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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies
PLoS ONE, Volume 8, No. 5, Article e64636, Year 2013
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Description
Background:Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.Methods:Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1).Results:53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.Conclusions:All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases. © 2013 Olofin et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3667136/bin/pone.0064636.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3667136/bin/pone.0064636.s002.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3667136/bin/pone.0064636.s003.docx
Authors & Co-Authors
Olofin, Ibironke
Unknown Affiliation
McDonald, Christine M.
Unknown Affiliation
Ezzati, Majid Hassanpour
Unknown Affiliation
Flaxman, Seth R.
Unknown Affiliation
Black, Robert E.
Unknown Affiliation
Fawzi, Wafaie W.
Unknown Affiliation
Caulfield, Laura E.
Unknown Affiliation
Danaei, Goodarz
Unknown Affiliation
Adair, Linda S.
Unknown Affiliation
Arifeen, Shams E.
Unknown Affiliation
Bhandari, Nita R.
Unknown Affiliation
Garenne, Michel L.
Unknown Affiliation
Kirkwood, Betty R.
Unknown Affiliation
Mølbak, Kåre
Unknown Affiliation
Katz, Joanne D.
Unknown Affiliation
Sommer, Alfred
Unknown Affiliation
West, Keith Parker
Unknown Affiliation
Penny, Mary Edith
Unknown Affiliation
Statistics
Citations: 424
Authors: 18
Affiliations: 14
Identifiers
Doi:
10.1371/journal.pone.0064636
e-ISSN:
19326203
Research Areas
Environmental
Food Security
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study