Dr. Jim Shelton's Pearls: Role of Nutrition in Child Survival

Jim Shelton

CCP | Editor-in-Chief, Global Health Science & Practice

Dr. Jim Shelton's Pearls is an occasional series by USAID’s Global Health Science Advisor that answers commonly asked questions about family planning. 

Question: We are working hard on our objective to end preventable child and maternal deaths in our country, and we are trying to decide how much priority to give to nutrition.  What proportion of child deaths in low and middle income countries are attributable to undernutrition?

Answer: A remarkable 45% according to a recent analysis in a recent Lancet special series on nutrition. When looking at deaths due to undernutrition, the authors identified these key nutrition related factors:

A mother breastfeeds in Ile district, Zambezia, Mozambique

A mother breastfeeds in Ile district, Zambezia, Mozambique.

© 2005 Arturo Sanabria, Courtesy of Photoshare

  • Fetal growth restriction
  • Stunting
  • Underweight
  • Wasting
  • Suboptimal breastfeeding
  • Zinc and Vitamin A deficiency (these to a lesser extent)

What’s new is appreciation of a key role of fetal growth restriction including small for gestational age (SGA). Notably, addressing that key factor calls for a programmatic shift to emphasize more women’s nutrition during pregnancy and even pre-pregnancy, which of course has additional benefit for women’s health.

There is considerable interaction among these factors.  For example the joint effect of suboptimal breastfeeding and fetal growth restriction together on newborn mortality alone was 19% of all child mortality. As with any estimate, these are subject to the underlying assumptions. But clearly nutrition is profoundly important.

Reference: Black RB et al. Maternal and child nutrition and overweight in low-income and middle-income countries. Lancet 2013; 382:427-51.

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