Assessment of undernutrition by composite index of anthropometric failure among under five children in a slum of Kolkata, West Bengal

Surajit Lahiri, Saibendu Kumar Lahiri


Background: Under-nutrition is a major public health problem in India among under-five children. Composite index of anthropometric failure (CIAF) provides an overall estimate of under-nutrition as a single measure and helps in detection of children with multiple anthropometric failures.

Methods: This cross-sectional community-based study was done in Baghbazar slum of north Kolkata to determine the prevalence of under-nutrition among the under-five children and to find out the determinants of under-nutrition assessed by CIAF using multivariate analysis. WHO Z score system and the composite index of anthropometric failure (CIAF) were used to estimate the magnitude of under-nutrition.

Results: 41.2% children were diagnosed with anthropometric Failure. CIAF was more in female (43.1%) than male (39.1%). Multivariate analysis shows that low education level of mother, low socio-economic status (class III and below) and overcrowding were significantly associated with CIAF.

Conclusions: CIAF gives a better estimate of under-nutrition than the currently used weight for age Z score. The study shows the importance of proper infant and child feeding practices, family planning practices, appropriate maternal care, female literacy, improvement of economic condition, housing standards and proper treatment of illness in prevention of under-nutrition among under-five children.


Composite index of anthropometric failure, Under-nutrition, Stunting, Under-weight

Full Text:



Pelletier DL. The relationship between child anthropometry and mortality in developing countries: Implications for policy, progress and future research. J Nutr. 1994;124(10):2047-81.

Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year. Lancet. 2003;361:2226-34.

Nandy S, Irving M, Gordon D. Poverty, child undernutrition and morbidity: New evidence from India. Bull World Health Organ. 2005;83:210-6.

World Health Organization. Childhood nutrition and progress in implementing the international code of marketing of Breast-milk substitute. Geneva: WHO;2002. Report No.: DocumentA55/14.

Svedberg P. Poverty and under-nutrition: Theory, measurement, and policy. New Delhi: Oxford India Paperback; 2000.

Berger MR, Gardner FC, Wagle A. Prevalence of malnutrition in human immunodeficiency virus/acquired immunodeficiency syndrome orphans in the Nyanza province of Kenya: a comparison of conventional indexes with a Composite Index of Anthropometric Failure. J Am Diet Assoc. 2008;108:1014-7.

Seetharaman N, Chacko TV, Shankar SLR. Measuring malnutrition- the role of Z scores and the Composite Index of Anthropometric Failure (CIAF). Indian J Community Med. 2007;32:35.

Mandal GC, Bose K. Assessment of overall prevalence of under-nutrition using Composite Index of Anthropometric Failure (CIAF) among preschool children of West Bengal, India. Iranian J Pediatrics. 2009;19:237-43.

Mukhopadhyay DK, Biswas AB. Food security and anthropometric failure among tribal children in Bankura, West Bengal. Indian Pediatr. 2011;48(4):311-4.

Shit S, Taraphdar P, Mukhopadhyay DK, Sinhababu A, Biswas AB. Assessment of nutritional status by composite index for anthropometric failure: a study among slum children in Bankura, West Bengal. Indian J Public Health. 2012;56(4):305-7.

Das S, Bose K. Report on - anthropometric failure among rural 2-6 years old Indian Bauri caste children of West Bengal. Anthrop Rev. 2009;72:81-8.

Sen J, Mondal N. Socio-economic and demographic factors affecting the composite index of anthropometric failure (CIAF). Ann Hum Biol. 2012;39(2):129-36.

Anwar F, Gupta MK, Prabha C, Srivastava RK. Malnutrition among rural Indian children: an assessment using web of indices. Int J Public Health Epidemiol. 2013;2(4):78-84.

Brahmbhatt KR, Hameed S, Naik PM, Prasanna KS, Jayram S. Role of new anthropometric indices, validity of MUAC and Weech‘s formula in detecting under-nutrition among under-five children in Karnataka. Inte J of Biomedical and Advance Research. 2013;3(12):896-900.

Deshmukh PR, Dongre AR, Sinha N, Garg BS. Acute childhood morbidities in rural Wardha: some epidemiological correlates and health care seeking. Indian J Med Sci. 2009;63(8):345-54.

Seetharaman N, Chacko TV, Shankar SRL, Mathew AC. Measuring malnutrition: the role of Z-scores and the Composite Index of Anthropometric Failure (CIAF). Indian J Community Med. 2007;32(1):35-9.

Anjum F, Pandit MI, Mir AA, Bhat IA. Z score and CIAF: a comprehensive measure of magnitude of under nutrition in a rural school going population of Kashmir, India. Global J of Medicine and Public Health. 2012;1(5):46-9.

Nandy S, Miranda JJ. Overlooking under-nutrition, using a composite index of Anthropometric failure to assess how under-weight misses and misleads the assessment of undernutrition in young children. Soc Sci Med. 2008;66:1963-6.

Khan REA, Jamal WN. Determinants of under-nutrition of primary school-age children: a case study of urban Bahawalpur. ISOSS 2009. Proceedings of the 5th International Conference on Statistical Sciences, Mathematics, Statistics and Applications. 2009: 23-5.

Lekprichakul T, Umetsu C, Yamauchi T. Child growth as a measure of household resilience: a re-examination of child nutrition situation using new growth reference standard. Vulnerability and Resilience of Social-Ecological Systems, FR3 Project report. Kyoto: Research Institute for Humanity and Nature; 2010: 98.