IJE Advance Access originally published online on March 11, 2005
International Journal of Epidemiology 2005 34(2):368-375; doi:10.1093/ije/dyh335
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article |
Comorbidity in childhood in northern Ghana: magnitude, associated factors, and impact on mortality
1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 Department of International Health, Johns Hopkins University School of Public Health, Wolfe Street, Baltimore, MD 21205–2179, USA
* Corresponding author. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: bridget.fenn{at}lshtm.ac.uk
Background It has been observed that in developing countries terminal illness in children under 5 yr of age is frequently characterized by comorbidity. This study seeks to quantify the co-occurrence of illness at the community level and investigates whether this co-occurrence increases the risk of mortality. We develop an appropriate measure of co-occurrence and investigate whether the comorbidity occurs by chance or whether it is due to shared risk factors.
Methods The data used for the analysis was taken from a study carried out from 1989 to 1991 in northern Ghana on children aged 2–59 months (n = 1879). Coding for diarrhoea, pneumonia, and measles was carried out using the classification system of the WHO/UNICEF strategy for the Integrated Management of Childhood Illness; malaria was confirmed by laboratory analysis. A bivariate probit analysis was conducted to quantify comorbidity. We used an additive regression model, implemented using the Generalized Estimating Equation approach, to examine the impact on mortality.
Results There is evidence of co-occurrence of diarrhoeal diseases and pneumonia, with greater comorbidity with increasing severity of disease. There is no evidence that the co-occurrence of diarrhoea with severe dehydration and severe pneumonia is characterized by a synergistic effect on mortality risk.
Conclusions Our study has shown that it is possible to have significant co-occurrence of illness at the community level. The bivariate probit procedure was easily adopted and considered appropriate for the analysis of comorbidity. The lack of suitable datasets for a more thorough analysis of comorbidity, and for the evaluation of synergistic effects on mortality, is a major limitation.
Keywords Comorbidity, childhood infectious diseases, northern Ghana, synergy
Accepted 11 August 2004
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  W.-P. Schmidt, S. Cairncross, M. L Barreto, T. Clasen, and B. Genser Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years Int. J. Epidemiol., June 1, 2009; 38(3): 766 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L F. Walker and R. E Black Commentary: What is the role of co-morbidity in child mortality? Int. J. Epidemiol., June 1, 2009; 38(3): 772 - 774. [Full Text] [PDF]
|
|
|
|
 |
|
 D C Fuhr and M J De Silva Physical long-term health problems and mental comorbidity: evidence from Vietnam Arch. Dis. Child., August 1, 2008; 93(8): 686 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Gwer, C. R.J.C. Newton, and J. A. Berkley Over-Diagnosis and Co-Morbidity of Severe Malaria in African Children: A Guide for Clinicians Am J Trop Med Hyg, December 1, 2007; 77(6_Suppl): 6 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H P S Sachdev Commentary: Utilizing information on causes of neonatal deaths in less-developed countries Int. J. Epidemiol., June 1, 2006; 35(3): 718 - 719. [Full Text] [PDF]
|
|
|
|
|
|
K. Mulholland Commentary: Comorbidity as a factor in child health and child survival in developing countries Int. J. Epidemiol., April 1, 2005; 34(2): 375 - 377. [Full Text] [PDF]
|
|