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.


RESULTS
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
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.
Prost
Marc-André
MA
Epidemiology and Population Health Department, London School of Hygiene & Tropical Medicine, London, United Kingdom. marco@thepep.net
Jahn
Andreas
A
Floyd
Sian
S
Mvula
Hazzie
H
Mwaiyeghele
Eleneus
E
Mwinuka
Venance
V
Mhango
Thomas
T
Crampin
Amelia C
AC
McGrath
Nuala
N
Fine
Paul E M
PE
Glynn
Judith R
JR
D000328:Adult; D000886:Anthropometry; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D012307:Risk Factors; D014944:World Health Organization