The potentiating effects of malnutrition on child mortality: epidemiologic evidence and policy implications

The physiologic synergism between malnutrition and infection has been recognized for some time, but its implications have not been addressed in current child survival policies and programs. This paper summarizes the conclusions from a recent analysis of 28 epidemiologic studies of the malnutrition-mortality relationship. It concludes that the relationship is consistent across diverse world populations, that there is a significant effect of both mild-to-moderate malnutrition and severe malnutrition, and that the effect is not simply due to confounding by socioeconomic factors or intercurrent illness. In addition, evidence is provided supporting the hypothesis that malnutrition and infection have multiplicative effects on child mortality, rather than the additive effects implicitly assumed, and the policy implications of these findings are described.