Dear all,

On the topic of weighing, I hope any of you working in developing country settings might be interested in this paper which colleagues and I have recently published in Archives of Disease in Childhood (online first for now - print issue TBC - you can download the full version for free since it's open access)

The paper presents data challenging a common assumption that the since the new WHO growth standards are based on breastfed infants, their use will always result in less infants being diagnosed as 'malnourished'. Any comments or feedback gratefully received - there's a "RESPONSES" section on the ADC website where comments can be posted. 

http://adc.bmj.com/content/early/2011/02/01/adc.2010.191882.full 
http://adc.bmj.com/content/early/2011/02/01/adc.2010.191882.short?rss=1 


TITLE
"Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis"

Abstract

OBJECTIVES: To determine wasting prevalence among infants aged under 6 months and describe the effects of new case definitions based on WHO growth standards.

DESIGN: Secondary data analysis of demographic and health survey datasets.

SETTING: 21 developing countries.

POPULATION: 15 534 infants under 6 months and 147 694 children aged 6 to under 60 months (median 5072 individuals/country, range 1710–45 398). Wasting was defined as weight-for-height z-score <−2, moderate wasting as −3 to <−2 z-scores, severe wasting as z-score <−3.
RESULTS: Using National Center for Health Statistics (NCHS) growth references, the nationwide prevalence of wasting in infant under-6-month ranges from 1.1% to 15% (median 3.7%, IQR 1.8–6.5%; ~3 million wasted infants <6 months worldwide). Prevalence is more than doubled using WHO standards: 2.0–34% (median 15%, IQR 6.2–17%; ~8.5 million wasted infants <6 months worldwide). Prevalence differences using WHO standards are more marked for infants under 6 months than children, with the greatest increase being for severe wasting (indicated by a regression line slope of 3.5 for infants <6 months vs 1.7 for children). Moderate infant-6-month wasting is also greater using WHO, whereas moderate child wasting is 0.9 times the NCHS prevalence.

CONCLUSIONS: Whether defined by NCHS references or WHO standards, wasting among infants under 6 months is prevalent in many of the developing countries examined in this study. Use of WHO standards to define wasting results in a greater disease burden, particularly for severe wasting. Policy makers, programme managers and clinicians in child health and nutrition programmes should consider resource and risk/benefit implications of changing case definitions.



With best wishes,


Marko

Dr Marko Kerac
UCL Centre for International Health and Development
http://www.ucl.ac.uk/cihd/ 
http://www.ucl.ac.uk/cihd/research/nutrition/mami 

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