Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact
Schroeder, D.G.; Brown, K.H.
Bulletin of the World Health Organization 72(4): 569-579
1994
ISSN/ISBN: 0042-9686 PMID: 7923536 Document Number: 286765
By pooling the results from five previously published prospective studies, the relative risks of mortality were estimated among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate the total number of young childhood deaths attributable to malnutrition in developing countries. Children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts ( 80% of the median reference weight-for-age). The relative risk of mild-to-moderate malnutrition was 1.2-3.5 compared with the reference categories of better nourished children whose expected weight-for-age was greater than either 75% or 80% of the median value. Severely malnourished children ( 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year in developing countries an estimated 1,251,280 excess deaths occur in mild-to-moderately malnourished children aged 6-60 months, while 1,067,268 excess deaths occur in severely malnourished children: in total 2,318,548 deaths. These excess deaths represent 41% of all deaths in this age group, or 21% of all deaths among under-5-year-olds. The relative risk of severe malnutrition ranged from 3.1 to 19.2 compared with the reference categories. A test for heterogeneity indicated that there were significant differences between the study relative risks (P 0.005). The pooled relative risk was 6.8; the overall association was highly significant (P 0.001). Child survival programs should assign greater priority to the control of childhood malnutrition.