Measuring malnutrition -The role of Z scores and the composite index of anthropometric failure (CIAF)

• Main Authors: Seetharaman N, Chacko T, Shankar SLR, Mathew A
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2007-01-01
• Series: Indian Journal of Community Medicine
• Subjects: Z-Score Classification; Composite Index of Anthropometric Failure (CIAF); Anthropometry; Malnutrition; ICDS.
• Online Access: http://www.ijcm.org.in/article.asp?issn=0970-0218;year=2007;volume=32;issue=1;spage=35;epage=39;aulast=Seetharaman

<b>Background : </b> The current WHO recommendation is to use the Z-Score or SD system to grade undernutrition which allows us to measure all the three indices and express the results in terms of Z scores or standard deviation units from the median of the international reference population. <b> Objectives : </b> To estimate the prevalence of undernutrition among under-five children in Coimbatore slums, using the Z-Score system of classification and the recently constructed Composite Index of Anthropometric Failure (CIAF). 2. To compare the Z-Score system with the Indian Academy of Pediatrics (IAP) classification of undernutrition. <b> Methods : </b> Nutritional assessment was done using anthropometry and clinical examination. Children were weighed and measured as per the WHO guidelines on Anthropometry. Epi-Info 2002 software package was used to calculate the Z scores and for statistical analysis. <b> Results : </b> Only 31.4&#x0025; of the children studied were normal; 68.6&#x0025; were in a state of "Anthropometric Failure". As per the Z score system, 49.6&#x0025; were underweight (21.7&#x0025; severely); 48.4&#x0025; were stunted (20.3&#x0025; severely) and 20.2&#x0025; were wasted (6.9&#x0025; severely). Whereas, as per IAP criteria, 51.4&#x0025; were undernourished and 3.2&#x0025; were severely undernourished. Using Underweight (low weight-for-age) as the only criterion for identifying undernourished children (as done in the Integrated Child Development Services currently) may underestimate the true prevalence of undernutrition, by as much as 21.9&#x0025;. <b> Conclusions : </b> More widespread use of the Z-Score system is recommended for identifying all the facets of undernutrition. Estimates of the true prevalence of undernutrition must incorporate a composite index of anthropometric failure.