Testing hypothesized predictors of immune activation in Tanzanian infants and children: community, household, caretaker, and child effects.

Abstract

There is increasing interest in the epidemiology of immune activation among young children because of the links with mortality and growth. We hypothesized that infant and child inflammation, as measured by elevated C-reactive protein (CRP), would be associated with household assets, household size, measures of sanitation, and food insecurity. We also hypothesized that children in the poorest households and with elevated CRP would show evidence of growth faltering. A nationally representative cross-sectional study of Tanzania children 6-59 months of age. Survey data, anthropometrics, and dried blood spots were available for 1,387 children. Measures of elevated CRP (CRP ≥ 1.1 mg/l) were used to assess inflammation. Fifty-four percent of the sample had CRP ≥ 1.1 mg/l. In bivariate analyses, several measures of sanitation were associated with elevated CRP but in multiple regression models only age, sex, literacy, maternal reports of illness, household size, and living in the wealthiest households predicted CRP. There were no associations between elevated CRP and any measure of child growth. Among children in Tanzania, a single elevated CRP does not predict poor growth functioning. Elevated CRP is associated with individual, caretaker, household, and community-level variables. Future work should strive to measure local biologies in more nuanced ways.