BMJ Global Health (Dec 2024)

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

  • Khatia Munguambe,
  • Quique Bassat,
  • Mahbubur Rahman,
  • Sibone Mocumbi,
  • Cynthia G Whitney,
  • Amy Wise,
  • Shams El Arifeen,
  • Meerjady Sabrina Flora,
  • Soter Ameh,
  • Emily S Gurley,
  • Mustafizur Rahman,
  • Ariel Nhacolo,
  • Cheick Bougadari Traore,
  • Inacio Mandomando,
  • Clara Menendez,
  • Janet Agaya,
  • Jane Juma,
  • Shabir A Madhi,
  • Tadesse Gure,
  • George Aol,
  • Hennie Lombaard,
  • Ziyaad Dangor,
  • James Bunn,
  • Samba O Sow,
  • Amara Jambai,
  • Dickson Gethi,
  • Sanwarul Bari,
  • Natalia Rakislova,
  • Tacilta Nhampossa,
  • Maria Maixenchs,
  • Mohammed Kamal,
  • Joseph Oundo,
  • Lola Madrid,
  • Tahmina Shirin,
  • Ikechukwu Udo Ogbuanu,
  • Addisu Alemu,
  • Hailemariam Legesse,
  • Awa Traore,
  • Portia C Mutevedzi,
  • Helina Heluf,
  • Victor Akelo,
  • Dickens Onyango,
  • Richard Omore,
  • Yasmin Adam,
  • Peter Otieno,
  • Margaret Mannah,
  • Karen L Kotloff,
  • Milagritos D Tapia,
  • Rima Koka,
  • Mohammad Zahid Hossain,
  • Dickens Kowuor,
  • Tom Sesay,
  • James Squire,
  • Francis Moses,
  • Kitiezo Aggrey Igunza,
  • Andrew Moseray,
  • Afruna Rahman,
  • Nana Kourouma,
  • Seydou Sissoko,
  • Rosauro Varo,
  • Sana Mahtab,
  • Martin Hale,
  • Jeanie du Toit,
  • Zachary J Madewell,
  • Dianna M Blau,
  • Fatima Solomon,
  • Gillian Sorour,
  • Jeannette Wadula,
  • Karen Petersen,
  • Sanjay G Lala,
  • Sithembiso Velaphi,
  • Richard Chawana,
  • Nellie Myburgh,
  • Shahana Parveen,
  • Mahbubul Hoque,
  • Saria Tasnim,
  • Ferdousi Islam,
  • Farida Ariuman,
  • Mohammad Mosiur Rahman,
  • Dilruba Ahmed,
  • Fikremelekot Temesgen,
  • Melisachew Mulatu Yeshi,
  • Mahlet Abayneh Gizaw,
  • Stian MS Orlien,
  • Solomon Ali,
  • Peter Nyamthimba Onyango,
  • Richard Oliech,
  • Joyce Akinyi Were,
  • Thomas Misore,
  • Harun Owuor,
  • Christopher Muga,
  • Christine Ochola,
  • Ashka Mehta,
  • Brigitte Gaume,
  • Adama Mamby Keita,
  • Diakaridia Kone,
  • Diakaridia Sidibe,
  • Doh Sanogo,
  • Kounandji Diarra,
  • Tiéman Diarra,
  • Kiranpreet Chawla,
  • Zara Manhique,
  • Fatmata Bintu Tarawally,
  • Martin Seppeh,
  • Ronald Mash,
  • Julius Ojulong,
  • Babatunde Duduyemi,
  • Alim Swaray-Deen,
  • Okokon Ita,
  • Cornell Chukwuegbo,
  • Sulaiman Sannoh,
  • Princewill Nwajiobi,
  • Erick Kaluma,
  • Oluseyi Balogun,
  • Carrie Jo Cain,
  • Solomon Samura,
  • Samuel Pratt,
  • Joseph Kamanda Sesay,
  • Osman Kaykay,
  • Binyam Halu,
  • Francis Smart,
  • Sartie Kenneh,
  • Ferdousi Begum,
  • Priya Mehta-Gupta Das,
  • Ogony Benard Oluoch,
  • Caleb K Sagam,
  • Ronita Luke,
  • Milton Kincardett,
  • Elisio G Xerinda,
  • Markus Roos Breines,
  • Ketema Degefa,
  • J. Anthony G Scott,
  • Kazi Munisul Islam,
  • Parminder S Suchdev,
  • Nelesh P. Govender,
  • Peter J. Swart,
  • Nawshad Uddin Ahmed,
  • Alexander M. Ibrahim,
  • Sharon M. Tennant,
  • Carol L. Greene,
  • J. Kristie Johnson,
  • Karen D. Fairchild,
  • Uma U. Onwuchekwa,
  • Joseph Bangura

DOI
https://doi.org/10.1136/bmjgh-2024-017262
Journal volume & issue
Vol. 9, no. 12

Abstract

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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.