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: OBJECTIVE
  To determine wasting prevalence among infants aged under 6 months and describe the effects of new case definitions based on WHO growth standards.
  
  
  METHODS
  Secondary data analysis of demographic and health survey datasets.
  
  
  METHODS
  21 developing countries.
  
  
  METHODS
  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.
authors.affiliation: Centre for International Health and Development, UCL Institute of Child Health, London, UK. marko.kerac@gmail.com
authors.forename: Marko
authors.initials: M
authors.lastname: Kerac
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.forename: Carlos
authors.initials: C
authors.lastname: Grijalva-Eternod
authors.forename: Marie
authors.initials: M
authors.lastname: McGrath
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shoham
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Cole
authors.forename: Andrew
authors.initials: A
authors.lastname: Seal
mesh_terms: D000886:Anthropometry / Q000379:methods; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology; D002675:Child, Preschool; D003906:Developing Countries; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012016:Reference Values; D013217:Starvation / Q000453:epidemiology; D019282:Wasting Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D014944:World Health Organization