We examined prospectively the relation between malnutrition and mortality among Sudanese children. A cohort of 28753 children between the ages of 6 mo and 6 y was examined every 6 mo for 18 mo. Two hundred thirty-two children died during 18 mo of follow-up (480624 child-months). Low weight-for-height was associated with an increased risk of mortality (P < 0.0001). Even children with Z scores between -1 and -2 were 50% more likely to die in the following 6 mo than were children with Z scores > -1 (multivariate relative mortality: 1.5; 95% CI: 1.1, 2.2). There was also an inverse relation between height-for-age and mortality (P < 0.0001). Among breast-fed children, the relative mortality associated with a Z score for weight-for-height of < -3 compared with > -2 was 7.3 (95% CI: 3.3, 15.9); among children not breast-fed, it was 26.0 (95% CI: 12.8, 53.0; P for interaction = 0.001). A strong and significant synergy was also found between infection and wasting or stunting as predictors of child mortality (P for interaction = 0.001 and 0.02. respectively). In developing countries, children who are below the customary cutoff point of -2 Z for weight-for-height may be at higher risk of death. Breast-feeding and reduction of morbidity should be advocated in programs designed to reduce malnutrition and mortality among children.
PIP: The authors prospectively examined the relation between malnutrition and mortality in a cohort of 28,753 Sudanese children aged 6 months to 6 years. Children in the cohort were examined every 6 months for 18 months, during which 232 children died. Low weight-for-height was significantly associated with an increased risk of mortality. Even children with Z scores between -1 and -2 were 50% more likely to die in the following 6 months than were children with Z scores greater than -1. A significant inverse relation was identified between height-for-age and mortality. Among breast-fed children, the relative mortality associated with a Z score for weight-for-height of less than -3 compared with greater than -2 was 7.3, 26.0 among non-breast-fed children. A strong and significant synergy was also found between infection and wasting or stunting as predictors of child mortality. These findings indicate that children in developing countries who are below the customary cutoff point of -2 Z for weight-for-height may be at greater risk of death. Breast feeding and the reduction of morbidity should be advocated in programs designed to reduce malnutrition and mortality among children.