Although the association between nutritional status and mortality risk
is obvious for extreme malnutrition, the issue is not so clear for mi
ld to moderate undernutrition. We have investigated this association i
n children of 0-5 years in the rural area of Bwamanda, Zaire, where an
integrated development project, with good medical facilities, has ope
rated for 20 years. A random cluster sample of 5167 children was taken
; newborn infants and immigrants were included at six quarterly survey
rounds from October, 1989, until February, 1991. All surveys included
clinical and anthropometric assessment of nutritional status. Deaths
were recorded up to April, 1992; there were 246 deaths. Marasmus, kwas
hiorkor, and other causes of death were defined by the verbal autopsy
method and checked against medical records kept at the central hospita
l and the peripheral dispensaries. As expected, we found an increased
risk of death in severe malnutrition. When deaths directly attributed
to marasmus or kwashiorkor were excluded, mild to moderate stunting or
wasting were not associated with higher mortality in the short term (
within 3 months of the previous study round) or in the long term (from
3-30 months after study entry). The commonest causes of death were ma
laria and anaemia. Extreme marasmus and kwashiorkor caused 16% of deat
hs, and are important causes of death even in this favoured area with
an integrated development project. Nutritional interventions should be
targeted more selectively so that children with moderate malnutrition
can be protected from progression to marasmus or kwashiorkor.