A METHODOLOGY FOR ESTIMATING THE CONTRIBUTION OF MALNUTRITION TO CHILD-MORTALITY IN DEVELOPING-COUNTRIES

According to conventional methods of classifying cause of death, appro ximately 70% of child deaths (0-4 y) worldwide are due to a small numb er of priority infectious diseases which, in turn, receive the vast ma jority of donor and national resources in the health sector, Despite t he long-recognized synergism between malnutrition and infection in the causation of child mortality, malnutrition does not appear as a major cause of death in health statistics from developing countries. Part o f the reason for this has been the difficulty of estimating the percen t of deaths due to malnutrition, because the conventional methods of c lassifying cause of death do not recognize the potentiating effect of malnutrition on the disease. The purpose of this paper is to develop a nd test a simple methodology to estimate the percent of child deaths i n a given country or community that is due to malnutrition's potentiat ing effects on prevailing infectious diseases. The cornerstone of the methodology is knowledge of the strength of the association between ma lnutrition and mortality in developing countries, as measured in eight prospective studies. These studies reveal remarkable consistency in r elative risk across different grades of malnutrition. The mean and SE of relative risk for severe malnutrition is 8.4 +/- 2.1, for moderate malnutrition it is 4.6 +/- 0.9, and for mild malnutrition it is 2.5 +/ - 0.3. When applied to survey data from Ethiopia, Malawi, Guatemala an d India for illustrative purposes, this methodology indicates that 42- 57% of all child deaths in these samples (6-59 mo) ace due to malnutri tion's potentiating effects on infectious disease, of which 76-89% is attributable to mild-to-moderate malnutrition. This methodology is rec ommended for use in a variety of policy and planning applications.