GULU UNIVERSITY MEDICAL JOURNAL

Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5.
Malnutrition and Child Morbidity and Mortality
Ronald Wanyama,
Biochemistry Department, Faculty of Medicine, Gulu University
E-mail: wanyamar@yahoo.com. Tel: +256-77/71-2330638
Nutrition during pregnancy and infancy is crucial
for growth and development and also for subsequent
adult health. As much as child nutritional status is
a powerful determinant of child survival along with
other factors (Pelletier & Frongillo 2003), it is always
given less attention especially in Sub-Saharan Africa
(SSA). For example, in the report of the G8 Meeting
in Gleneagles, UK, in 2005, the chapter dealing with
education and health prioritizes basic health systems,
HIV/AIDS, malaria and tuberculosis. In contrast,
nutrition is given less than half a page and reduced
to parasite control and micronutrient support. Indeed
malnutrition is now seen as a neglected epidemic since
the scale of the problem has not changed since 1990.
Although malnutrition is prevalent in developing
countries, it is rarely cited as being among the leading
causes of death. This is due in part to the conventional
way that cause of death data are reported and analyzed.
In many countries, mortality statistics are compiled
from records in which a single proximate cause of death
has been reported.
One of the Millennium Development Goals (MDGs)
is to reduce child mortality by 50% by 2015 but
since the time the goal was set the absolute number
and proportion of undernourished children have
increased in SSA. This makes SSA the only region in
the world where the absolute number and proportion
of undernourished children have increased in the last
decade. Eastern Africa is the sub-region experiencing
the largest increases in numbers of underweight
children – projected to have increased by 36% from
1990 to 2005. Findings for stunting and wasting are
similar (Global Nutrition Report, 2004). SSA is also
the only region of the world where the number of child
deaths is rising. With such trend and slow progress
(FAO, 2005) towards the Millennium Development
Goal target on child mortality, it has been pointed out
that if current trends continue; SSA will achieve the
MDG for child mortality around 2115 – one century
after the target date.
Malnutrition is one of the most important factors
contributing to child mortality and a leading cause of
the global burden of disease in developing countries
(UNICEF, 1998; Ezzati et al., 2002). The magnitude of
the health loss associated with childhood malnutrition
worldwide is such that every three seconds, a
child under the age of five dies (more than 26,000
children everyday) mostly from preventable causes
(WHO, 2008). The majority of these deaths occur
in developing countries. Malnutrition (as measured
by child anthropometry) contributes to more than
half of child deaths worldwide. 56% of deaths among
children under five (Pelletier, 1994; Black et al., 2003)
in the developing world are due to the underlying
effects of malnutrition on disease. Several other studies
have documented that severely malnourished children
are at a much greater risk of dying than are healthy
children (Bull WHO, 1996). Research also indicates
that malnutrition multiplies the number of deaths
caused by infectious diseases rather than following an
additive model. It is not a cause of death on its own
but magnifies the role of infectious diseases in causing
mortality.
The substantial contribution to child mortality of
all degrees of malnutrition is now widely recognized
(Schroeder & Brown, 1994; Pelletier et al., 1995).
‘Under-nutrition steals a child’s strength and makes
illnesses that the body might otherwise fight off far
more dangerous’. Malnourished children are up to
12 times more likely to die from easily preventable
and treatable diseases (like measles, pneumonia, and
diarrhea) than are well-nourished children. On average,
a child who is severely underweight is 8.4 times more
likely to die from infectious diseases than a wellnourished
child (Pelletier et al., 1994). Children who
are moderately underweight and mildly underweight
are 4.6 and 2.5 times respectively more likely to die
than well-nourished children. 83% of all malnutrition
related deaths worldwide occur in children who are
mildly and moderately underweight.
Gulu University Medical Students’ Association (GUMSA) Passion for life 11