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 -
