Adoption of the WHO Child Growth Standards to Classify Indonesian Children under 2 Years of Age According to Nutrition Status: Stronger Indication for Nutritional Intervention

Abstract

The National Center for Health Statistics/World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries. To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status. Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than -2.0. We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew. The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.