Malnutrition as an underlying cause of childhood …

1 Malnutrition as an underlying cause of childhooddeaths associated with infectious diseasesin developing countriesAmy L. Rice,1 Lisa Sacco,2 Adnan Hyder,3& Robert E. Black4 IntroductionRecent estimates suggest that Malnutrition (measured as poor anthropometric status) is associatedwith about 50% of all deaths among children. Although the association between Malnutrition and all-causemortality is well documented, the Malnutrition -related risk of death associated with specific diseases is less welldescribed.

2 We reviewed published literature to examine the evidence for a relation between Malnutrition and childmortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% ofdeaths in children was searched for suitable review articles and original reports of community-based andhospital-based studies. Findings from cohort studies and case control studies were reviewed and strongest and most consistent relation between Malnutrition and an increased risk of death wasobserved for diarrhoea and acute respiratory infection.

3 The evidence, although limited, also suggests a potentiallyincreased risk for death from malaria. A less consistent association was observed between nutritional status anddeath from measles. Although some hospital-based studies and case control studies reported an increased risk ofmortality from measles, few community-based studies reported any risk of Malnutrition -related mortality seems to vary for different diseases. These findings haveimportant implications for the evaluation of nutritional intervention programmes and child survival programmesbeing implemented in settings with different disease :developing countries; child nutrition disorders; communicable diseases, mortality; infantile diarrhea,mortality; measles, mortality; health planning; child health of the World Health Organization, 2000,78: 1207 page 1218 le re sume en franc ais.

4 En la pa gina 1219 figura un resumen en espan 12 million children younger than5 years of age die every year; most of these childrenlive indeveloping countries. More than 50% of thesedeaths are attributed to diarrhoea, acute respiratoryillness, malaria, or measles, conditions that are eitherpreventable or treatable with low-cost interventions(1). Although Malnutrition is prevalent in developingcountries, itisrarelycited asbeing amongtheleadingcauses of death. This is due in part to theconventional way that cause of death data arereported and analysed.

5 In many countries, mortalitystatistics are compiled from records in which a singleproximate cause of death has been the early1990sPelletier and colleaguesuseda different approach to estimate the contribution ofmalnutrition to all- cause mortality in children (2).Their analytical framework takes the underlyingcauses of death into account and it suggested thatmalnutrition (measured as poor anthropometricstatus) is an associated cause in about half of alldeaths occurring among children in developingcountries (2,3).

6 The results also highlighted the factthat even children with mild to moderate malnutri-tion, rather than only those with more severe forms, ,international attention has been refocused on thepotential impact that preventing mild and moderatemalnutrition, as well as severe Malnutrition , can haveon the survival of all- cause mortality is well documented, theassociation between Malnutrition and mortalityattributed to specific causes is less well varies for different diseases also has implica-tions for the implementation and evaluation of1 Assistant Scientist, Department of International Health, JohnsHopkins University, School of Public Health, 615 North Wolfe Street,Room W2041, Baltimore, MD 21205, USA (email.)

7 Should be addressed to this student, Department of International Health, Johns HopkinsUniversity, School of Public Health, Baltimore, Scientist, Department of International Health,Johns Hopkins University, School of Public Health, Baltimore,Baltimore, , Department of International Health, Johns HopkinsUniversity, School of Public Health, Baltimore, of the World Health Organization, 2000,78(10)#World Health Organization 2000programmes designed to ensure the survival ofchildren. If Malnutrition does not increase the risk ofmortality from all causes of death equally, interven-tion programmes that succeed in improving nutri-tional status may not have the same potential forreducingchildren smortalityinregionswithdifferentdisease synergistic relation between malnutritionand infection is well known, and nutritional interven-tions have been recognized as an important approachfor reducing mortality from acute respiratory illnessand diarrhoea (4).

8 The WHO Integrated Managementof childhood Illness initiative is based on the premisethat combining efforts to promote the appropriatecase-management of serious infectious diseases withnutritional interventions, immunization programmes,and other disease prevention and health promotionactivities will be more effective in decreasing childmortality than implementing any one of the compo-nents alone (5,6).Infectious diseases remain the most importantimmediate cause of death among children and ofdisability worldwide.

9 The burden of ill-healthassociated with these conditions is especially high indeveloping countries. Despite the progressive rise inchronicdiseasesasimportantcausesofmort ality,theepidemiological transition that is under way in thedeveloping world does not reduce the need tocontinue investigating appropriate strategies forreducing child mortality from infectious diseases. Infact, these developments will make dealing with theunfinished agenda of mortality from infectiousdiseases even more of a is currently supporting a project toestimate quantitatively the contribution of project, we reviewed the published literature toidentify studies that addressed the relation betweenmalnutrition and mortality from diarrhoea, acuterespiratory infections, malaria, and Malnutrition may be an important asso-ciated cause of death in other conditions.

10 The presentrevie w was restricted to these four major causes ofdeath. The objective of this report is to provide adescriptive overvie wof the was searched for literature publishedeither in English or with an English abstract in aforeign-language publication for the years 1966 of the following groups of keywordswere used: mortality, death; Malnutrition , protein-energy- Malnutrition , anthropometry; diarrhea, dys-entery; acute respiratory illness, acute respiratoryinfection, ARI, acute lower respiratory illness, acutelower respiratory infection, ALRI, pneumonia.