Abstract

Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

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
BMJ Glob Health. 2024;9

Permenent descriptor
https://doi.org/10.1136/bmjgh-2024-017262


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.