Mwamba Guillaume N, Nzaji Michel Kabamba, Hoff Nicole A, Mukadi Patrick K, Musene Kamy Kaminye, Gerber Sue K, Halbrook Megan, Sinai Cyrus, Fuller Trevon, Numbi Oscar Luboya, Wemakoy Emile Okitolonda, Tamfum Jean Jacques Muyembe, Mukadi Dalau Nkamba, Mapatano Mala Ali, Rimoin Anne W, Dikassa Paul-Samson Lusamba
Department of Public Health, Faculty of Medicine, University of Kamina, Kamina, Democratic Republic of the Congo.
Expanded Program on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo.
J Multidiscip Healthc. 2024 Mar 19;17:1219-1229. doi: 10.2147/JMDH.S437351. eCollection 2024.
Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC.
In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA.
Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes.
This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.
在易于爆发疫苗衍生脊髓灰质炎病毒（VDPV）的地区，营养不良被视为脊髓灰质炎血清转化不足的一个风险因素。为评估营养不良的患病率及其与脊髓灰质炎病毒免疫不足的关联，在刚果民主共和国上洛马米省和坦噶尼喀省开展了一项横断面家庭调查。
2018年3月，我们纳入了来自27个区中8个区的968名6至59个月大的健康儿童。这些区内研究地点的选择采用分层随机抽样方法，根据从卫星图像识别出的栖息地特征选择村庄。经过针对此项任务的专门培训的访谈员，用参与者首选的语言（法语或斯瓦希里语）获得口头同意。此外，参与者提供一份通过手指针刺采集的干血斑样本。为评估营养不良状况，我们测量了身高和体重，应用世界卫生组织标准来确定体重不足、消瘦和发育迟缓的发生率。通过检测中和抗体对脊髓灰质炎病毒1型、2型和3型的免疫评估在美国亚特兰大的疾病控制与预防中心进行。
在研究人群中，我们发现体重不足率为24.7%，发育迟缓率为54.8%，消瘦率为15.4%。在95%置信区间下，体重不足（比值比=1.50；[1.11 - 2.03]）以及未服用维生素A（比值比=1.96；[1.52 - 2.54]）与脊髓灰质炎1型血清阴性显著相关。体重不足（比值比=1.64；[1.20 - 2.24]）以及未服用维生素A（比值比=1.55；[1.20 - 2.01]）与脊髓灰质炎2型血清阴性显著相关。体重不足（比值比=1.50；[1.11 - 2.03]）以及未服用维生素A（比值比=1.80；[1.38 - 2.35]）与脊髓灰质炎3型血清阴性显著相关。体重不足（比值比=1.68；95%置信区间[1.10 - 2.57]）以及未服用维生素A（比值比=1.82；95%置信区间[1.30 - 2.55]）与所有脊髓灰质炎血清型的血清阴性显著相关。
本研究揭示了儿童体重不足与脊髓灰质炎血清阴性之间存在显著关联。为减少高危地区的疫苗接种失败情况，应采用疫苗接种和营养计划相结合的综合方法。
