Madewell ZJ
Keita AM
Das PM
Mehta A
Akelo V
Oluoch OB
Omore R
Onyango D
Sagam CK
Cain CJ
Chukwuegbo C
Kaluma E
Luke R
Ogbuanu IU
Bassat Q
Kincardett M
Mandomando I
Rakislova N
Varo R
Xerinda EG
Dangor Z
du Toit J
Lala SG
Madhi SA
Mahtab S
Breines MR
Degefa K
Heluf H
Madrid L
Scott JAG
Sow SO
Tapia MD
El Arifeen S
Gurley ES
Hossain MZ
Islam KM
Rahman A
Mutevedzi PC
Whitney CG
Blau DM
Suchdev PS
Kotloff KL
Child Health
Mortality Prevention Surveillance Network
BMJ Glob Health. 2024;9
INTRODUCTION: Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. METHODS: We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2). RESULTS: Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5%) cases, including 85 (13.4%) with HIV infection. Postmortem measurements indicated 90.1%, 61.2% and 94.1% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4%), Streptococcus pneumoniae (21.5%), Plasmodium falciparum (18.7%) and Escherichia coli/Shigella (17.2%). CONCLUSION: Malnutrition was identified as a causal or significant factor in 39.5% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality.
