title: Sensitivity and specificity of visual clinical assessment as compared to WHO 2006 standard and NCHS 1977 reference in measuring the growth status of Malaysian infants.
abstract: OBJECTIVE
  To study the validity of the visual clinical assessment of weight relative to length and length relative to age as compared to the World Health Organization (WHO) 2006 standard and National Center for Health Statistics (NCHS) 1977 reference in asssessing the physical growth of children younger than 1 year.
  
  
  METHODS
  A prospective cohort study was carried out among 684 infants attending goverment health clinics in 2 states in Malaysia. Body weight, length, and clinical assessment were measured on the same day for 9 visits, scheduled every month until 6 months of age and every 2 months until 12 months of age. All of the 3 z-scores for weight for age (WAZ), length for age (HAZ), and weight for length (WHZ) were calculated using WHO Anthro for Personal Computers software.
  
  
  RESULTS
  The average sensitivity and specificity for the visual clinical assessment for the detection of thinness were higher using the WHO 2006 standard as compared with using NCHS 1977. However, the overall sensitivity of the visual clinical assessment for the detection of thin and lean children was lower from 1 month of age until a year as compared with the WHO 2006 standard and NCHS 1977 reference. The positive predictive value (PPV) for the visual clinical assessment versus the WHO 2006 standard was almost doubled as compared with the PPV of visual clinical assessment versus the NCHS 1977 reference. The overall average sensitivity, specificity, PPV, and negative predictive value for the detection of stunting was higher for visual clinical assessment versus the WHO 2006 standard as compared with visual clinical assessment versus the NCHS 1977 reference.
  
  
  CONCLUSIONS
  The sensitivity and specificity of visual clinical assessment for the detection of wasting and stunting among infants are better for the WHO 2006 standard than the NCHS 1977 reference.
authors.affiliation: Nutrition Research Division, Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia. rusidah.s@iku.moh.gov.my
authors.forename: Rusidah
authors.initials: R
authors.lastname: Selamat
authors.forename: Fuziah
authors.initials: F
authors.lastname: Zain
authors.forename: Junidah
authors.initials: J
authors.lastname: Raib
authors.forename: Rosini
authors.initials: R
authors.lastname: Zakaria
authors.forename: Mohd Shaffari
authors.initials: MS
authors.lastname: Marzuki
authors.forename: Taziah Fatimah
authors.initials: TF
authors.lastname: Ibrahim
mesh_terms: D000886:Anthropometry / Q000379:methods*; D005260:Female; D006128:Growth; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000592:standards*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D009309:National Center for Health Statistics, U.S.; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States; D019282:Wasting Syndrome / Q000453:epidemiology; D014944:World Health Organization