DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20192866

Identification of undernutrition in under five children: Z score or a composite index of anthropometric failure?

Reena Titoria, Prabhu Ponnusamy, Sunil Mehra

Abstract


Background: Undernutrition continues to be the primary cause of ill health and premature mortality. The sustainable development goal 2 aims to end all forms of hunger by 2030 and lead towards an improvement in child health. The national data categorize the level of undernutrition as underweight, wasting and stunting. The weight for age estimates used under ICDS misses out the other forms of malnutrition. This study was conducted to assess the prevalence of undernutrition using a composite index of anthropometric failure (CIAF) and compare it with conventional indices.

Methods: A community based setting and cross-sectional study design. By simple random sampling 265 under-five children residing in a marginalized community of North West district of Delhi. Interviewer administered questionnaire was used to collect information and anthropometric measurements were taken using standard operative procedures. Z scores were calculated by WHO-ANTHRO software version 3.2.2. Descriptive analysis was conducted using statistical package for social sciences version 22.

Results: The prevalence of anthropometric failure by CIAF was 60.5% and based on other indices undernutrition was found as 44.5% stunting, 35.4% underweight and 26.4% wasting. MUAC detected 23.7% of undernourished. CIAF provides a better picture of undernutrition compared to other indices.

Conclusions: Since CIAF is more than that estimated by any of the conventional indicators, it proves to be a better indicator in assessing the overall burden of under-nutrition in a population. Development of policies based on CIAF to reduce the burden of undernutrition may prove to be more effective. 


Keywords


Composite index of anthropometric failure, Stunting, Under-five children, Underweight, Wasting, Z score

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References


Waterlow JC, Buzina R, Keller W, Lane JM, Nichaman MZ, Tanner JM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin World Health Organization. 1977;55:489–98.

World Health Organization, UNICEF. WHO child growth standards and the identification of severe acute malnutrition in infants and children: joint statement by the World Health Organization and the United Nations Children's Fund, 2009.

Svedberg P. Poverty and undernutrition: theory, measurement, and policy. Clarendon Press; 2000.

Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD. Poverty, child undernutrition and morbidity: new evidence from India. Bulletin World Health Organization. 2005;83(3):210-6.

International Institute for Population Sciences (IIPS) and ICF. (2017). National Family Health Survey (NFHS-4); 2015–16. Available at: http://rchiips.org/ nfhs/FCTS/DL/DL_Factsheet_90_North%20West.pdf. Accessed on 1 November 2018.

Walters T, Sibson V, McGrath M. Mid upper arm circumference and weight-for-height z-score as indicators of severe acute malnutrition. Emergency Nutrition Network (ENN). 2012. Available at: http://www.ennonline.net/muacandweightforheightindicators. Accessed 5 November 2018.

WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards: Length/height-forage, weight-for-age, weight-for-length, weight-for height and body mass index-for-age: Methods and development. Geneva, World Health Organization; 2006. Available at: http://www.who. int/childgrowth/standards/technical _report/en/ind ex.html. Accessed 25 November 2018

Solanki R, Patel T, Shah H, Singh US. Measuring undernutrition through z-scores and Composite Index of Anthropometric Failure (CIAF): a study among slum children in Ahmedabad City, Gujarat. National J Community Med. 2014;5(4):434-9.

Sen J, Mondal N. Socio-economic and demographic factors affecting the Composite Index of Anthropometric Failure (CIAF). Annals of Human Biology. 2012;39(2):129-36.

Biswas S, Bose K, Mukhopadhyay A, Bhadra M. Prevalence of undernutrition among pre-school children of Chapra, Nadia District, West Bengal, India, measured by composite index of anthropometric failure (CIAF). Anthropologischer Anzeiger. 2009;67(3):269-79.

Shrimpton R, Victora CG, de Onis M, Lima RC, Blössner M, Clugston G. Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics. 2001;107(5):e75.

Dewan D, Gupta R, Kumar D. Can we rely solely on conventional measures to estimate undernutrition among under‐fives? Indian J Community Health. 2015;27(3):361‐5.

Mukhopadhyay DK, Biswas R, Chakraborty M, Sadhukhan SK, Banik KK. Anthropometric failure, a new approach to measure undernutrition: an experience from a rural community of West Bengal, India. J Indian Med Association. 2009;107(4):211-4.