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Type: Journal article
Title: Poor growth and pneumonia seasonality in infants in the Philippines: cohort and time series studies
Author: Paynter, S.
Ware, R.
Lucero, M.
Tallo, V.
Nohynek, H.
Simões, E.
Weinstein, P.
Sly, P.
Williams, G.
ARIVAC Consortium
Citation: PLoS One, 2013; 8(6):e67528-1-e67528-9
Publisher: Public Library of Science
Issue Date: 2013
ISSN: 1932-6203
Statement of
Stuart Paynter, Robert S. Ware, Marilla G. Lucero, Veronica Tallo, Hanna Nohynek, Eric A. F. Simões, Philip Weinstein, Peter D. Sly, Gail Williams, the ARIVAC Consortium
Abstract: Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was -0.41 [95%CI -0.53 to -0.27] for pneumonia admissions, and -0.63 [95%CI -0.72 to -0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended.
Keywords: Humans
Rights: © 2013 Paynter et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
RMID: 0030024652
DOI: 10.1371/journal.pone.0067528
Appears in Collections:Public Health publications

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