More than 8 million of the 13 million under-five deaths in the world each year can be put down to diarrhea, pneumonia, malaria and vaccine-preventable diseases. But this simple way of classifying hides the fact that death is not usually an event with one cause but a process with many causes. In particular, it is the conspiracy between malnutrition and infection which pulls many children into the downward spiral of poor growth and early death.

Nonetheless, the fact that it is possible to put dramatic figures on the disease element in this partnership has helped to focus attention on problems like measles and diarrheal disease-and on the availability of low-cost methods of preventing or treating them.

Now, a new study has attempted to quantify the role of malnutrition in child deaths.

Using data from 53 developing countries, researchers from Cornell University have concluded that more than half of those 13 million child deaths each year are associated with malnutrition. Further, they show that more than three quarters of all these malnutrition-assisted deaths are linked not to severe malnutrition but to mild and moderate forms.

This finding contradicts the idea that death rates only rise when children are severely malnourished. By the same token, it suggests that nutrition programs focusing only on the severely malnourished will have far less impact than programs to improve nutrition among the much larger number of mildly and moderately malnourished children.

The method used in this calculation was developed from eight large-scale community studies. Despite very different settings, all of these studies demonstrated a remarkably consistent relationship between the risk of death and the child's weight-for-age.

This is the first time that such estimates have been made for so many countries using epidemiological methods. But confidence in the result is boosted by the fact that the overall findings conform well to the conclusions of the one large-scale clinical study that was conducted more than 20 years ago.

As discussed in the 1994 edition of The Progress of Nations from UNICEF, low-cost methods of reducing all forms of malnutrition are available and have been shown to work. And action on both fronts-to improve nutrition and to protect against disease-could save many more lives (and be far more cost-effective) than action on either front alone.

From The Progress of Nations 1995, Copyright 1995 by United Nations Children's Fund (UNICEF). Published by UNICEF.

Source: David L. Pelletier and others, "The effects of malnutrition on child mortality in developing countries," Bulletin of the World Health Organization, vol. 73, no. 4, 1995.