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

IF 7.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH BMJ Global Health Pub Date : 2024-12-05 DOI:10.1136/bmjgh-2024-017262

Zachary J Madewell, Adama Mamby Keita, Priya Mehta-Gupta Das, Ashka Mehta, Victor Akelo, Ogony Benard Oluoch, Richard Omore, Dickens Onyango, Caleb K Sagam, Carrie Jo Cain, Cornell Chukwuegbo, Erick Kaluma, Ronita Luke, Ikechukwu Udo Ogbuanu, Quique Bassat, Milton Kincardett, Inacio Mandomando, Natalia Rakislova, Rosauro Varo, Elisio G Xerinda, Ziyaad Dangor, Jeanie du Toit, Sanjay G Lala, Shabir A Madhi, Sana Mahtab, Markus Roos Breines, Ketema Degefa, Helina Heluf, Lola Madrid, J Anthony G Scott, Samba O Sow, Milagritos D Tapia, Shams El Arifeen, Emily S Gurley, Mohammad Zahid Hossain, Kazi Munisul Islam, Afruna Rahman, Portia C Mutevedzi, Cynthia G Whitney, Dianna M Blau, Parminder S Suchdev, Karen L Kotloff

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Abstract

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.

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营养不良对撒哈拉以南非洲和南亚婴儿和儿童死亡的影响。

导言：营养不良占全球所有儿童死亡的45%，但这些模型估计在营养不良和5岁以下儿童死亡率高的国家缺乏直接测量。我们在儿童健康和死亡率预防监测（CHAMPS）网络中调查了营养不良在婴儿和儿童死亡中的作用。方法：我们分析了2016年至2023年在孟加拉国、埃塞俄比亚、肯尼亚、马里、莫桑比克、塞拉利昂和南非7个地点收集的CHAMPS数据。一个专家小组对每例死亡进行评估，以确定营养不良是否是潜在的、先前的或直接的原因或其他重大情况。根据死后人体测量法使用WHO体重不足的生长标准对营养不良进行进一步分类（年龄体重z分数）结果：在1601例婴儿和儿童死亡中，632例（39.5%）的营养不良被认为是原因或显著原因，其中85例（13.4%）感染了艾滋病毒。死后测量显示，这些病例中体重不足、发育不良和消瘦的比例分别为90.1%、61.2%和94.1%。大多数与营养不良相关的死亡（n=632）有感染原因（89.1%）。与其他原因相比，与传染病相关的死亡相比，营养不良作为病因或重要疾病的调整后几率是2.4倍（95% CI 1.7至3.2）。营养不良相关死亡的常见病原体包括肺炎克雷伯菌（30.4%）、肺炎链球菌（21.5%）、恶性疟原虫（18.7%）和大肠杆菌/志贺氏菌（17.2%）。结论：营养不良被确定为CHAMPS网络中39.5%的5岁以下儿童死亡的一个原因或重要因素，通常与传染病合并。这些调查结果突出表明，需要采取综合干预措施，解决营养不良和传染病问题，以有效降低5岁以下儿童死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Global Health Medicine-Health Policy

CiteScore

11.40

自引率

4.90%

发文量

429

审稿时长

18 weeks

期刊介绍： BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.