I062 Am J C/in Nutr 1997:65:1062-9. Printed in USA. 0 1997 American Society for Clinical Nutrition A prospective study of malnutrition in relation to child mortality in the Sudan13

ABSTRACT We examined prospectively the relation be-tween malnutrition and mortality among Sudanese children. A cohort of 28 753 children between the ages of 6 mo and 6 y was examined every 6 mo for 1 8 mo. Two hundred thirty-two children died during 18 mo of follow-up (480 624 child-months). Low weight-for-height was associated with an increased risk of mortal-ity (P < 0.0001). Even children with Z scores between- 1 and-2 were 50 % more likely to die in the following 6 mo than were children with Z scores>- I (multivariate relative mortality: IS; 95 % CI: 1. 1, 2.2). There was also an inverse relation between height-for-age and mortality (P < 0.0001). Among breast-fed children, the relative mortality associated with a Z score for weight-for-height of <-3 compared with>-2 was 7.3 (95 % CI: 3.3, 15.9): among children not breast-fed, it was 26.0 (95 % CI: 12.8, 53.0: P for interaction = 0.001). A strong and significant synergy was also found between infection and wasting or stunting as predictors ofchild mortality (P for interaction = 0.001 and 0.02, respectively). In developing countries, children who are below the customary cutoff point of-2 Z for weight-for-height may be at higher risk of death. Breast-feeding and reduction of morbidity should be advocated in programs designed to reduce malnutrition and mortality among children. Am J Cli,i Nutr l997;65