EPIDEMIOLOGIC EVIDENCE FOR A POTENTIATING EFFECT OF MALNUTRITION ON CHILD-MORTALITY

Objectives. Despite broad agreement that severe malnutrition contribut es to child mortality in developing countries and that malnutrition ha s a physiologically synergistic relationship with morbidity, evidence of an epidemiologic synergistic has been lacking. Also, the literature provides conflicting evidence concerning the existence of elevated mo rtality among children with mild to moderate malnutrition. A review of published population-based studies of anthropometry-mortality relatio nships was undertaken to clarify these relationships. Methods. Six stu dies with the relevant data were reanalyzed to test for synergism and elevated mortality in mild to moderate malnutrition. Results. The resu lts demonstrate that mortality increases exponentially with declining weight for age. This effect is consistent across studies and there is no apparent threshold effect on mortality. The primary difference acro ss studies is in baseline levels of mortality, which determine the qua ntitative impact of malnutrition on mortality in a population. Conclus ions. These results indicate that mild to moderate malnutrition is ass ociated with elevated mortality and that there is an epidemiologic syn ergism between malnutrition and morbidity. This previously undemonstra ted finding has significant implications for child survival policies a nd research.