The impact of short stature on child morbidity in a rural African community

This study was undertaken to assess whether short stature in children under 5 years of age is associated with an increased risk of acute or persistent diarrhoea, acute respiratory infection, or indeed any illness, taking account of possible confounding factors such as whether breastfed, water quality, degree of household crowding, age and gender. After initial anthropometric assessment, the morbidity and diet of a cohort of 403 Somali children were recorded for 1 year at 2-week intervals. In multivariate analyses of the findings, adjustments were made for the possible confounding factors listed. Short stature was associated with an increased incidence of acute diarrhoea (< -2 SD score, RR 1.7, 95% CI 1.3-2.2) and with a risk of developing persistent diarrhoea, but not with the incidence of acute respiratory infections. When adjusting for age only, short stature increased the risk of developing any illness, but this association was not shown when adjusting for the other possible confounding factors. There was a dose-effect relationship between different degrees of short stature and acute diarrhoea, with an increased incidence of acute diarrhoea among the shortest children. Efforts were made to account for the possibility of reverse causality, which seemed not to change the main findings. Thus, short stature seemed to increase the risk of subsequent acute diarrhoea in children under 5 years of age.