In 2021, 4.7 million children under the age of five died; 2.4 million of those were attributed to child and maternal malnutrition.¹ That means around half of child deaths were linked to nutritional deficiencies.

When you think about these deaths, you might imagine a very acute form of hunger: a starving child. While this can happen during famines or in areas with very low levels of food availability, it’s only a small fraction of the total deaths linked to malnutrition.²

In most cases, children don’t die of malnutrition. They die from conditions that are exacerbated or are triggered by it. In most cases, it’s a risk factor for premature death. Take the example of the risk factor of smoking. People die from lung cancer, but their risk of developing it is significantly increased if they’ve been a smoker.

In the chart below, we can see how many child deaths are attributed to different nutritional risk factors.

By far, the biggest is low birth weight, which often happens because the mother is malnourished or has experienced infectious diseases during pregnancy. Infants that are born with a low birth weight — which the World Health Organization defines as weighing less than 2,500 grams or 5.5 pounds — have a much higher risk of infant mortality and health complications.³

After the first few weeks or months of life, children are also more vulnerable to infection and disease when they’re underweight or are malnourished and don’t develop at a healthy rate. Hundreds of thousands die as a result of “wasting”, which means their weight is too low for their height. Or “stunting”, meaning they are too short for their age.

This is not only about getting enough calories. Children are also malnourished when they don’t eat diverse foods, so they don’t get enough protein, vitamins, and micronutrients.

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Death rates from malnutrition are much higher in low-income countries, where children often don’t get the diversity of nutrients they need and where infectious diseases are much more common.

You can see this in the scatterplot below, where malnutrition deaths are plotted on the vertical axis and gross domestic product (GDP) per person on the horizontal axis. In rich countries — on the right of the chart — rates are 20 to 50 times lower than in the poorest countries, on the left.

Because of this, most malnutrition deaths occur in Sub-Saharan Africa and South Asia.

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The world is making progress due to improvements in malnutrition and tackling infectious diseases

Thankfully, we know that we can make progress on this problem. That’s because the world has already made progress. Fewer children are dying from malnutrition than a few decades ago.

The chart below shows the IHME’s estimates of the number of child deaths related to malnutrition since 1990.

Around 6.6 million deaths were linked to these risks in 1990. By 2021, this had fallen to around 2.4 million.

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Improvements in nutrition have driven some of this decline. Childhood stunting has fallen from 33% to 23% since 1990, and wasting has dropped from 9% to 7% since 2000. The share of children who are underweight has also gone down from 21% to 12%.

Progress in tackling infectious diseases has also been crucial. Disease and malnutrition have a bidirectional relationship, where one makes people more vulnerable to the other. As I wrote earlier, most people don’t die of malnutrition; poor nutrition can make them more vulnerable to infections, and vice versa.

Take the example of diarrheal diseases. Malnourished kids have weaker immune systems and are more susceptible to these diseases. Once they are sick, it’s much harder to retain nutrients from food, which is already in short supply. This makes them even weaker and more malnourished, locking them into a cycle that is hard to break.

This means that if diseases are less common, the health risks from being malnourished are also lower.

This has happened in the last few decades. Deaths from diarrheal diseases have plummeted thanks to clean water, improvements in sanitation, handwashing, and better and more widespread treatments for diarrheal diseases. Antimalarials and bednets have reduced malaria death rates. Most children are vaccinated against tuberculosis, and a growing number against rotavirus.

Support for mothers and babies during pregnancy and after birth has also improved. More births are attended by skilled health workers, which means that when babies are born with very low birth weights, professional medical workers are there to help and advise.

Tackling the diseases and health conditions that affect malnourished children is another way to reduce the poor health outcomes of malnutrition. But of course, improving the nutrition of children and mothers is crucial.

It’s critical to invest in good nutrition for kids and mothers

If we’re trying to reduce childhood malnutrition, it’s tempting to focus on what kids eat. But this challenge starts with the nutrition of mothers, particularly during pregnancy.

Several factors, including genetics, contribute to low birth weight in infants — but the risk tends to be higher when the mother has poor nutrition and dietary deficiencies during pregnancy.⁴ Without sufficient supplies of nutrients, fetal development is restricted, and babies cannot grow fully. In addition, the IHME estimates that around 34,000 women died from pregnancy-related causes in 2021 as a result of being malnourished.

Again, this is not just about calories. Women who don’t get enough vital nutrients — such as iron, zinc, iodine, calcium, and vitamin B₁₂ — are not only at much higher risk of complications during pregnancy and childbirth themselves but are also much more likely to have infants with low birth weight and delays in development.

The obvious solution is to ensure women have a diverse diet with lots of fruits, vegetables, pulses, and other nutrient-dense foods. The problem is that this is not affordable for many of the poorest women in the world.

As I previously wrote, billions of people can’t afford a “healthy”, sufficient diet even if they spend most of their income on food. Hopefully, this will improve over time as incomes rise and healthy food becomes cheaper and more easily accessible. However, these changes will take time and will not solve the problem soon.

Because of this, we need to fast-track alternative solutions that deliver essential nutrients more efficiently to women and children. Doing so can save hundreds of thousands, perhaps millions, of lives every year.

Providing dietary supplements is one option. There is good evidence that oral supplementation of various nutrients during pregnancy reduces the risk of low birth weight or premature births.⁵ Studies also show that giving supplements to children who are malnourished reduces the risk of dying from various causes, including diarrheal diseases and measles.⁶ The charity evaluator GiveWell lists vitamin-A supplementation as one of its most cost-effective interventions to reduce child mortality and improve lives. It estimates that delivering vitamin A costs just $1 per capsule and could lead to a significant reduction in child deaths.⁷

Another is fortifying staple foods like cereals with crucial micronutrients, directly adding small quantities of iron, zinc, iodine, or vitamins to products before they reach the market. This is very common across the world. In the UK, for example, I can buy breakfast cereals, bread, or milk with added nutrients. Food fortification is also incredibly cheap, ranging from just $0.05 to $0.25 per person per year. One problem, however, is that food products need to go through processing, which means that fortification is often not a solution for rural communities.

Biofortification could be an alternative. This is when crops are bred to have more nutrients. Rice or corn grown through biofortification has higher levels of zinc, iron, or vitamin A. “Golden rice” — where rice is grown with higher levels of vitamin A — is the most well-known example of biofortification.⁸

Ultimately, we want people to be able to afford healthy and diverse diets so that they don’t need to rely on supplementation. But this will take time. There are cheaper and faster ways to deliver better nutrition for mothers and children that could save lives today.

Hannah Ritchie (2024) - “Half of all child deaths are linked to malnutrition” Published online at OurWorldinData.org. Retrieved from: 'https://ourworldindata.org/half-child-deaths-linked-malnutrition' [Online Resource]

@article{owid-half-child-deaths-linked-malnutrition,
    author = {Hannah Ritchie},
    title = {Half of all child deaths are linked to malnutrition},
    journal = {Our World in Data},
    year = {2024},
    note = {https://ourworldindata.org/half-child-deaths-linked-malnutrition}
}

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