The Association of C - reactive protein and Alpha-1-acid-glyoprotein with Reported Acute Illness Outcomes in Preschool Children in Western Kenya Open Access

Abstract

Abstract

The Association of C - reactive protein and Alpha-1-acid-glyoprotein with Reported Acute Illness Outcomes in Preschool Children in Western Kenya

Alexandra M Pyan

Study Design: Cross-sectional

Objective: To establish the association between inflammation biomarkers, C-reactive protein (CRP) and α-1-acid-glycoprotein (AGP), and reported acute illness outcomes in preschool children in a region with high levels of malnutrition and endemic infectious disease.

Research Design and Methods: In a population-based, cross-sectional study of 849 children aged 6-35 months in Nyando Division, Western Kenya, we measured CRP, AGP, hemoglobin, anthropometry, socioeconomic status, both blood smear and self-reported malaria, fever, and diarrhea. Prevalence odds ratios for acute illness outcomes (malaria, diarrhea, fever, and any of the three) were determined using logistic regression with the exposures of elevated CRP, elevated AGP and either elevated CRP or AGP.

Results: The strongest observed associations were with malaria and elevated CRP (POR: 7.7; 95% Confidence Interval 5.2, 11.4) and elevated AGP (7.7; 5.1, 11.52); as well as either elevated CRP or AGP (8.1; 5.2, 12.4). All unadjusted bivariate associations with the three exposures and acute illness outcomes were statistically significant. The association between elevated CRP and fever had effect modification by age and was stratified into three age categories while also controlling for breastfeeding status and stunting. The association for either elevated CRP or AGP and fever had effect modification by breastfeeding status. No other confounders or effect modifiers were found to be significant in any of the models.

Conclusions:Overall we observed strong associations between malaria and the biomarkers of inflammation. The population had a high prevalence of acute illness with 54.9% reporting at least one of the selected outcomes and 5.9% reported all three. All models were significant indicating a strong association between reported acute illness and CRP and AGP. Due to these associations these inflammation biomarkers have the potential to reflect the burden of acute disease in the population.

Table of Contents

Chapter I: Literature Review

1

Chapter II: Manuscript

14

A. Abstract

15

B. Introduction

16

C. Methods

20

D. Results

25

E. Discussion

29

F. References

37

G. Tables

43

Chapter III: Future Directions and Public Health Implications

48

Appendix

51

A. Multivariate SAS Code

51

B. Questionnaire

150

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	CRP Acute illness Kenya Inflammation AGP
Committee Chair / Thesis Advisor	Sullivan, Kevin M, Emory University
Committee Members	Suchdev, Parminder S, Emory University
Partnering Agencies	CDC

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