Conference Proceeding

Implications of Applying New WHO Growth Standards on Assessment of Nutritional Status among Under-Five Children in a Rural Health Center in India

01/2010; In proceeding of: AcademyHealth Annual Research Meeting

ABSTRACT Research Objective: World Health Organization, after a review of NCHS anthropometric references of 1977 concluded that these did not adequately represent early childhood growth and that new growth curves were necessary. In view of this, WHO generated new curves based on the Multicentre Growth Reference Study. These standards provide a more robust tool for assessing child growth. The design characteristics provide a wider array of references for expanded uses, such as monitoring of childhood obesity and management of early lactation. Since the NCHS growth charts were still in use, we did a study to assess the nutritional status of under-five children using NCHS and WHO standards with the weight-for-age and height-for- age charts, to compare the two standards in detecting malnutrition among children and study the implications of adopting new WHO standards in assessing prevalence and detection of malnutrition.
Study Design: We conducted a cross – sectional study where we retrieved from hospital records the anthropometric measurements of 100 under five children in rural Karnataka, India in September 2008. The heights and weights of children were plotted on the weight-for- age and height-for-age charts separately for males and females on the growth charts based on the NCHS reference. These were then plotted on the WHO growth charts and the nutritional statuses according to the two references were compared.

Population Studied: Children under five years of age who attended the out-patient department of a community health center in village Karkala, Karnataka, India were selected for the study.
Principal Findings: Our study showed that the WHO growth standards pick up more underweight children as compared to NCHS standards (19% vs. 11%). The prevalence rates were higher with the WHO standards for the 0-6 months (n=30), 6-12 months (n=26) and 2-5 years age groups (n=14) than with the NCHS standards (26.7% vs. 6.7%, 15.4% vs. 7.7% and 24.1% vs. 7.1% respectively). However, in the 1-2 years age group (n=30), the prevalence was less with the WHO standards than with the NCHS standards (13.3% vs. 20%). The prevalence was higher with the WHO standards in the first half of infancy. Regarding height- for-age, the prevalence of stunting was less with the WHO standards as compared to NCHS standards (11% vs. 13%). However, the prevalence was higher upto 6 months of age (n=30) with the WHO standards (13.3% vs. 6.7%). Amongst 6-12 months (n=26) and 1-2 year age group (n=30), WHO standards showed lower prevalence (7.7% vs. 15.4% and 13.3% vs. 20% respectively). The prevalence (7.1%) was same in the 2- 5 years age group (n=14).
Conclusions: Our study, though small in sample size, showed that adoption of the new standards would help in picking up more malnourished children and probably at an earlier stage.
Implications for Policy, Delivery, or Practice: The new approach is important to improve early detection and proper management of malnourished children and prevent life-long sequelae, which prevent them from achieving their full potential of physical development.

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    ABSTRACT: To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference. Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared. The data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province. In all, 1533 and 1051 children aged 0-35 months from national and Thatta surveys, respectively. WHO standard gave a significantly higher prevalence of stunting for both national [36.7 (95 % CI 33.2, 40.2)] and Thatta surveys [52.9 (95 % CI 48.9, 56.9)] compared to the NCHS reference [national: 29.1 (95 % CI 25.9, 32.2) and Thatta: 44.8 (95 % CI 41.1, 48.5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22.9 (95 % CI 20.3, 25.5)] compared to the NCHS reference [15.7 (95 % CI 13.5, 17.8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children. Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country's targets for Millennium Development Goal 1 and for monitoring nutritional trends.
    Public Health Nutrition 06/2008; 12(5):716-22. · 2.25 Impact Factor


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Jan 26, 2012

Avika Dixit