Quantifying the increased risk of illness in malnourished children: a global meta-analysis and propensity score
Mukhtar A Ijaiya1, Seun Anjorin2, Olalekan A Uthman3
1Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT, Nigeria. Mukhtarijaiya@yahoo.com.
Insights
Childhood malnutrition, specifically wasting and double-burden malnutrition, is linked to increased child morbidity. Overweight children show a reduced immediate risk but may face long-term issues, necessitating tailored nutrition strategies.
Area of Science:
- Global Public Health
- Pediatric Nutrition
- Epidemiology
Background:
- Childhood morbidity and mortality remain significant global health concerns.
- Malnutrition is a key risk factor for various childhood illnesses, including respiratory infections, diarrhea, and perinatal conditions.
- Understanding the link between different forms of malnutrition and child morbidity is crucial for effective public health interventions.
Purpose of the Study:
- To explore and quantify the associations between various forms of childhood malnutrition and child morbidity.
- To estimate the population-attributable fraction (PAF) of child morbidity linked to malnutrition using a natural experimental design.
- To analyze both unadjusted and adjusted risks of morbidity in relation to malnutrition subtypes.
Main Methods:
- An individual participant data (IPD) meta-analysis was conducted.
- Propensity score matching was employed to create comparable cohorts.
- Demographic and health survey data from 27 low- and middle-income countries (2015-2020) were utilized.
Main Results:
- Wasting was associated with a statistically significant increased risk of child morbidity (RR: 1.094).
- Double-burden malnutrition showed a non-significant increased risk in the initial analysis, but a reduced risk in the matched sample (RR: 0.983).
- Overweight children exhibited a reduced risk of immediate morbidity (RR: 0.80 in matched sample).
Conclusions:
- Childhood wasting and double-burden malnutrition are associated with increased morbidity risks.
- Overweight in children is linked to lower immediate morbidity but warrants attention for potential long-term health consequences.
- Nuanced, subtype-specific nutritional strategies are essential for addressing child health outcomes.
Background:
Childhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity.
Methods:
We performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort.
Results:
The IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively.
Conclusions:
Our study revealed a correlation between specific childhood malnutrition subtypes-double-burden malnutrition and wasting-and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition.
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