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  • Title: Child anthropometry and mortality in Malawi: testing for effect modification by age and length of follow-up and confounding by socioeconomic factors.
    Author: Pelletier DL, Low JW, Johnson FC, Msukwa LA.
    Journal: J Nutr; 1994 Oct; 124(10 Suppl):2082S-2105S. PubMed ID: 7931717.
    Abstract:
    As shown in a review of 28 studies, anthropometric measurements of preschool-aged children are consistently related to the risk of subsequent mortality in community-based studies from Asia and Africa (Pelletier 1994). Although the results are consistent at this general level, a number of important questions remain concerning the relationship. The purpose of this study is to address two of these questions using data from a similar study conducted in rural northern Malawi: 1) In relation to screening, are the anthropometry-mortality relationships affected by the child's age and the interval between measurement and death ("length of follow-up") and 2) In relation to policy implications, is the anthropometry-mortality relationship due to confounding by socioeconomic factors, especially when considering mild-to-moderate malnutrition. The results reveal that mortality prediction is significantly affected by child's age and length of follow-up, but the strength and direction of this effect modification varies across the four commonly used anthropometric indicators [weight-for-age (WA), height-for-age (HA), weight-for-height (WH) and arm circumference-for-age (ACA)]. An important result for public health practice is that there are no statistically significant differences in prediction across these four indicators when applied to young children (6-23 mo) and employing a 1-y follow-up period. As regards confounding, the results indicate that the anthropometry-mortality relationship is not due to confounding by socioeconomic factors when all grades of malnutrition are considered. When only mild-to-moderate malnutrition is considered, statistically controlling for confounders reduces most of the anthropometric predictors to nonsignificance (probability values to > 0.20), but the strength of the association (odds ratio) remains of the same order of magnitude. However, when effect modification by child's age and length of follow-up is taken into account, the effect of mild-to-moderate malnutrition (WA and WH) remains statistically significant for young children dying with 1 y of follow-up. The author has previously shown in a review of 28 studies that anthropometric measurements of preschool-aged children are consistently related to the risk of subsequent mortality in community-based studies from Asia and Africa. A number of questions, however, remain about the relationship. This study was therefore conducted to address two of the questions using data from a similar study in rural northern Malawi. First, in relation to screening, are the anthropometry-mortality relationships affected by child's age and the interval between measurement and death, and second, in relation to policy, is the anthropometry-mortality relationship due to confounding by socioeconomic factors, especially when considering mild to moderate malnutrition? The authors find that mortality prediction is significantly affected by child's age and length of follow-up, but the strength and direction of the effect modification varies across the four commonly used anthropometric indicators of weight-for-age, height-for-age, weight-for-height, and arm circumference-for-age. There are no statistically significant differences in prediction across the four indicators when applied to children aged 6-23 months and employing a one-year follow-up period. As for confounding, the study found the anthropometry-mortality relationship to not be due to socioeconomic factors when all grades of malnutrition are considered.
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