A prospective study of malnutrition in relation to child mortality in the Sudan.
We examined prospectively the relation between malnutrition and mortality among Sudanese children. A cohort of 28753 children between the ages of 6 mo and 6 y was examined every 6 mo for 18 mo. Two hundred thirty-two children died during 18 mo of follow-up (480624 child-months). Low weight-for-height was associated with an increased risk of mortality (P < 0.0001). Even children with Z scores between -1 and -2 were 50% more likely to die in the following 6 mo than were children with Z scores > -1 (multivariate relative mortality: 1.5; 95% CI: 1.1, 2.2). There was also an inverse relation between height-for-age and mortality (P < 0.0001). Among breast-fed children, the relative mortality associated with a Z score for weight-for-height of < -3 compared with > -2 was 7.3 (95% CI: 3.3, 15.9); among children not breast-fed, it was 26.0 (95% CI: 12.8, 53.0; P for interaction = 0.001). A strong and significant synergy was also found between infection and wasting or stunting as predictors of child mortality (P for interaction = 0.001 and 0.02. respectively). In developing countries, children who are below the customary cutoff point of -2 Z for weight-for-height may be at higher risk of death. Breast-feeding and reduction of morbidity should be advocated in programs designed to reduce malnutrition and mortality among children.
Fawzi
W W
WW
Department of Nutrition and Epidemiology and Biostatistics, Harvard School of Public Health, Boston 02115, USA. mina@hsph.harvard.edu
Herrera
M G
MG
Spiegelman
D L
DL
el Amin
A
A
Nestel
P
P
Mohamed
K A
KA
D000375:Aging / Q000502:physiology; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D001942:Breast Feeding; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D009748:Nutrition Disorders / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D009752:Nutritional Status; D011446:Prospective Studies; D018570:Risk Assessment; D012621:Seasons; D012727:Sex Characteristics; D013397:Sudan / Q000453:epidemiology; D014801:Vitamin A / Q000494:pharmacology; D014802:Vitamin A Deficiency / Q000453:epidemiology / Q000503:physiopathology
D014801:Vitamin A