￼Implications of Applying New WHO Growth Standards on Assessment of Nutritional Status among Under-Five Children in a Rural Health Center in India
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. DOI:10.1017/S1368980008002383 · 2.48 Impact Factor
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ABSTRACT: The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development.Food and nutrition bulletin 04/2004; 25(1 Suppl):S15-26. · 1.50 Impact Factor
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ABSTRACT: To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.Public Health Nutrition 11/2006; 9(7):942-7. DOI:10.1017/PHN20062005 · 2.48 Impact Factor