Multi-country analysis of the effects of diarrhoea on childhood stunting
Open accessAbstract
Diarrhoea is an important cause of death and illness among children in developing countries; however, it remains controversial as to whether diarrhoea leads to stunting. We conducted a pooled analysis of nine studies that collected daily diarrhoea morbidity and longitudinal anthropometry to determine the effects of the longitudinal history of diarrhoea prior to 24 months on stunting at age 24 months. Data covered a 20-year period and five countries. We used logistic regression to model the effect of diarrhoea on stunting. The prevalence of stunting at age 24 months varied by study (range 21-90%), as did the longitudinal history of diarrhoea prior to 24 months (incidence range 3.6-13.4 episodes per child-year, prevalence range 2.4-16.3%). The effect of diarrhoea on stunting, however, was similar across studies. The odds of stunting at age 24 months increased multiplicatively with each diarrhoeal episode and with each day of diarrhoea before 24 months (all P < 0.001). The adjusted odds of stunting increased by 1.13 for every five episodes (95% CI 1.07-1.19), and by 1.16 for every 5% unit increase in longitudinal prevalence (95% CI 1.07-1.25). In this assembled sample of 24-month-old children, the proportion of stunting attributed to >or=5 diarrhoeal episodes before 24 months was 25% (95% CI 8-38%) and that attributed to being ill with diarrhoea for >or=2% of the time before 24 months was 18% (95% CI 1-31%). These observations are consistent with the hypothesis that a higher cumulative burden of diarrhoea increases the risk of stunting.
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Undernutrition can be a consequence of repeated bouts of diarrhoea.
“Undernutrition can be a consequence of repeated bouts of diarrhoea.5, 13”
A pooled analysis of nine studies found that the odds of growth stunting by age 2 years increased by 1.13 (95% CI 1.07-1.19) for every five episodes of diarrhoea.
“A pooled analysis of nine studies that assessed morbidity and anthropometry showed that the odds of growth stunting by age 2 years increased by 1·13 (95% CI 1·07–1·19) for every five episodes of diarrhoea.13”
From Global burden of childhood pneumonia and diarrhoea (2013) · cites this paper as [13]
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- Authors
- Checkley, W., Buckley, G., Gilman, R. H., Assis, A. M., Guerrant, R. L., Morris, S. S., Mølbak, K., Valentiner-Branth, P., Lanata, C. F., Black, R. E., & and The Childhood Malnutrition and Infection Network
- Affiliations
- Johns Hopkins University (US)
- Universidade Federal da Bahia (BR)
- University of Virginia (US)
- London School of Hygiene & Tropical Medicine (GB)
- Statens Serum Institut (DK)
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark.
- Instituto de Investigación Nutricional (PE)
- Corresponding author
- Checkley, William
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-06-20
- Volume
- 37
- Issue
- 4
- Pages
- 816-830
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC2734063
- OpenAlex
- W2095946686
- Cited by
- 653
- References
- 2
- Citations by year
- 2026: 25 · 2025: 26 · 2024: 34 · 2023: 40 · 2022: 45 · 2021: 52 · 2020: 45 · 2019: 46 · 2018: 49 · 2017: 50 · 2016: 47 · 2015: 40 · 2014: 47 · 2013: 32 · 2012: 21
- FWCI
- 16.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (publishedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Vanderbilt University
- Johns Hopkins University
- National Institutes of Health (5f32hl090179-02)
- Statens Serum Institut
- National Heart, Lung, and Blood Institute (F32-HL090179)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Keywords
- childhood diarrhea, stunting, child growth, anthropometry, diarrhea prevalence, attributable fraction
- MeSH terms
- Data Interpretation, Statistical, Developing Countries, Diarrhea, Female, Growth Disorders, Humans, Infant, Infant, Newborn, Longitudinal Studies, Male, Recurrence, Incidence, Prevalence, Logistic Models
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