Relationships between child anthropometry and mortality in developing countries : implications for policy, programs, and future research

The purpose is to estimate the contribution of PEM to child mortality, to distinguish the effects of severe PEM from those of mild-to-moderate PEM, and to examine some related issues that are relevant to policy and research in this area. The accumulated results consistently show that the risk of mortality is inversely related to anthropometric indicators of nutritional status and that even mild-to-moderate PEM is associated with elevated risk. Another important finding is that malnutrition has its biggest effect on mortality in those populations with already high levels of mortality. One policy implication of this is that significant reductions in mortality can be expected by improving either nutritional status or health status, and that a synergistic effect can be expected by improving both simultaneously. The results further suggest that, for a given anthropometric deficit, child mortality in South Asian children is lower than in children from other regions. This may relate to small maternal stature in these populations; this area requires further study. On the basis of a priori expectations, as well as results from the few studies examining these issues, the review concludes that the child anthropometry-mortality relationship is likely to be modified by a number of factors, including the child"s age and sex, the length of time between measurement and follow-up visits, seasonality, and breastfeeding. This conclusion has important implications for policies and programs. These implications, as well as suggestions for further research, are discussed. Includes references, 14 tables, and 10 figures. (Author abstract, modified)