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June 17, 2004

Improved Nutrition Could Prevent More than Half of Child Deaths Annually Worldwide

CaulfieldUndernutrition is the underlying cause of more than 53 percent of all child deaths that occur annually, including those from infectious diseases, pneumonia, diarrhea, measles and malaria, according to a new analysis by researchers with the Johns Hopkins Bloomberg School of Public Health and the World Health Organization. Childhood undernutrition, defined as underweight or low-weight-for-age, is the leading risk factor contributing to the global burden of disease. The researchers said they believe that strategies to prevent undernutrition should be one of the top priorities in the global effort to reduce child mortality. Their study appears in the July 1, 2004, issue of the American Journal of Clinical Nutrition.

“Malnutrition does not have to be severe to have a significant impact on child health and survival,” explained lead author Laura E. Caulfield, PhD, an associate professor with the Bloomberg School’s Center for Human Nutrition. “Our analysis shows that even children who were small, but whose weight would not classify them as malnourished, were twice as likely to die as children in our reference group,” she said.

This analysis confirms earlier research that showed that 55 percent of all child deaths were due to undernutrition. However, the new analysis went further. It examined whether the risk of dying due to being underweight varies by cause of death. Using data from 10 large cohort studies from sub-Saharan Africa and Southeast Asia with information on weight-for-age z score and survival or death by cause, researchers calculated the mortality rates by anthropometric status and cause of death (including diarrhea, pneumonia, malaria and measles) in each study.

The study’s authors concluded that undernutrition is responsible for 60 percent of deaths as a result of diarrhea, 52 percent of deaths as a result of pneumonia, 45 percent of deaths as a result of measles and 57 percent of deaths as a result of malaria worldwide. While it is well known that child undernutrition contributes to diarrhea-related morbidity and mortality, this analysis adds new evidence that a large percentage of child deaths related to malaria are attributable to child undernutrition.

“Rates of undernutrition are not declining quickly enough,” Dr. Caulfield said. “If we invest more resources in child nutrition interventions, we can potentially save millions of young lives.”

“Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles” was written by Laura E. Caulfield, Mercedes de Onis, Monika Blössner and Robert E. Black.

Funding for this research study was provided by the World Health Organization Department of Child and Adolescent Health and Development and by the Family Health and Child Survival Cooperative Agreement between the United States Agency for International Development (USAID), Office of Health and Nutrition and the Johns Hopkins Bloomberg School of Public Health, Department of International Health.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Lowe at 410-955-6878 or