Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000.
OBJECTIVE
To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000.


METHODS
World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modeling techniques were used for the uncertainty analysis.


METHODS
South Africa.


METHODS
Children under 5 years of age and pregnant women.


METHODS
Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other non- HIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW.


RESULTS
Among children under 5 years, 11.8% were underweight. In the same age group, 11,808 deaths (95% uncertainty interval 11,100 - 12,642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5.


CONCLUSIONS
The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health.
Nannan
Nadine
N
Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Cape Town. nadine.nannan@mrc.ac.za
Norman
Rosana
R
Hendricks
Michael
M
Dhansay
Muhammad A
MA
Bradshaw
Debbie
D
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013851:Thinness / Q000150:complications / Q000453:epidemiology