Nutritional Status of Children

Measures, Estimates and Explanations

Nutritional Status of Children 2

Malnutrition Indicators

• Malnutrition indicators: Differ with respect to the stage in one’s life cycle.

Thank You

Nutritional Status of Children 4

Intra-uterine Undernutrition: Low Birth Weight (LBW)

• Cause: Maternal malnutrition:

• Effect: Malnutrition during intra-uterine life.

Retards the growth and development of the foetus during pregnancy.

The foetus is born with birth weight lower than normal.

The cut-off value for birth weight is 2.5 kg(WHO).

Babies born with birth weight <2.5 kg are LBW babies.

Nutritional Status of Children 5

Childhood Malnutrition

• Severe consequences if it occurs early in life.

– Adverse impact on subsequent growth, morbidity, cognitive development, educational attainment and productivity in adulthood.

Nutritional Status of Children 6

Nutrition status: Children U5

• Anthropometric Indicators:Height-for-age (HFA),Weight-for-age (WFA), Weight-for-height (WFH), andMUAC-for-age. Most sensitive indicators of food security, vulnerability

and overall socio-economic development of a country. Stunting, Wasting and Underweight. Z-score classification.

Nutritional Status of Children 7

Malnutrition IndicatorsMeasure the clinical phenomena of malnutrition.Standard cutoff points are used internationally to

define under nutrition in children 6-59 months.The cutoff points for nutrition indicators are derived

from the WHO child growth standard population (WHO standards) or NCHS reference population (NCHS population).

Nutritional Status of Children 8

Stunting (low height-for-age)

• Cause: Chronic under nutrition retards growth of a child by height.

• Stunting: child is shorter for its age.

• Information requirement: Estimates of height and age.

Nutritional Status of Children 9

Stunting (low height-for-age)

• Low HFA identifies past or chronic under nutrition (stunting)

• Stunting indicates reduced linear growth Cannot measure short-term changes in malnutrition For children <2 yrs of age, the term is

length-for-age/LA For children > 2 yrs age, the index is referred to as

height-for-age/HA

Nutritional Status of Children 10

Stunting: Classification

• Height-for-age up to -2SD = Normal

• Height-for-age <-2SD to -3SD = Moderate

• Height-for-age <-3SD = Severe

Nutritional Status of Children 11

Wasting (low weight–for-height)

• Cause: Acute, short-run malnutrition Affects only body weight.

“Wasting” of the body, i.e. loss of body mass compared to the body size.

Indicator: Weight-for-height.

Nutritional Status of Children 12

Wasting (low weight–for-height)

Weight for-height:Low WFH identifies current or acute under

nutrition (wasting)Useful when exact age is difficult to determine• - Weight for-length (< 2 yrs) or weight for-

height (in > 2 yrs)- Appropriate for examining short-term effects

Nutritional Status of Children 13

Wasting: Classification

• Normal weight-for-height: If its weight-for-height is within 2 standard deviations (-2SD) of the median weight-for-height of a reference population.

• Moderately wasted: If the weight-for-height falls below 2SD (<-2SD) but within 3 SD below the reference median (-3SD).

• Severely wasted: If the weight-for-height falls below 3SD of the reference median (<-3SD).

Nutritional Status of Children 14

Wasting: Classification

• Weight-for-height up to –2SD = Normal

• Weight-for-height <-2SD to –3SD = Moderate

• Weight-for-height <-3SD = Severe

Nutritional Status of Children 15

Underweight (low weight-for-age)

Composite indicator of long-term and acute short-term malnutrition.

The body weight may be lost from malnutrition for a long time => low weight-for-age.

Weight may also be lost from acute, short-term malnutrition => low weight-for-age.

Nutritional Status of Children 16

Underweight: Classification

• Normal weight-for-age: If weight-for-age is within 2 standard deviations (-2SD) of the median weight-for-age of a reference population.

• Moderately underweight: If the weight-for-age falls below 2SD (<-2SD) but within 3 SD below the reference median (-3SD).

• Severely underweight: If the weight-for-age falls below 3SD of the reference median (<-3SD).

Nutritional Status of Children 17

Underweight: Classification

• Weight-for-age up to -2SD = Normal

• Weight-for-age <-2SD to -3SD = Moderate

• Weight-for-age <-3SD = Severe

Nutritional Status of Children 18

Nutritional Status of Children 19

Mid- Upper Arm Circumference (MUAC)

Low MUAC (<12.5 cm) indicates acute malnutrition among children 6-59 months.

Is relatively easy to measure and a good predictor of immediate risk of death.

Is used for rapid screening of acute malnutrition.

Nutritional Status of Children 20

Nutritional Status of Children 21

Nutritional Status of Children 22

Undernutrition trends among <5 children in Bangladesh

47.8

1713

44.6

57.4

68.3

41

51

65.8

43

43.1

51.4

64.264.6

48.3

42.4

14.416.7 16.6

12 12.7

10

20

30

40

50

60

70

80

1989/90 1992 1995 2000 2005 2007 2009

Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA

Per

cent

Underweight <5 Stunting <5Wasting <5 MDG target for underweight

23

Food consumption, energy and nutrient intake and nutritional status in rural

Bangladesh: Changes from 1981 – 1982 to 1995 – 96

Source: Hels et al. (2003)

Nutritional Status of Children 24

Nutritional Status of Children 25

Nutritional Status of Children 26

Nutritional Status of Children 27

Nutritional Status of Children 28