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Unmasking malnutrition

Pakistan - 740,000 child deaths a year and half of them linked to malnutrition.

Over 8 million of the 13 million under-five deaths in the world each year can be put down to diarrhoea, pneumonia, malaria, and vaccine-preventable diseases. But this simple way of classifying hides the fact that death is not usually an event with one cause but a process with many causes. In particular, it is the conspiracy between malnutrition and infection which pulls many children into the downward spiral of poor growth and early death.

Nonetheless, the fact that it is possible to put dramatic figures on the disease element in this partnership has helped to focus attention on problems like measles and diarrhoeal disease - and on the availability of low-cost methods of preventing or treating them.

Now, a new study has attempted to quantify the role of malnutrition in child deaths.

Using data from 53 developing countries, researchers from Cornell University have concluded that over half of those 13 million child deaths each year are associated with malnutrition. Further, they show that more than three quarters of all these malnutrition-assisted deaths are linked not to severe malnutrition but to mild and moderate forms.

This contradicts the idea that death rates only rise when children are severely malnourished. By the same token, it suggests that nutrition programmes focusing only on the severely malnourished will have far less impact than programmes to improve nutrition among the much larger number of mildly and moderately malnourished children.

The method used in this calculation was developed from eight large-scale community studies. Despite very different settings, all of these studies demonstrated a remarkably consistent relationship between the risk of death and the child's weight-for-age.

This is the first time that such estimates have been made for so many countries using epidemiological methods. But confidence in the result is boosted by the fact that the overall findings conform well to the conclusions of the one large-scale clinical study that was conducted more than 20 years ago.

As discussed in the 1994 edition of The Progress of Nations, low-cost methods of reducing all forms of malnutrition are available and have been shown to work. And action on both fronts - to improve nutrition and to protect against disease - could save many more lives (and be far more cost-effective) than action on either front alone.

The table below shows the role of malnutrition in child deaths for the 53 countries in which the new method has so far been applied.

Mild murder

Percentage of under-five deaths linked to malnutrition (selected countries)

        % of malnutrition-      % of all under-
           assisted deaths          five deaths
        where malnutrition      associated with
               was mild or         malnutrition
             moderate only        (all degrees)
India                   74                   67
Bangladesh              73                   66
Nepal                   80                   65
Viet Nam                78                   56
Pakistan                79                   55
Indonesia               92                   54
Haiti                   79                   53
Tanzania                93                   53
Burundi                 83                   52
Nigeria                 80                   52
Sri Lanka               86                   50
Myanmar                 83                   49
Guatemala               83                   48
Madagascar              85                   48
Mali                    82                   48
Philippines             93                   46
Namibia                 90                   44
Rwanda                  96                   44
Djibouti                80                   43
Ghana                   90                   42
Sierra Leone            83                   42
Togo                    88                   41
Thailand                94                   40
Zambia                  91                   40
Senegal                 89                   39
Uganda                  91                   39
Cape Verde              85                   38
Guyana                  94                   37
Honduras                94                   36
China                   98                   35
Ecuador                 94                   32
Morocco                 95                   31
Lesotho                100                   29
Bolivia                100                   27
Egypt                  100                   27
Brazil                  99                   26
Côte d'Ivoire          100                   26
Antigua                 92                   25
Colombia               100                   25
Iraq                   100                   25
Zimbabwe               100                   24
Dominican Rep.         100                   23
Nicaragua              100                   23
Peru                   100                   23
Tunisia                100                   23
Uruguay                100                   19
Jamaica                100                   18
Jordan                 100                   17
Trinidad/Tobago        100                   17 
Barbados               100                   15
Seychelles             100                   15
Dominica               100                   14
Paraguay               100                   13
Source: David L. Pelletier and others, `The effects of malnutrition on child mortality in developing countries', Bulletin of the World Health Organization, vol. 73, no. 4, 1995 (in press).

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