarrhea followed that of all grouped illnesses, acute lower respiratory infections (ALRI) were more highly concentrated in as few as 8% of children
Summary
Children in low-income countries are exposed to numerous infections in early life either concurrently or within a short timeframe because of high rates of infectious diseases and pathogens in their environments, poor nutritional status, and immune function, and lack of access to health care. Children may experience multiple illnesses concurrently or consecutively, increasing the risk of severe disease or death.[3] If there are vulnerable children within a population who experience multiple illnesses or a greater number of days with illnesses, targeting interventions to them may more efficiently improve the health of the community. Lower respiratory diseases and diarrhea are common ailments in children in low-income countries, and, after neonatal causes, continue to be the second and third leading causes of mortality in children under the age of five.[2] Importantly, there is. Evidence that diarrhea is a risk factor for lower respiratory infections,[4,5,6] highlighting the risks of consecutive or comorbidities as the prevalence of any single illness fails to give a complete picture of the infectious disease burdens. We are able to determine if the illness burden in a site is driven by a subset of vulnerable children and estimate the relationship between recent history of diarrhea, ALRI, or fever and future risk of episodes
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