8. Do Child Survival Interventions Reduce Malnutrition? The Dark Side of Child Survival

Abstract

This document is the eighth chapter in a book that identifies priorities for action to enhance child growth and nutrition in developing countries. The chapter assesses whether or not the following child survival interventions improve the nutritional status of young children: 1) oral rehydration therapy (use of oral rehydration solution and enhanced feeding during and following diarrhea) 2) measles immunization 3) control of acute respiratory infections (ARIs) and 4) promotion of breast feeding and improvement of weaning practices. A review of published theories about competing risks of death and the impact of combined interventions indicates that many of these child survival strategies (such as the use of oral rehydration solution and measles immunization) have less potential to reduce mortality than would a broad-based intervention. Breast-feeding promotion on the other hand both decreases the incidence of diseases such as diarrhea and ARI and reduces frailty resulting from the diseases. Mortality can be reduced while morbidity and malnutrition (and thus the risk of replacement mortality) remain high. The most direct child survival intervention to improve child malnutrition is improving young child feeding by promoting breast feeding and educating mothers about appropriate weaning foods. Because a well-fed child has a better chance of fending off the assaults of an unhygienic environment the central focus of child survival programs should be both to improve the feeding of young children and to control infections.