Preventing low birthweight and reduction of child mortality.

Surprisingly little attention is paid to birthweight improvement as a means of reducing child mortality. Half of the 10 million pre-school-age children that die each year have malnutrition as an underlying or associated cause. Furthermore, the majority of these deaths are associated with the mild and moderate forms of malnutrition, reflecting how this effect is manifest across the whole population distribution. Similar relationships are seen between birthweight and neonatal mortality, with the least risk of neonatal death occurring in children born weighing more than 3.5 kg. Child malnutrition is increasingly recognized to be largely determined during the period of fetal and infant growth, when maternal nutrition has its strongest influence. Although the effects of maternal food supplements on mean birthweight are relatively small, because of their influence across the population distribution they have great biological significance. An increase of 100 g in mean birthweight is associated with a 30-50% reduction in neonatal mortality. The programmes that need to be put in place to improve maternal nutritional status are discussed, and the programme initiatives being promoted by UNICEF to prevent low birthweight, including multiple micronutrient supplementation trials are further described.