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

Pyan, Alexandra Murphy (2014)
Master's Thesis (181 pages)
Committee Chair / Thesis Adviser: Sullivan, Kevin M
Committee Members: Suchdev, Parminder S
Research Fields: Health Sciences, Public Health; Health Sciences, Epidemiology
Partnering Agencies: CDC
Keywords: Inflammation; CRP; AGP; Kenya; Acute illness
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
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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 --


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