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Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants

Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants
Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants
BACKGROUND: The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified.

METHODOLOGY/PRINCIPAL FINDINGS: Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0-4 months and 11-15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards.

CONCLUSIONS/SIGNIFICANCE: Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.
1932-6203
e2684
Prost, M.A.
c4eaad64-29f9-4403-b8a7-a32d4cea3859
Jahn, A.
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Floyd, S.
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Mvula, H.
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Mwaiyeghele, E.
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Mwinuka, V.
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Mhango, T.
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Crampin, A.C.
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McGrath, N.
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Fine, P.E.
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Glynn, J.R.
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Prost, M.A.
c4eaad64-29f9-4403-b8a7-a32d4cea3859
Jahn, A.
75299d2a-929b-48fa-ab3f-5511268cebbf
Floyd, S.
982a6a32-cec8-4cea-893b-e04b983c9050
Mvula, H.
eadd559e-f5f2-419f-9eb4-288f41674643
Mwaiyeghele, E.
1e7fd197-4b86-4d57-9da6-7d29994542d5
Mwinuka, V.
3cfbded1-c5e7-4bee-8b64-dae61a9743d6
Mhango, T.
bb35d188-a425-4379-b44b-8f3595a5c7a7
Crampin, A.C.
79d516bb-98a6-4b0c-a1c2-2406f13f4649
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Fine, P.E.
165bb366-2524-48a6-a8aa-49f9c4b3d2ec
Glynn, J.R.
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Prost, M.A., Jahn, A., Floyd, S., Mvula, H., Mwaiyeghele, E., Mwinuka, V., Mhango, T., Crampin, A.C., McGrath, N., Fine, P.E. and Glynn, J.R. (2008) Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants. PLoS ONE, 3 (7), e2684. (doi:10.1371/journal.pone.0002684). (PMID:18628980)

Record type: Article

Abstract

BACKGROUND: The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified.

METHODOLOGY/PRINCIPAL FINDINGS: Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0-4 months and 11-15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards.

CONCLUSIONS/SIGNIFICANCE: Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.

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Published date: 16 July 2008
Organisations: Faculty of Health Sciences

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Local EPrints ID: 350456
URI: http://eprints.soton.ac.uk/id/eprint/350456
ISSN: 1932-6203
PURE UUID: dd0812f0-3087-484d-9134-3188df437ef0
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 25 Mar 2013 12:51
Last modified: 15 Mar 2024 03:46

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Contributors

Author: M.A. Prost
Author: A. Jahn
Author: S. Floyd
Author: H. Mvula
Author: E. Mwaiyeghele
Author: V. Mwinuka
Author: T. Mhango
Author: A.C. Crampin
Author: N. McGrath ORCID iD
Author: P.E. Fine
Author: J.R. Glynn

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