MALNUTRITION, CELL-MEDIATED IMMUNE-DEFICIENCY, AND DIARRHEA - A COMMUNITY-BASED LONGITUDINAL-STUDY IN RURAL BANGLADESHI CHILDREN

A community-based longitudinal study was conducted in Matlab, a rural area of Bangladesh. from May 1988 to April 1989 to examine the associa tions among malnutrition, cell-mediated immune deficiency, and the inc idence of diarrhea in children under age 5 years. A cohort of 705 chil dren was followed for a year; illnesses were ascertained every fourth day by home visits, anthropometric status was evaluated monthly, and c ell-mediated immune status was assessed by a multiple antigen skin tes t at baseline and every 3 months. The diarrhea incidence rate was 4.6 episodes per year. Approximately three quarters of the children were b elow -2 z score weight for age and height for age, and about a third w ere below -2 z score weight for height. There was a modest association between undernutrition and the incidence of diarrhea. About 10-20% of the study children were anergic, and these children experienced a 50% increased incidence of diarrhea compared with their immunocompetent c ounterparts. This association persisted after controlling for the effe cts of age, nutritional status, socioeconomic status, and history of d iarrhea in the previous 3 momths. Malnutrition and cell-mediated immun e deficiency were important independent risk factors for the occurrenc e of diarrhea and must both be considered in the design of interventio ns for the control of this condition.