Poor growth and pneumonia seasonality in infants in the Philippines: cohort and time series studies

PLoS One. 2013 Jun 28;8(6):e67528. doi: 10.1371/journal.pone.0067528. Print 2013.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight
  • Cohort Studies
  • Humans
  • Infant
  • Nutritional Status
  • Philippines / epidemiology
  • Pneumonia / epidemiology*
  • Pneumonia / etiology*
  • Pneumonia / virology
  • Respiratory Syncytial Viruses
  • Risk
  • Risk Factors
  • Seasons
  • Tropical Climate

Grants and funding

This study is part of the research of the ARIVAC Consortium. The ARIVAC project was supported by the European Commission DG Research INCO program (contracts IC18-CY97-2019, ICA4-CT-1999-10008, ICA4-CT-2002-10062); Academy of Finland (contracts: 206283, 106974, 108873, and 108878); Finnish Ministry of Foreign Affairs (bilateral contracts 75502901 and 327/412/2000); Finnish Physicians for Social Responsibility; GAVI ADIP Pneumo; Sanofi Pasteur; Research Institute for Tropical Medicine of the Philippines; National Public Health Institute Finland; University of Queensland; University of Colorado; National Health and Medical Research Council of Australia; and Programme for appropriate Technology in Health (PATH). The views expressed by the authors do not necessarily reflect the views of PATH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.