Malnutrition, morbidity and mortality in children and their mothers.
Proceedings of the Nutritional Society 2000 Feb;59(1):135-46
being underweight or stunted is recognized as an important risk factor
for increased prevalence and severity of infection and high mortality
rates, there is increasing evidence for an independent role for micronutrient
deficiency. Improving vitamin A status reduces mortality among older infants
and young children and reduces pregnancy-related mortality; it also reduces
the prevalence of severe illness and clinic attendance among children.
Improving Zn status reduces morbidity from diarrhoeal and respiratory
infection. Treatment of established infection with vitamin A is effective
in measles-associated complications, but is not as useful in the majority
of diarrhoeal or respiratory syndromes. Zn supplements, however, have
significant benefit on the clinical outcome of diarrhoeal and respiratory
infections. Concerns that Fe supplements might increase morbidity if given
in malarious populations appear to be decreasing, in the light of new
studies on Fe supplements showing improved haemoglobin without an increase
in morbidity. Breast-feeding, well known to protect against diarrhoea,
is also important in protecting against respiratory infection, especially
in the young infant. Transmission of human immunodeficiency virus (HIV)
in breast milk is recognized, but new data showing reduced transmission
in infants who receive exclusive breast-feeding rather than mixed feeding
reinforces the importance of promoting this practice in areas where environmental
contamination precludes the safe use of other infant feeding regimens.
The presence of subclinical mastitis, now recognized to occur in approximately
20 % of mothers in several developing countries, has been shown to increase
the concentration of HIV in breast milk. Preliminary findings suggest
that the prevalence of subclinical mastitis is reduced by dietary supplements
containing antioxidants. Governments and international agencies
now have a strong scientific basis to be much more active and innovative
in the introduction of focused nutrition interventions especially micronutrients,
for the control of infection.