title: Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared.
  
  
  METHODS
  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.
  
  
  METHODS
  In all, 1533 and 1051 children aged 0-35 months from national and Thatta surveys, respectively.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Community Health Sciences, The Aga Khan University, Karachi-74800, Pakistan. rozina.nuruddin@aku.edu
authors.forename: Rozina
authors.initials: R
authors.lastname: Nuruddin
authors.forename: Meng Kin
authors.initials: MK
authors.lastname: Lim
authors.forename: Wilbur C
authors.initials: WC
authors.lastname: Hadden
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
mesh_terms: D001837:Body Weights and Measures / Q000592:standards*; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044342:Malnutrition / Q000453:epidemiology; D009309:National Center for Health Statistics, U.S.; D009748:Nutrition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D012015:Reference Standards; D012424:Rural Population; D012574:Schools; D011795:Surveys and Questionnaires; D014481:United States; D019282:Wasting Syndrome / Q000453:epidemiology; D014944:World Health Organization