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

Autor:	Madewell ZJ; Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Keita AM; Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali., Das PM; Rollins School of Public Health, Emory University, Atlanta, Georgia, USA., Mehta A; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Akelo V; US Centers for Disease Control and Prevention, Kisumu, Kenya., Oluoch OB; Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya., Omore R; Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya., Onyango D; Kisumu County Department of Health, Kisumu, Nyanza, Kenya., Sagam CK; Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya., Cain CJ; World Hope International, Freetown, Sierra Leone., Chukwuegbo C; Federal Medical Centre, Umuahia, Nigeria., Kaluma E; Crown Agents, Freetown, Sierra Leone., Luke R; Ministry of Health and Sanitation, Freetown, Sierra Leone., Ogbuanu IU; Crown Agents, Freetown, Sierra Leone., Bassat Q; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Manhica, Maputo, Mozambique.; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.; ICREA, Pg. Lluís Companys 23, Barcelona, Spain.; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública-CIBERESP, Madrid, Spain., Kincardett M; Centro de Investigação em Saúde de Manhiça-CISM, Manhica, Maputo, Mozambique., Mandomando I; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Manhica, Maputo, Mozambique.; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique., Rakislova N; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain., Varo R; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Manhica, Maputo, Mozambique., Xerinda EG; Centro de Investigação em Saúde de Manhiça-CISM, Manhica, Maputo, Mozambique., Dangor Z; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa., du Toit J; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa., Lala SG; Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa., Madhi SA; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa., Mahtab S; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa., Breines MR; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Degefa K; College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia., Heluf H; College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia., Madrid L; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia., Scott JAG; Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Sow SO; Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali., Tapia MD; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., El Arifeen S; International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh., Gurley ES; International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Hossain MZ; International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh., Islam KM; International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh., Rahman A; International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh., Mutevedzi PC; Emory Global Health Institute, Emory University, Atlanta, Georgia, USA., Whitney CG; Emory Global Health Institute, Emory University, Atlanta, Georgia, USA., Blau DM; Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Suchdev PS; Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA psuchde@emory.edu.; Emory Global Health Institute, Emory University, Atlanta, Georgia, USA.; Department of Pediatrics, Emory University, Atlanta, Georgia, USA., Kotloff KL; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 Dec 05; Vol. 9 (12). Date of Electronic Publication: 2024 Dec 05.
DOI:	10.1136/bmjgh-2024-017262
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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