HAZ Scores Research Articles

Nutritional risk factors for hookworm infection among school age children in the Kintampo North Municipality, Ghana

Hookworm is highly prevalent in the Kintampo North Municipality of Ghana, and a previous study identified a significant relationship between BMI and infection status in adults.ObjectivesTo investigate the role of nutritional status and dietary risk factors on hookworm infection and response to deworming treatment in school‐age children.MethodsChildren (n=812) ages 6 to 11 years attending 16 schools were screened for participation on the basis of HAZ scores (low and high). Household level food security and socioeconomic variables, child‐level dietary diversity, hookworm and malaria infection status and response to albendazole were measured in a cross sectional sample (n=286).ResultsPrevalence of hookworm was 39%, and anemia was 62%. Significant risk factors for hookworm infection included lower consumption of protein‐rich food groups (p<0.05), malaria co‐infection (p<0.05), access to health care (p<0.01), and household geographic location (p<0.05) after controlling for age, gender, household wealth, and recent deworming. The degree of stunting and anemia did not correlate with hookworm infection status.ConclusionsDietary diversity may influence the risk of hookworm infection in Ghana. In areas of high prevalence but low intensity infection, hookworm may not cause traditionally recognized clinical sequelae such as anemia and stunting.

Pattern of growth faltering and recovery in under-5 children in India using WHO growth standards — A study on first and third national family health survey

To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. General community. Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. Mean WAZ score at 0 month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.

Migration and child development during the food price crisis in El Salvador

Migration is often used as parts of both ex post and ex ante strategies to mitigate risks to household incomes. There is little empirical evidence, however, of the way that migration actually helps households in times of shocks. In this paper, I describe how the peak of the worldwide food price crisis affected anthropometric statistics among young children in El Salvador, and how households with access to international migrants were not affected as negatively as households without such access. In 2008, El Salvador experienced food price inflation of 15%, and the evaluation of Red Solidaria, El Salvador’s conditional cash transfer program, shows that height-for-age (HAZ) Z scores among children under 3 years old declined by 0.2 standard deviations on average. In this paper, I use the Red Solidaria evaluation data to assess whether children in households with access to remittances or international migrants were better off than households without access to migration income. Using both repeated cross-sectional data and individual panel data, I find that as theory would expect, children in households with access to international migrants have much lower declines in their HAZ scores.

The nutrition status of children aged 6-23 months after three months of Wenchuan Earthquake in Beichuan and Lixian, Sichuan Province

This project aims to investigate the nutrition status of children aged from 6 to 23 months living in Beichuan and Lixian where were seriously affected by the earthquake in 2008. The height, body weight and hemoglobin concentration were measured for 478 children from Leigu township, Qushan township in Beichuan county and Zagunao township, Xuecheng township and Putou township in Lixian county; the number of group 6 - 11, 12 - 17, 18 - 23 months were 190, 144, 144 respectively. The height for age (HAZ), the body weight for age (WAZ) and the weight for height (WHZ) were calculated respectively. The low weight, stunting, wasting prevalence, anemic rate were analyzed. The WAZ scores of 6 - 23 months males and females in Beichuan county and Lixian county ranged from -0.97 to -0.13 and from -0.67 to -0.23, HAZ scores ranged from -1.23 to -0.31 and from -1.25 to -0.38, respectively. The WAZ (-0.89 ± 1.16) and HAZ (-1.20 ± 1.60) of 18 - 23 months infants in Beichuan county were significantly different from the WAZ and HAZ of 6 - 11 months (WAZ: -0.32 ± 0.92; HAZ: -0.58 ± 0.98) and 12 - 17 months (WAZ: -0.47 ± 1.00; HAZ: -0.68 ± 1.34) infants (F values were 7.161 and 4.584, respectively; all P values < 0.05). The WAZ (-0.63 ± 1.03) and HAZ (-1.11 ± 1.15) of 18 - 23 months in Lixian county infants were significantly different from the WAZ and HAZ of 6 - 11 months (WAZ: -0.23 ± 0.93; HAZ: -0.51 ± 1.55) infants and 12 - 17 months (WAZ: -0.58 ± 0.52; HAZ: -0.80 ± 1.19) (F values were 3.156, 4.345, all P values < 0.05). The prevalence of low weight infants (18 - 23 months) these two counties were 15.6% (12/77) and 9.1% (6/66), respectively. The prevalence of stunting in Beichuan and Lixian have reached 26% (20/77) and 24.2% (16/66), respectively. The wasting rate of 18 - 23 months infants had reached 9.1% (7/77) in Beichuan. The total anemia prevalence among infants reached 49.6% (123/248) and 78.8% (178/226) in Beichuan and Lixian, respectively. The prevalence of moderate anemia have reached 7.7% (19/248) and 19.9% (45/226), respectively. After the earthquake in Beichuan, Lixian, the growth of infants aged 6 to 23 months old was below average. The prevalence of anemia was high. The malnutrition status of infant and young children aged from 18 to 23 months in Beichuan and Lixian was more serious, should be targeted of nutrition interventions.

Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi. All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models. A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4-11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from -2.1 (-2.7 to -1.3) and -2.6 (-3.6 to -1.8) to -1.4 (-2.1 to -0.8) and -1.8 (-2.4 to -1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART. Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.

Impact of intestinal permeability, inflammation status and parasitic infections on infant growth faltering in rural Bangladesh

A longitudinal study of 298 rural Bangladeshi infants found evidence of growth faltering starting at 3 months of age. Anthropometric status declined substantially in the first 2 years of life, with weight-for-height (WHZ) falling from - 0.49 to - 1.75, weight-for-age (WAZ) from - 1.18 to - 2.87 and height-for-age (HAZ) from - 1.00 to - 1.88. Higher concentrations of the acute-phase protein alpha-1-acid glycoprotein (AGP) and higher gut mucosal damage (as signified by raised lactulose:mannitol (L:M) ratios) were both associated with chronic malnutrition as indicated by poorer HAZ and WAZ scores (P = 0.011 and 0.005 for AGP and 0.039 and 0.019 for L:M ratio, respectively). Higher Hb levels were related to improved z-scores, while elevation of Giardia-specific IgM titre (GSIgM) was associated with poor WAZ and WHZ (P = 0.015 and 0.039, respectively). IgG did not show any significant association with z-scores and the L:M ratio did not correlate with any of the inflammation markers or Giardia infection. The prevalence of geohelminth infections was low (only 4 % in the total study period). However, the level of GSIgM indicated high endemicity of Giardia infection from early in life, although very few cysts were detected from stool samples. These findings suggest that rural Bangladeshi infants are being exposed to high levels of infection with concomitant gut damage and growth faltering.

Index for measuring child feeding practices

The present investigation was undertaken with the objective of creating an Infant and Child Feeding Index (ICFI) from a set of complementary feeding (CF) practices and to determine its association with growth of infants and young children (6-23 months). A semi-structured interview schedule was used to collect information for 204 children from one large slum (n=104) and two private pediatric clinics (n=100) of urban Vadodara. Results revealed that about half (50.5%) of the children were stunted Ht for Age Z score (HAZ<-2SD), nearly one-fourth (25.5%) were underweight Wt for Age Z score (WAZ<-2SD), but wasting (WHZ Wt for Ht Z score<-2SD) was low (3%). Significant associations were revealed between almost all positive CF practices and nutritional status of the children as measured by HAZ and WAZ (p<0.01), but not with WHZ. Good associations were revealed between ICFI and HAZ and WAZ, but not with WHZ. On multivariate analysis of factors affecting the HAZ, WAZ and WHZ scores, ICFI was not found to be significant whereas maternal education was the most significant factor, which was also found to be associated significantly with ICFI. It is concluded that the composite index in its present form can reflect the CF practices more holistically than just one or few behaviors studied separately. More research is needed in the direction of constituting a composite index which can then be used for research, monitoring, evaluation and much needed advocacy for complementary feeding.

Wasting and Intestinal Barrier Function in Children Taking Alanyl‐Glutamine–Supplemented Enteral Formula

We examined the effect of a diet supplemented with alanyl-glutamine (AG) or placebo glycine (G) on intestinal barrier function and growth in children in northeastern Brazil. One hundred seven children ages 7.9 to 82.2 months with a weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) z-score less than -1 were studied. From July 2003 to November 2004, 51 study patients received AG (24 g/d) and 56 received G (25 g/d; isonitrogenic concentration) control for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed on days 1 and 10 of nutritional supplementation. Weight and height were measured on days 1, 10, 30, and 120 of the protocol. The patients were similar on admission with regard to age, sex, birth weight, nutritional status, lactulose/mannitol ratio, and serum concentrations of glutamine and arginine. The percentage of lactulose urinary excretion significantly improved (decreased) in children receiving AG for 10 days but not in those receiving glycine controls. AG significantly increased cumulative change over 120 days in WHZ and WAZ scores but not HAZ scores after adjustment for age and season in comparison with the placebo glycine group. Children tolerated AG-supplemented enteral formula well, and it significantly improved cumulative WHZ and WAZ over 120 days in comparison with children in the placebo glycine group. The data also suggested a beneficial effect of AG in the barrier function paracellular pathway, albeit with reduced mannitol excretion. Thus, although the effect of AG on reduced mannitol concentration requires clarification, AG appears to improve nutrition and barrier function.

Malaria and Nutritional Status in Children Living on the Coast of Kenya

The relationship between malnutrition and malaria is controversial. On one hand, malaria may cause malnutrition, while on the other, malnutrition itself may modulate susceptibility to the disease. We investigated the association between Plasmodium falciparum malaria and malnutrition in a cohort of children living on the coast of Kenya. The study involved longitudinal follow‐up for clinical malaria episodes and anthropometric measurements at four cross‐sectional surveys. We used Poisson regression analysis to investigate the association between malaria and nutritional status. Compared to baseline (children with a WAZ or HAZ score of ≥−2), the crude incidence rate ratios (IRRs) for malaria in children with low HAZ or WAZ scores (<−2) during the period prior to assessment were 1.17 (95% CI 0.91–1.50; 0 = 0.21) and 0.94 (0.71–1.25; 0.67), respectively, suggesting no association between malaria and the subsequent development of PEM. However, we found that age was acting as an effect modifier in the association between malaria and malnutrition. The IRR for malaria in children 0–2 years old who were subsequently characterized as wasted was 1.65 (1.10–2.20; P = 0.01), and a significant overall relationship between malaria and low‐HAZ was found on regression analysis when adjusting for the interaction with age (IRR 1.89; 1.01–3.53; P < 0.05). Although children living on the coast of Kenya continue to suffer clinical episodes of uncomplicated malaria throughout their first decade, the association between malaria and malnutrition appears to be limited to the first 2 years of life.

Assessment of linear growth of affluent urban Pakistani adolescents according to CDC 2000 references

Summary. Background: The appropriateness of using international reference data for assessing growth of children and adolescents from developing countries has been debated. If the growth performance in at least those sections of the society that may be considered affluent has reached the levels represented by the international reference, the case for adoption of the NCHS reference would be strong. Findings from studies in younger children indicate appropriateness of these standards but data from older children are lacking.Aim: The study aimed to compare the linear growth of affluent Pakistani adolescents living in Karachi with the NCHS reference so as to assess the appropriateness of using these standards for assessing the growth status of Pakistani adolescents.Subjects and methods: Data were collected from 876 girls and 819 boys aged 10–15 years studying in well known and established affluent urban public schools in Karachi. A portable stadiometer (Minimeter by CMS, London) was used for measuring heights. Heights were compared using the United States Center for Disease Control (CDC 2000) reference values to assess growth status.Results: The mean ages of boys and girls were 12.82 and 12.63, respectively. Mean Height for Age Z score (HAZ) (−0.02) was very close to CDC 2000 reference values but the growth pattern was not similar. Younger children were relatively taller and the older children were shorter than CDC standards. Mean HAZ scores for 10, 11, 12, 13, 14 and 15-year-old boys and girls were 1.12 and 1.03, 0.54 and 0.55, 0.47 and 0.26, 0.29 and −0.21, −0.08 and −0.64, −0.19 and −0.53, respectively. The mean HAZ for boys (0.12) was slightly higher and that for girls slightly lower (HAZ = −0.14) than the reference population. Even among the relatively affluent group of children studied HAZ scores increased with relative socio-economic status.Conclusions: Although in terms of averages for 10–15-year-old boys and girls the height status was not very different from CDC standards, the growth curves of Pakistani children was slightly different from CDC 2000 standards. Further studies are needed to assess the appropriateness of using international growth standards for assessing height status of Pakistani adolescents.

Growth of infants during the first 18 months of life in urban and rural areas of southern China.

Observe the growth pattern of infants from birth to 18 months. A prospective study was conducted from 1994 to 1996 in urban and township-rural areas of Guangdong Province, southern China, recruiting 568 and 257 newborn infants, respectively. Anthropometric data was collected at birth, 1.5, 4, 5, 6, 8, 10, 12, 15, and 18 months. The urban infants at birth had Z-scores of weight for age (WAZ), height for age (HAZ) and weight for height (WHZ) below the National Center for Health Statistics (NCHS) median (P < 0.01). However, from 1.5 to 4 months, the WAZ and WHZ scores were above (P < 0.01), but by 7 months fell and remained at - 0.7 to - 0.8 SD below the NCHS median (P < 0.01). HAZ scores improved after birth, were at the NCHS median to 8 months (P = NS), and then decreased to 0.2-0.4 SD below the NCHS median (P < 0.01). Compared with the urban infants, the township-rural infants were lighter and shorter throughout the first 18 months of life, and from 8 months of age, were - 1 SD or more below the NCHS median. Growth retardation was found in this sample of Chinese infants. The magnitude of growth retardation was greater for infants in the township-rural area compared with those in the urban area.

Comparative anthropometrics of 3 to 24-month-old children breastfed in both high and low socio-economic strata in Lagos, Nigeria

This is a cross-sectional study of infants seen in the Nitel Health Centres in Lagos metropolis and Mushin Primary Health Care Centres in the Mushin Local Government Area of Lagos State. A total of 297 infants aged 3–24 months were studied. Anthropometric and breast feeding patterns of the children were studied. The mean weights of the mothers were 67.2 kg for Nitel mothers and 62.11 kg for the mothers in Mushin Primary Health Care Centres. The mean heights for the mothers were 71.47 cm and 66.1 cm, respectively. About 98.8% of the mothers in the Primary Health Care Centres of Mushin breastfed. About 7.4% of the total population studied had WAZ scores of less than −2s.d. while 12.8% had HAZ scores of less than −2s.d. and 7.43% had WHZ scores of less than −2s.d. Malnutrition was considered to be very high. There was a positive correlation between the anthropometric measurement and education. Public Health (2001) 115, 157–162.

Growth and feeding practices of 4 and 8 months infants in Southern China

A cross-sectional study was conducted to observe the growth and feeding practices of infants in Southern China. The study comprised 758 infants at 4 (n = 383) and 8 (n = 375) months of age in Guangzhou City, and 398 infants at 4 months of age in the rural areas of Guangdong Province. Anthropometrics and feeding information were obtained. In the city, the mean Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) of the infants were above the National Center for Health Statistics (NCHS) reference median at 4 months. By 8 months, WAZ and WHZ, but not HAZ scores, were below the NCHS reference median (p < 0.05). Rural infants were lighter and shorter than the NCHS reference at 4 months (p < 0.05). Prevalence of breast feeding was 65% at 4 months and 44% at 8 months for urban infants, but 99% of the rural infants were breastfed at 4 months. Rural infants were fed less commercial baby cereals, high-protein foods, and fruits, but more homemade cereals than urban infants. The attained size of the 4 months old urban infants was positively associated with the exposure loads of breast milk, fruits, and vitamin supplements, but negatively associated with formula, rice porridge, and glucose drinks. Body weight of the 4-month rural infants was negatively associated with the exposure loads of formula and glucose drinks. By 8 months, the growth of the urban infants was associated positively with the exposure loads of fruits, high-protein foods, and vitamins supplements, but negatively with home made cereals and Chinese herbs. Improved feeding practices, including the usage of appropriate weaning and complementary foods, are needed for optimal growth of both urban and rural infants.

Urbanization and child growth in Nepal

The growth of children (0–60 months) of rural-to-urban migrant women was studied in a population of carpet-making workers in a peri-urban community of Kathmandu, Nepal. Mean height-for-age (HAZ) and weight-for-age (WAZ) z-scores are compared for two groups of children belonging to recent urban migrant women (resident <5 years) and to long-term migrants (resident ⩾5 years). The process of urbanization and adaptation to the city environment was explored by examining cohort differences in health care utilization, diarrheal morbidity, breastfeeding practices, demographic, and socioeconomic characteristics. On average, both children of recent and long-term migrants have moderate-to-severe linear growth retardation after 12 months of age. There is, however, a statistically significant difference in mean HAZ and WAZ scores between children depending on maternal length of urban residence status; children of long-term migrants have better growth status compared to children of recent migrants. Nevertheless, there are no significant differences between long-term and recent migrant families in terms of socioeconomic characteristics and selected biobehavioral practices which have been associated with modernization and adaptation to an urban environment. It is concluded that the process of adaptation to an urban environment cannot be explained by standard biobehavioral indicators of modernization and requires further consideration. Am. J Hum. Biol. 10:307–315, 1998. © 1998 Wiley-Liss, Inc.

Urbanization and child growth in Nepal.

The growth of children (0-60 months) of rural-to-urban migrant women was studied in a population of carpet-making workers in a peri-urban community of Kathmandu, Nepal. Mean height-for-age (HAZ) and weight-for-age (WAZ) z-scores are compared for two groups of children belonging to recent urban migrant women (resident <5 years) and to long-term migrants (resident ⩾5 years). The process of urbanization and adaptation to the city environment was explored by examining cohort differences in health care utilization, diarrheal morbidity, breastfeeding practices, demographic, and socioeconomic characteristics. On average, both children of recent and long-term migrants have moderate-to-severe linear growth retardation after 12 months of age. There is, however, a statistically significant difference in mean HAZ and WAZ scores between children depending on maternal length of urban residence status; children of long-term migrants have better growth status compared to children of recent migrants. Nevertheless, there are no significant differences between long-term and recent migrant families in terms of socioeconomic characteristics and selected biobehavioral practices which have been associated with modernization and adaptation to an urban environment. It is concluded that the process of adaptation to an urban environment cannot be explained by standard biobehavioral indicators of modernization and requires further consideration. Am. J Hum. Biol. 10:307-315, 1998. © 1998 Wiley-Liss, Inc.

Field validation of the Tallstick in marginal communities in Nicaragua.

The Tallstick is a new, simplified anthropometric field tool which allows immediate visual interpretation of height-for-age. This tool was field tested in community-based programmes in Managua, Nicaragua, and the rural community of Los Zarzales, screening 1004 children aged 0-60 months for nutritional stunting. Overall sensitivity and specificity analysis comparing HAZ scores and Tallstick results revealed that the Tallstick correctly identified 83-85 per cent of severely stunted children (HAZ < -2.5) and two-thirds of those with HAZ of -2 and below. It also had good positive predictive value for the mildly stunted. As a screening tool for low weight-for-age, the Tallstick performed better than arm circumference. The best of the community volunteers trained with the Tallstick could use it as well as their trainers. Progressive stunting was found in the 280 children in the sample who did not receive any form of milk. The advantages of the Tallstick for community-level screening and the importance of sustained linear growth are discussed.

Growth in children from the Wosera subdistrict, Papua New Guinea, in relation to energy and protein intakes and zinc status

In a cross-sectional study of 123 children aged 24-120 mo from the Wosera subdistrict of Papua New Guinea, height, weight, hematocrit, hemoglobin, hair zinc, and presence of malaria were measured. Two 24-h recalls were undertaken in 67 of the children aged 72-120 mo; 52%, 73%, and 76% had energy, protein, and zinc intakes, respectively, less than two-thirds of the FAO/WHO/UNU recommendations. Stunting was prevalent (29%); 16% were moderately wasted. The prevalence of stunting and hair zinc concentrations less than 1.68 mumol/g was gender related; 38% of males vs 20% of females had Z scores for height-for-age (HAZ scores) less than -2 (P = 0.04); 26% of males vs 11% of females had hair zinc less than 1.68 mumol/g (P less than 0.05). Analysis of variance showed that age, sex, hemoglobin, and log hair zinc influenced HAZ scores, depending on the age group; both sex and the log of the hair zinc values were significant factors in the older children. Stunting in Worsera children was related to chronic deficits in energy and protein and was excerbated in the older male children by suboptimal zinc status.