**3. Impact of HIV-malnutrition: mortality and morbidity**

Malnutrition contributes to increased mortality among children, mainly due to infections. Children with severe acute malnutrition had 12 times the risk of dying when compared with well-nourished children of the same age [15]. HIV infection further increases the risk of dying among children with malnutrition. A systematic review and meta-analysis of 17 studies on 4891 children with severe acute malnutrition in sub-Saharan Africa revealed that children with HIV infection were more likely to die than those not infected with HIV (30.4 vs. 8.4%, P < 0.001, relative risk 2.81, 95% CI 2.04–3.87) [16]. Non-immunological factors also contribute to increased mortality among children with malnutrition. These include impaired respiratory excursions due to reduced muscle mass predisposing to chest infections, reduced electrolyte absorption from the gut, impaired renal concentration capacity which puts the child at risk for dehydration and lastly impaired cardiac function that can cause heart failure [17]. The NHFL study showed that for every 1% increase in weight loss since the previous visit, the risk of death rose by 11%. When weight loss was >10% below the baseline weight, the relative risk of death increased nearly sixfold [14].
