Peter P Moschovis1, Emmanuel O D Addo-Yobo2, Salem Banajeh3, Noel Chisaka4, David C Christiani1, Douglas Hayden1, Prakash Jeena5, William B MacLeod6, Greta Mino7, Archana Patel8, Shamim Qazi9, Mathuram Santosham10, Donald M Thea6, Patricia L Hibberd1. 1. Massachusetts General Hospital, Boston, MA, USA. 2. Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana. 3. Al-Sabeen Hospital for Women & Children, Sana'a University, Sana'a, Yemen. 4. World Bank, Washington, DC, USA. 5. University of KwaZulu-Natal, Durban, South Africa. 6. Boston University, Boston, MA, USA. 7. Children's Hospital Dr Francisco de Ycaza Bustamante, Guayaquil, Ecuador. 8. Lata Medical Research Foundation, Indira Gandhi Government Medical College, Nagpur, India. 9. World Health Organization, Geneva, Switzerland. 10. Johns Hopkins University, Baltimore, MD, USA.
Abstract
OBJECTIVE: Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials. METHODS: We analysed data from two WHO and USAID-sponsored inpatient treatment trials, the Severe Pneumonia Evaluation Antimicrobial Research study (n = 958) and the Amoxicillin Penicillin Pneumonia International Study (n = 1702), which enrolled children aged 2-59 months across 16 sites in LMICs. We assessed the effect of stunting (height-for-age Z score < -2) on treatment outcome and time to resolution of hypoxaemic pneumonia. RESULTS: Among 2542 (96%) children with valid data for height, 28% were stunted and 12.8% failed treatment by 5 days. The failure rate among stunted patients was 16.0% vs. 11.5% among non-stunted patients [unadjusted RR = 1.24 (95% CI 1.08, 1.41); adjusted RR = 1.28 (95% CI 1.10, 1.48)]. An inverse relationship was observed between height and failure rates, even among non-stunted children. Among 845 patients with hypoxaemic pneumonia, stunting was associated with a lower probability of normalisation of respiratory rate [HR = 0.63 (95% CI 0.52, 0.75)] and oxygen saturation [HR = 0.74 (95% CI 0.61, 0.89)]. CONCLUSIONS: Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.
OBJECTIVE: Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials. METHODS: We analysed data from two WHO and USAID-sponsored inpatient treatment trials, the Severe Pneumonia Evaluation Antimicrobial Research study (n = 958) and the Amoxicillin Penicillin Pneumonia International Study (n = 1702), which enrolled children aged 2-59 months across 16 sites in LMICs. We assessed the effect of stunting (height-for-age Z score < -2) on treatment outcome and time to resolution of hypoxaemic pneumonia. RESULTS: Among 2542 (96%) children with valid data for height, 28% were stunted and 12.8% failed treatment by 5 days. The failure rate among stunted patients was 16.0% vs. 11.5% among non-stunted patients [unadjusted RR = 1.24 (95% CI 1.08, 1.41); adjusted RR = 1.28 (95% CI 1.10, 1.48)]. An inverse relationship was observed between height and failure rates, even among non-stunted children. Among 845 patients with hypoxaemic pneumonia, stunting was associated with a lower probability of normalisation of respiratory rate [HR = 0.63 (95% CI 0.52, 0.75)] and oxygen saturation [HR = 0.74 (95% CI 0.61, 0.89)]. CONCLUSIONS: Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.
Authors: Christian L Coles; Drora Fraser; Noga Givon-Lavi; David Greenberg; Raphael Gorodischer; Jacob Bar-Ziv; Ron Dagan Journal: Am J Epidemiol Date: 2005-10-05 Impact factor: 4.897
Authors: Eduardo Villamor; Lara Misegades; Maulidi R Fataki; Roger L Mbise; Wafaie W Fawzi Journal: Int J Epidemiol Date: 2005-01-13 Impact factor: 7.196
Authors: Rai Asghar; Salem Banajeh; Josefina Egas; Patricia Hibberd; Imran Iqbal; Mary Katep-Bwalya; Zafarullah Kundi; Paul Law; William MacLeod; Irene Maulen-Radovan; Greta Mino; Samir Saha; Fernando Sempertegui; Jonathon Simon; Mathuram Santosham; Sunit Singhi; Donald M Thea; Shamim Qazi Journal: BMJ Date: 2008-01-08
Authors: Pui-Ying Iroh Tam; Matthew O Wiens; Jerome Kabakyenga; Julius Kiwanuka; Elias Kumbakumba; Peter P Moschovis Journal: Pediatr Infect Dis J Date: 2018-10 Impact factor: 2.129
Authors: Sabiha Nasrin; Md Tariqujjaman; Marufa Sultana; Rifat A Zaman; Shahjahan Ali; Mohammod J Chisti; Abu S G Faruque; Tahmeed Ahmed; George J Fuchs; Niklaus Gyr; Nur H Alam Journal: PLoS One Date: 2022-03-23 Impact factor: 3.240