Growing crisis of child mortality due to malnutrition as the world gets richer

By Vikas Meshram 

A recent study published in the international journal The Lancet Child & Adolescent Health, based on the Global Burden of Disease (GBD) data, highlights the grave reality of malnutrition and stunting among children worldwide. According to the report, in the year 2000, nearly 2.75 million children died due to undernutrition and impaired growth in early childhood. Although some progress has been made over the past two decades, malnutrition and stunting remain major health threats for children under the age of five.

The study identifies Sub-Saharan Africa as the most severely affected region. Approximately 618,000 child deaths in this region were linked to stunting-related causes, while 165,000 deaths were recorded in Southern Africa alone.

The report highlights three key indicators of growth failure. Among them, low weight proved to be the deadliest, accounting for 12% of deaths among children under five, followed by wasting (9%) and stunting (8%). The study also reveals that the global number of stunted children is far higher than previously estimated. For children who are physically weak and fail to grow adequately, even common infections can become life-threatening. An estimated 800,000 children die each year from pneumonia, malaria, measles, and diarrhea.

The situation in sub-Saharan Africa is particularly alarming. Seventy-seven percent of children who died from diarrhea were malnourished, while 65% of children who died from respiratory infections were physically undernourished.

South Asia presents an equally worrying picture. In this region, 79% of children who died from diarrhea were stunted, while 53% of deaths due to respiratory infections occurred among stunted children.

In contrast, high-income countries show comparatively lower proportions of stunting-related deaths. For instance, 33% of children who died from diarrhea and 35% of those who died from respiratory infections were malnourished.

Researchers involved in the study, including Professor Dr. Bobby Reiner, noted in a press release that inadequate nutrition, food insecurity, climate change, poor sanitation, conflict, and war are all responsible for stunted growth among children.

“All these factors interact and collectively affect children’s health. Therefore, no single policy can solve the problem,” he explained.

The study also reveals that signs of stunting often appear within the first three months of life in most newborns. This underscores the critical importance of maternal health care before and during pregnancy.

Stunting and physical weakness reinforce each other in a vicious cycle. Stunted children face a higher risk of diseases later in life, while physically weak children are more likely to become stunted. This cycle intensifies with age. Stunting in childhood increases the risk of preterm birth and low birth weight in the next generation.

Among older infants and young children, nutritional deficiencies, repeated infections, and other health problems are major causes of stunting. Dr. Reiner emphasizes, "Once stunting occurs, it is extremely difficult to reverse. Therefore, it is crucial to identify and prioritize regions where the problem is most severe.”

Meanwhile, the Gates Foundation’s report has, for the first time, expressed concern that global child mortality rates may begin to rise again. The report notes that although the world has become wealthier, spending on children in poor countries has declined. According to the findings, wealthy nations have cut global health spending by 27%, leading to an estimated 200,000 additional child deaths this year alone. These deaths are largely due to diseases that could have been prevented through vaccination and basic treatment funded by rich countries.

Health experts warn that cutting global health aid by 30% could result in 16 million additional child deaths by 2045. Ironically, developed nations appear to be ignoring this looming crisis, focusing instead on increasing defense and domestic spending. Wealthy countries currently spend less than 1% of their budgets on children in poor nations. The Gates Foundation urges rich countries to direct scarce resources where they can save the most lives.

The children at greatest risk are those who die before reaching their fifth birthday. If this crisis worsens, decades of global progress could be reversed. Undoubtedly, every child born anywhere in the world deserves a chance to survive and thrive.

The Gates Foundation’s Goalkeepers Report and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington estimate that by 2025, 4.6 million children may die before their fifth birthday. Due to significant cuts in global aid, this number could rise by 200,000 to reach 4.8 million children this year. In addition to reduced aid, rising debt in poor countries and weak health systems threaten to undo gains against diseases such as malaria, HIV, and polio.

Recent reports demonstrate that targeted investments in proven solutions and next-generation innovations can save millions of children’s lives even with limited budgets. Without question, children in poor countries deserve safe and healthy lives.

Bill Gates, Chair of the Gates Foundation, states that the world must increase financial resources to protect children’s health in poor countries and improve the efficiency of existing systems.

We must do more with less. If we fail, it will be a stain on our generation—that despite having the most advanced science and innovation in human history, we failed to mobilize funding to save millions of children’s lives.”

By setting the right priorities, strengthening commitments, and investing in high-impact interventions, the rise in child mortality can be halted. If this is achieved, millions of children could be saved by 2045. This will require maximizing foreign aid, strengthening primary health care, ensuring routine and quality immunization, and making innovative use of data systems.

The Gates Foundation firmly believes that investing in next-generation innovations can help eliminate some of the deadliest childhood diseases, such as malaria and pneumonia, once and for all.