Abstract:
Children with acute and chronic malnutrition are at increased risk of morbidity and
mortality following a diarrheal episode. To compare diarrheal disease severity and
pathogen prevalence among children with and without acute and chronic malnutrition,
we conducted a cross-sectional study of human immunodeficiency virus-uninfected
Kenyan children aged 6-59 months, who presented with acute diarrhea. Children
underwent clinical and anthropometric assessments and provided stool for bacterial and
protozoal pathogen detection. Clinical and microbiological features were compared using
log binomial regression among children with and without wasting (mid-upper arm
circumference ≤ 125 mm) or stunting (height-for-age z score ≤ -2). Among 1,363
children, 7.0% were wasted and 16.9% were stunted. After adjustment for potential
confounders, children with wasting were more likely than nonwasted children to present
with at least one Integrated Management of Childhood Illness danger sign (adjusted
prevalence ratio [aPR]: 1.3, 95% confidence interval [CI]: 1.0 to 1.5, P = 0.05), severe
dehydration (aPR: 2.4, 95% CI: 1.5 to 3.8, P < 0.01), and enteroaggregative Escherichia
coli recovered from their stool (aPR: 1.8, 1.1-2.8, P = 0.02). There were no differences in
the prevalence of other pathogens by wasting status after confounder adjustment.
Stunting was not associated with clinical severity or the presence of specific pathogens.
Wasted children with diarrhea presented with more severe disease than children without
malnutrition which may be explained by a delay in care-seeking or diminished immune
response to infection. Combating social determinants and host risk factors associated
with severe disease, rather than specific pathogens, may reduce the disparities in poor
diarrhea-associated outcomes experienced by malnourished children.