THE EFFECTS OF MALNUTRITION ON CHILD-MORTALITY IN DEVELOPING-COUNTRIES

Conventional methods of classifying causes of death suggest that about 70% of the deaths of children (aged 0-4 years) worldwide are due to d iarrhoeal illness, acute respiratory infection, malaria, and immunizab le diseases. The role of malnutrition in child mortality is not reveal ed by these conventional methods, despite the long-standing recognitio n of the synergism between malnutrition and infectious diseases. This paper describes a recently-developed epidemiological method to estimat e the percentage of child deaths (aged 6-59 months) which could be att ributed to the potentiating effects of malnutrition in infectious dise ase. The results from 53 developing countries with nationally represen tative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition's potentiating effects, and 83% of t hese were attributable to mild-to-moderate as opposed to severe malnut rition. For individual countries, malnutrition's total potentiating ef fects on mortality ranged from 13% to 66%, with at least three-quarter s of this arising from mild-to-moderate malnutrition in each case. The se results show that malnutrition has a far more powerful impact on ch ild mortality than is generally appreciated, and suggest that strategi es involving only the screening and treatment of the severely malnouri shed will do little to address this impact. The methodology provided i n this paper makes it possible to estimate the effects of malnutrition on child mortality in any population for which prevalence data exist.