THE POTENTIATING EFFECTS OF MALNUTRITION ON CHILD-MORTALITY - EPIDEMIOLOGIC EVIDENCE AND POLICY IMPLICATIONS

The physiologic synergism between malnutrition and infection has been recognized for some time, but ifs implications have not been addressed in current child survival policies and programs. This paper summarize s the conclusions from a recent analysis of 28 epidemiologic studies o f the malnutrition-mortality relationship. If concludes that the relat ionship is consistent across diverse world populations, that there is a significant effect of both mild-to-moderate malnutrition and severe malnutrition, and that the effect is not simply due to confounding by socioeconomic factors or intercurrent illness. In addition, evidence i s provided supporting the hypothesis that malnutrition and infection h ave multiplicative effects on child mortality, rather than the additiv e effects implicitly assumed, and the policy implications of these fin dings are described.