Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

Zachary J. Madewell; Adama Mamby Keita; Priya Mehta Gupta Das; Ashka Mehta; Victor Akelo; Ogony Benard Oluoch; Richard Omore; Dickens Onyango; Caleb K. Sagam; Carrie Jo Cain; Cornell Chukwuegbo; Erick Kaluma; Ronita Luke; Ikechukwu Udo Ogbuanu; Quique Bassat; Milton Kincardett; Inacio Mandomando; Natalia Rakislova; Rosauro Varo; Elisio G. Xerinda; Ziyaad Dangor; Jeanie Du Toit; Sanjay G. Lala; Shabir A. Madhi; Sana Mahtab; Markus Roos Breines; Ketema Degefa; Helina Heluf; Lola Madrid; J. Anthony G. Scott; Samba O. Sow; Milagritos D. Tapia; Shams El Arifeen; Emily S. Gurley; Mohammad Zahid Hossain; Kazi Munisul Islam; Afruna Rahman; Portia C. Mutevedzi; Cynthia G. Whitney; Dianna M. Blau; Parminder S. Suchdev; Karen L. Kotloff

doi:10.1136/bmjgh-2024-017262

Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

Zachary J. Madewell
, Adama Mamby Keita
, Priya Mehta Gupta Das
, Ashka Mehta
, Victor Akelo
, Ogony Benard Oluoch
, Richard Omore
, Dickens Onyango
, Caleb K. Sagam
, Carrie Jo Cain
, Cornell Chukwuegbo
, Erick Kaluma
, Ronita Luke
, Ikechukwu Udo Ogbuanu
, Quique Bassat
, Milton Kincardett
, Inacio Mandomando
, Natalia Rakislova
, Rosauro Varo
, Elisio G. Xerinda

Ziyaad Dangor, Jeanie Du Toit, Sanjay G. Lala, Shabir A. Madhi, Sana Mahtab, Markus Roos Breines, Ketema Degefa, Helina Heluf, Lola Madrid, J. Anthony G. Scott, Samba O. Sow, Milagritos D. Tapia, Shams El Arifeen, Emily S. Gurley, Mohammad Zahid Hossain, Kazi Munisul Islam, Afruna Rahman, Portia C. Mutevedzi, Cynthia G. Whitney, Dianna M. Blau, Parminder S. Suchdev, Karen L. Kotloff

Centers for Disease Control and Prevention
Ministère de la Santé
Emory University
University of Maryland, Baltimore
Kenya Medical Research Institute
Kisumu County Health Department
World Hope International
Federal Medical Centre
Crown Agents
Ministry of Health and Sanitation
University of Barcelona
Centro de investigação de Saúde de Manhiça
ICREA
Instituto de Salud Carlos III
Instituto Nacional de Saude Maputo
University of the Witwatersrand
London School of Hygiene and Tropical Medicine
Haramaya University
International Centre for Diarrhoeal Disease Research Bangladesh
Johns Hopkins University

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Introduction Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2). Results Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5%) cases, including 85 (13.4%) with HIV infection. Postmortem measurements indicated 90.1%, 61.2% and 94.1% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4%), Streptococcus pneumoniae (21.5%), Plasmodium falciparum (18.7%) and Escherichia coli/Shigella (17.2%). Conclusion Malnutrition was identified as a causal or significant factor in 39.5% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality.

Original language	English
Article number	e017262
Journal	BMJ Global Health
Volume	9
Issue number	12
DOIs	https://doi.org/10.1136/bmjgh-2024-017262
Publication status	Published - 5 Dec 2024
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

Keywords

Child health
Epidemiology
Global Health
Nutrition
Paediatrics

Access to Document

10.1136/bmjgh-2024-017262Licence: CC BY

Cite this

Madewell, Z. J., Keita, A. M., Das, P. M. G., Mehta, A., Akelo, V., Oluoch, O. B., Omore, R., Onyango, D., Sagam, C. K., Cain, C. J., Chukwuegbo, C., Kaluma, E., Luke, R., Ogbuanu, I. U., Bassat, Q., Kincardett, M., Mandomando, I., Rakislova, N., Varo, R., ... Kotloff, K. L. (2024). Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia. BMJ Global Health, 9(12), Article e017262. https://doi.org/10.1136/bmjgh-2024-017262

@article{edd089c275a24931b1b72f62dd8b8146,

title = "Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia",

abstract = "Introduction Malnutrition contributes to 45\% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2). Results Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5\%) cases, including 85 (13.4\%) with HIV infection. Postmortem measurements indicated 90.1\%, 61.2\% and 94.1\% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1\%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95\% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4\%), Streptococcus pneumoniae (21.5\%), Plasmodium falciparum (18.7\%) and Escherichia coli/Shigella (17.2\%). Conclusion Malnutrition was identified as a causal or significant factor in 39.5\% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality.",

keywords = "Child health, Epidemiology, Global Health, Nutrition, Paediatrics",

author = "Madewell, \{Zachary J.\} and Keita, \{Adama Mamby\} and Das, \{Priya Mehta Gupta\} and Ashka Mehta and Victor Akelo and Oluoch, \{Ogony Benard\} and Richard Omore and Dickens Onyango and Sagam, \{Caleb K.\} and Cain, \{Carrie Jo\} and Cornell Chukwuegbo and Erick Kaluma and Ronita Luke and Ogbuanu, \{Ikechukwu Udo\} and Quique Bassat and Milton Kincardett and Inacio Mandomando and Natalia Rakislova and Rosauro Varo and Xerinda, \{Elisio G.\} and Ziyaad Dangor and \{Du Toit\}, Jeanie and Lala, \{Sanjay G.\} and Madhi, \{Shabir A.\} and Sana Mahtab and Breines, \{Markus Roos\} and Ketema Degefa and Helina Heluf and Lola Madrid and Scott, \{J. Anthony G.\} and Sow, \{Samba O.\} and Tapia, \{Milagritos D.\} and \{El Arifeen\}, Shams and Gurley, \{Emily S.\} and Hossain, \{Mohammad Zahid\} and Islam, \{Kazi Munisul\} and Afruna Rahman and Mutevedzi, \{Portia C.\} and Whitney, \{Cynthia G.\} and Blau, \{Dianna M.\} and Suchdev, \{Parminder S.\} and Kotloff, \{Karen L.\}",

year = "2024",

month = dec,

day = "5",

doi = "10.1136/bmjgh-2024-017262",

language = "English",

volume = "9",

journal = "BMJ Global Health",

publisher = "BMJ Publishing Group",

number = "12",

}

Madewell, ZJ, Keita, AM, Das, PMG, Mehta, A, Akelo, V, Oluoch, OB, Omore, R, Onyango, D, Sagam, CK, Cain, CJ, Chukwuegbo, C, Kaluma, E, Luke, R, Ogbuanu, IU, Bassat, Q, Kincardett, M, Mandomando, I, Rakislova, N, Varo, R, Xerinda, EG, Dangor, Z, Du Toit, J, Lala, SG, Madhi, SA, Mahtab, S, Breines, MR, Degefa, K, Heluf, H, Madrid, L, Scott, JAG, Sow, SO, Tapia, MD, El Arifeen, S, Gurley, ES, Hossain, MZ, Islam, KM, Rahman, A, Mutevedzi, PC, Whitney, CG, Blau, DM, Suchdev, PS & Kotloff, KL 2024, 'Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia', BMJ Global Health, vol. 9, no. 12, e017262. https://doi.org/10.1136/bmjgh-2024-017262

TY - JOUR

T1 - Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

AU - Madewell, Zachary J.

AU - Keita, Adama Mamby

AU - Das, Priya Mehta Gupta

AU - Mehta, Ashka

AU - Akelo, Victor

AU - Oluoch, Ogony Benard

AU - Omore, Richard

AU - Onyango, Dickens

AU - Sagam, Caleb K.

AU - Cain, Carrie Jo

AU - Chukwuegbo, Cornell

AU - Kaluma, Erick

AU - Luke, Ronita

AU - Ogbuanu, Ikechukwu Udo

AU - Bassat, Quique

AU - Kincardett, Milton

AU - Mandomando, Inacio

AU - Rakislova, Natalia

AU - Varo, Rosauro

AU - Xerinda, Elisio G.

AU - Dangor, Ziyaad

AU - Du Toit, Jeanie

AU - Lala, Sanjay G.

AU - Madhi, Shabir A.

AU - Mahtab, Sana

AU - Breines, Markus Roos

AU - Degefa, Ketema

AU - Heluf, Helina

AU - Madrid, Lola

AU - Scott, J. Anthony G.

AU - Sow, Samba O.

AU - Tapia, Milagritos D.

AU - El Arifeen, Shams

AU - Gurley, Emily S.

AU - Hossain, Mohammad Zahid

AU - Islam, Kazi Munisul

AU - Rahman, Afruna

AU - Mutevedzi, Portia C.

AU - Whitney, Cynthia G.

AU - Blau, Dianna M.

AU - Suchdev, Parminder S.

AU - Kotloff, Karen L.

PY - 2024/12/5

Y1 - 2024/12/5

N2 - Introduction Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2). Results Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5%) cases, including 85 (13.4%) with HIV infection. Postmortem measurements indicated 90.1%, 61.2% and 94.1% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4%), Streptococcus pneumoniae (21.5%), Plasmodium falciparum (18.7%) and Escherichia coli/Shigella (17.2%). Conclusion Malnutrition was identified as a causal or significant factor in 39.5% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality.

AB - Introduction Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2). Results Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5%) cases, including 85 (13.4%) with HIV infection. Postmortem measurements indicated 90.1%, 61.2% and 94.1% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4%), Streptococcus pneumoniae (21.5%), Plasmodium falciparum (18.7%) and Escherichia coli/Shigella (17.2%). Conclusion Malnutrition was identified as a causal or significant factor in 39.5% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality.

KW - Child health

KW - Epidemiology

KW - Global Health

KW - Nutrition

KW - Paediatrics

U2 - 10.1136/bmjgh-2024-017262

DO - 10.1136/bmjgh-2024-017262

M3 - Article

VL - 9

JO - BMJ Global Health

JF - BMJ Global Health

IS - 12

M1 - e017262

ER -

Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

Abstract

UN SDGs

Keywords

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