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Title:   Author  item
                                            BLACK, ROBERT - JOHNS HOPKINS BLOOMBERGitem
                                            CAULFIELD, LAURA - JOHNS HOPKINS BLOOMBERGitem
                                            Allen, Lindsay

                                                         - *A*item
                                            BHUTTA, ZULFIQAR - AGA KHAN UNIVERSITYitem
                                            DE ONIS, MERCEDES - WORLD HEALTH ORGANIZATIONitem
                                            MATHERS, COLIN - WORLD HEALTH ORGANIZATIONitem
                                            EZZATI, MAJID - HARVARD SCHOOL PUB.HEALTHitem
                                            RIVERA, JUAN - MEXICO NATL.INST.P.HEALTH
  Submitted to: Lancet
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 1/17/2008
                                    Publication  Date: 1/19/2008
                                    Citation: Black, R.E., Caulfield, L.E., Allen, L.H., Bhutta, Z.A., De Onis, M., Mathers, C., Ezzati, M., Rivera, J. 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 371:243-260.Interpretive Summary: This article is the collective effort of a group of investigators who used new and existing data to estimate the risks to maternal and child health of being undernourished, and using poor breastfeeding practices. The adverse consequences were measured as Disability-Adjusted Life Years (DALYs), an indicator of deaths and burden of disease used by international organizations. Factors that caused a substantial share of the DALYs in children under 5 years of age were stunting, severe wasting and intrauterine growth restriction (21% of the DALYs) and vitamin A and zinc deficiency (each 6%). After correcting for co-exposure to these malnutrition problems, malnutrition was responsible for 3 billion deaths (30% of the total) and 124 million DALYs (29% of the total) in children under 5 years, or 9% of the global burden of disease. Maternal deaths due to iron deficiency, and especially suboptimal breastfeeding practices, also contributed substantially to global disease. A compelling case is made for implementing nutrition-related interventions.
                                Technical Abstract: Maternal and child undernutrition is highly prevalent in low- and middle-income countries, resulting in very substantial increases in mortality and overall disease burden. An extensive review of evidence was used to estimate the effects of the risks related to measures of undernutrition, as well as to sub-optimal breastfeeding practices. Stunting, severe wasting and intra-uterine growth restriction together were estimated to be responsible for 2.2 million Disability-adjusted life years (DALYs), 21% of the total for children less than 5 years old. Deficiencies of vitamin A and zinc were estimated to be responsible for 0.8 million and 0.7 million deaths, respectively, each about 6% of global childhood DALYs. Iron and iodine deficiencies resulted in relatively few deaths and together about 1% of DALYs. After accounting for co-exposure, these risks factors together were responsible for an estimated 3 million deaths (30%) and 124 million DALYs (29%) in children less than 5 years old; this burden constitutes 9% of the total global burden of disease. Iron deficiency as a risk factor for maternal mortality added 115,000 deaths and 0.4% of global DALYs. Sub-optimal breastfeeding was estimated to be responsible for 1.4 million child deaths and 44 million DALYs (10% of DALYs in children less than 5 years old). The very high mortality and disease burden resulting from these nutritional factors make a compelling case for the urgent implementation of nutrition-related interventions.


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