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Sep 19, 2007Article Details
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Main Article Content
Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000
Abstract
Objectives. To estimate the disease burden attributable to being
underweight as an indicator of undernutrition in children
under 5 years of age and in pregnant women for the year 2000.
Design. World Health Organization comparative risk
assessment (CRA) methodology was followed. The
1999 National Food Consumption Survey prevalence of
underweight classified in three low weight-for-age categories
was compared with standard growth charts to estimate
population-attributable fractions for mortality and morbidity
outcomes, based on increased risk for each category and
applied to revised burden of disease estimates for South Africa
in 2000. Maternal underweight, leading to an increased risk of
intra-uterine growth retardation and further risk of low birth
weight (LBW), was also assessed using the approach adopted
by the global assessment. Monte Carlo simulation-modelling
techniques were used for the uncertainty analysis.
Setting. South Africa.
Subjects. Children under 5 years of age and pregnant women.
Outcome measures. Mortality and disability-adjusted life years
(DALYs) from protein- energy malnutrition and a fraction of
those from diarrhoeal disease, pneumonia, malaria, other non-
HIV/AIDS infectious and parasitic conditions in children aged
0 - 4 years, and LBW.
Results. Among children under 5 years, 11.8% were
underweight. In the same age group, 11 808 deaths (95%
uncertainty interval 11 100 - 12 642) or 12.3% (95% uncertainty
interval 11.5 - 13.1%) were attributable to being underweight.
Protein-energy malnutrition contributed 44.7% and diarrhoeal
disease 29.6% of the total attributable burden. Childhood and
maternal underweight accounted for 2.7% (95% uncertainty
interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and
10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in
children under 5.
Conclusions. The study shows that reduction of the occurrence
of underweight would have a substantial impact on child
mortality, and also highlights the need to monitor this
important indicator of child health.
South African Medical Journal Vol. 97 (8) Part 2 2007: pp. 733-739
