Hungering for Survival: Trends in under-5 malnutrition and attributable disease burden

Abstract

<italic>Background</italic> Child malnutrition is a known risk factor for a myriad childhood diseases and causes of death, including intestinal infectious diseases, acute respiratory infections, measles, malaria, and protein-energy malnutrition. The nutrition literature lacks estimates of deaths and disease burden attributable to each malnutrition indicator over time and at the country level. In order to make informed decisions on interventions, policymakers need to be aware of the magnitude and trends of the burden of malnutrition. <italic>Methods and Findings</italic> After using all available data to generate time series of wasting, stunting, and underweight, we employed the comparative risk assessment method to calculate death and disease burden attributable to these three indicators of malnutrition. Deaths attributable to stunting declined from a peak of 3.89 (95% confidence intervals: 3.19-4.76) million in 1980 to 1.34 (1.11-1.59) million in 2011, and deaths attributable to underweight experienced a similar decrease from 3.22 (2.62-4.00) million in 1980 to 1.01 (0.83-1.22) million in 2011. Deaths from wasting declined from 2.06 (1.62-2.64) million in 1980 to 726 (588-896) thousand in 2011. DALYs attributable to stunting decreased from 278 (237-328) million in 1990 to 125 (105-148) million in 2010. DALYs attributable to wasting declined from 150 (122-186) million in 1990 to 70 (58-86) million. Finally, DALYs attributable to underweight experienced a large decrease from 226 (191-271) million in 1990 to 97 (78-116) million. At the regional level, Latin America has seen improvements, but the majority of the decrease in deaths can be attributed to changes in South Asia, driven primarily by India. While progress in sub-Saharan Africa on the whole has been small, some countries have still enjoyed large decreases. <italic>Conclusions</italic> There have been encouraging declines between 1980 and 2011 in the burden of deaths and DALYs attributable to malnutrition at the global level. At the regional-level, Asia has experienced much improvement, but there has been a discouraging stagnation of progress in sub-Saharan Africa. Countries such as China, Brazil, and Botswana have commendably reduced burden attributable to malnutrition over the past 3 decades, and the global community should examine these cases to apply lessons from these success stories to other settings.