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The newspaper of The Johns Hopkins University January 28, 2008 | Vol. 37 No. 19
Third of Child Deaths Due to Maternal, Child Undernutrition

By Tim Parsons
School of Public Health

Undernutrition in mothers and children is the cause of more than 35 percent of all child deaths and 11 percent of the global disease burden, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study is the first in a series of five studies, published Jan. 16 in the medical journal The Lancet, analyzing the global impact of maternal and child undernutrition. The research series highlights the critical role of early nutrition in the health and development of children and the economic growth of nations.

"More than 3.5 million mothers and children under 5 die unnecessarily each year in poor countries due to the underlying cause of undernutrition, and millions more are permanently disabled by the physical and mental effects of a poor dietary intake in the earliest months of life," said Robert Black, lead author of the series and chair of the Department of International Health at the Bloomberg School. "This series provides a new evidence base for expanded nutrition-related programs and interventions, which, if implemented at scale, would prevent many of these deaths and disabilities."

In the initial study, Black; co-author Zulfiqar Bhutta, of the Department of Pediatrics and Child Health at Aga Khan University in Pakistan; and other colleagues show that stunting, severe wasting and intrauterine growth restriction together contributed to 2.2 million deaths annually. For children under 5 years old, these symptoms of undernutrition also account for 91 million disability-adjusted life years, or DALYs, which is an estimate of years of life lost due to premature deaths and years of life lived with disabilities.

Conditions such as stunting, severe wasting and intrauterine growth restriction in the first two years of life are known to cause irreparable harm by impeding physical development and cognitive growth, which can limit economic potential. Lower income, poor health and reduced access to proper nutrition then continue to affect the health of children born into future generations, establishing a repetitive cycle.

The study also determined that deficiencies in vitamin A and zinc had the highest disease burden and contributed to 0.6 million and 0.4 million deaths, respectively. Combined they accounted for 9 percent of the global childhood DALYs. Suboptimum breast-feeding accounted for 1.4 million child deaths and 44 million DALYs in children under 5.

"By the time children reach their second birthday, if undernourished, they could suffer irreversible physical and cognitive damage, impacting their future health, economic well-being and welfare. These effects continue into adulthood and are passed on to the next generation as undernourished girls and women have children of their own," Black said. "There are effective interventions to reduce stunting, micronutrient deficiencies and child deaths. However, a global effort with greater cooperation is needed to reduce undernutrition."

Other papers in the five-part Lancet series review and analyze the effectiveness and potential impact of nutrition-related interventions and policy options in developing countries and recommend actions to accelerate efforts to improve maternal and child undernutrition. Recommendations include a new global governance structure, a more effective United Nations, fewer parallel organizations but also fewer mandate gaps, and more investment in capacity strengthening in high-burden countries.

A panel of leading international public health experts announced the research findings Jan. 16 at events in Washington, D.C., and in London. The full articles plus accompanying materials are available online at


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