Malnutrition, morbidity and mortality in children and their mothers

While being underweight or stunted is recognized as an important risk facto r for increased prevalence and severity of infection and high mortality rat es, there is increasing evidence for an independent role for micronutrient deficiency. Improving vitamin A status reduces mortality among older infant s and young children and reduces pregnancy-related mortality; it also reduc es the prevalence of severe illness and clinic attendance among children. I mproving Zn status reduces morbidity from diarrhoeal and respiratory infect ion. Treatment of established infection with vitamin A is effective in meas les-associated complications, but is not as useful in the majority of diarr hoeal or respiratory syndromes. Zn supplements, however, have significant b enefit on the clinical outcome of diarrhoeal and respiratory infections. Co ncerns that Fe supplements might increase morbidity if given in malarious p opulations appear to be decreasing, in the light of new studies on Fe suppl ements showing improved haemoglobin without an increase in morbidity. Breas t-feeding, well known to protect against diarrhoea, is also important in pr otecting against respiratory infection, especially in the young infant. Tra nsmission of human immunodeficiency virus (HIV) in breast milk is recognize d, but new data showing reduced transmission in infants who receive exclusi ve breast-feeding rather than mixed feeding reinforces the importance of pr omoting this practice in areas where environmental contamination precludes the safe use of other infant feeding regimens. The presence of subclinical mastitis, now recognized to occur in approximately 20 % of mothers in sever al developing countries, has been shown to increase the concentration of HI V in breast milk. Preliminary findings suggest that the prevalence of subcl inical mastitis is reduced by dietary supplements containing antioxidants. Governments and international agencies now have a strong scientific basis t o be much more active and innovative in the introduction of focused nutriti on interventions especially micronutrients, for the control of infection.