Potentiating Effects of Malnutrition on Child Mortality: Epidemiologic Evidence and Policy Implications

The physiological synergism between malnutrition and infection has been recognized for some time, its implications have not been addressed in current child survival policies and programmes. A recent analysis of 28 epidemiologic studies of the malnutrition-mortality relationship concluded that the relationship is consistent across diverse world populations; a significant effect exists of mild to moderate malnutrition (MMM), as well as of severe malnutrition; and the effect is not simply due to confounding by socioeconomic factors or inter-current illness. In addition, evidence supports the hypothesis that malnutrition and infection have multiplicative effects on child mortality, not the additive effects implicitly assumed. An empirically based model suggests that by potentiating infection, malnutrition accounts for 56% of child deaths, 83% of which are due to MMM. These estimates are far higher than conventional figures that do not take account of potentiation and MMM.