Multiple Anthropometric Failures Research Articles

Assessment of Undernutrition Among Under-Five Children by Using Composite Index of Anthropometric Failure (CIAF)

Undernutrition is acknowledged as a significant public health concern across many developing nations. Anthropometric measures serve as crucial tools for estimating the extent of undernutrition in children globally. The Composite Index of Anthropometric Failure (CIAF), offers a comprehensive assessment of undernutrition, aggregating various anthropometric indices to identify single or multiple anthropometric failures in children under five. This study aims to evaluate the prevalence of undernutrition using anthropometric measures and CIAF among urban slum children. Conducted as a cross-sectional community-based investigation in the slum areas of Sambalpur District, Odisha, India, the study employed standard procedures to measure height and weight anthropometrically. Age-sex-specific Z-score values for weight-for-age, height-for-age, and weight-for-height were calculated. A Z-score below -2.00 for any anthropometric index was indicative of undernourishment. The prevalence of undernutrition was determined using the standard CIAF classification. The study found an overall prevalence of wasting, underweight, stunting, and CIAF at 22.4%, 34.7%, 40.7%, and 58%, respectively. Sex-specific prevalence rates for wasting (23.9% vs. 20.9%), underweight (37.3% vs. 32.2%), stunting (39.9% vs. 41.5%), and CIAF (60.1% vs. 56%) exhibited statistically non-significant differences between boys and girls (p > 0.05). Notably, the investigation highlighted the CIAF's utility as it revealed a higher magnitude of undernutrition compared to conventional anthropometric measures.

Determinants of aggregate anthropometric failure among children under-five years in Ethiopia: Application of multilevel mixed-effects negative binomial regression modeling.

Undernutrition significantly contributes to failure to thrive in children under five, with those experiencing multiple forms of malnutrition facing the highest risks of morbidity and mortality. Conventional markers such as stunting, wasting, and underweight have received much attention but are insufficient to identify multiple types of malnutrition, prompting the development of the Composite Index of Anthropometric Failure (CIAF) and the Composite Index of Severe Anthropometric Failure (CISAF) as an aggregate indicators. This study aimed to identify factors associated with CIAF and CISAF among Ethiopian children aged 0-59 months using data from the 2019 Ethiopia Mini Demographic and Health Survey. The study included a weighted sample of 5,259 children and used multilevel mixed-effects negative binomial regression modeling to identify determinants of CIAF and CISAF. The result showed higher incidence-rate ratio (IRR) of CIAF in male children (adjusted IRR = 1.27; 95% CI = 1.13-1.42), children aged 12-24 months (aIRR = 2.01, 95%CI: 1.63-2.48), and 24-59 months (aIRR = 2.36, 95%CI: 1.91-2.92), those from households with multiple under-five children (aIRR = 1.16, 95%CI: 1.01-1.33), poorer households (aIRR = 1.48; 95%CI: 1.02-2.15), and those who lived in houses with an earthen floor (aIRR = 1.37, 95%CI: 1.03-1.82). Similarly, the factors positively associated with CISAF among children aged 0-59 months were male children (aIRR = 1.47, 95% CI = 1.21-1.79), age group 6-11 months (aIRR = 2.30, 95%CI: 1.40-3.78), age group 12-24 months (aIRR = 3.76, 95%CI: 2.40-5.88), age group 25-59 months (aIRR = 4.23, 95%CI: 2.79-6.39), children from households living with two and more under-five children (aIRR = 1.27, 95%CI:1.01-1.59), and children from poorer households (aIRR = 1.93, 95% CI = 1.02-3.67). Children were more likely to suffer from multiple anthropometric failures if they were: aged 6-23 months, aged 24-59 months, male sex, living in households with multiple under-five children, and living in households with poor environments. These findings underscore the need to employ a wide range of strategies to effectively intervene in multiple anthropometric failures in under-five children.

Prevalence and patterns of anthropometric failure among under-five children in Nigeria: Evidence from the National nutrition and health survey, 2018.

Globally, malnutrition among under-five children remains a public health concern. There is increasing concern at research and policy levels about anthropometric failure and the double burden of child malnutrition across different groups of children. The objective of this study was to describe the magnitude and distribution of various forms of anthropometric failure (AF) among children under age five in Nigeria. We used the 2018 National Nutrition and Health Survey data collected among 19,471 under-five children in Nigeria. The most prevalent AF was stunting only (17.7%) followed by stunting and underweight (13.9%). Wasting, stunting and underweight was found among 3.5% of the sample. Wasting, stunting and underweight was most common in age 6-11 months (7.0%) and 12-23 months (6.9%). Overall, about 1 out of 5 under-five children has multiple anthropometric failure. The peak age group for multiple AFs was between six months and 35 months. Multiple AF was less likely among females compared to males (RR=0.74, CI: 0.69, 0.80). The risk of multiple AF was higher in both North East (RR=2.15, CI: 1.78, 2.59) and North West (RR=2.98, CI: 2.51, 3.55) relative to the North Central. In contrast, the risk was lesser in the South East (RR=0.75, CI: 0.59, 0.95) and other southern regions. The study showed that multiple anthropometric failure is a common problem among children in Nigeria. Programmes that will support prevention and early identification of different types of malnutrition among under-five children across States in Nigeria are recommended.

Comparison of Different Nutritional Screening Approaches and the Determinants of Malnutrition in Under-Five Children in a Marginalized District of Punjab Province, Pakistan.

Objectives: This research measures the occurrence of malnutrition amongst under-five children in the Rahimyar Khan district of Southern Punjab in Pakistan. Employing different anthropometric measurement approaches such as (1) conventional indices (HAZ, WAZ, and WHZ), (2) CIAF, (3) BMI-for-age, and (4) MUAC, we compare their estimated results and examine the relationship between socioeconomic determinants and different anthropometric indicators. Methods: The study employs a proportional purposive random sampling method to collect data from 384 rural households in the community-based study using a self-administered survey and following the Lady Health Workers (LHWs) registered records. The nutritional status of 517 under-five children is measured with references to WHO (2009) child growth standards. Furthermore, the investigation used the model of binary logistic regression to measure the impact of socioeconomic factors on child malnutrition. Results: Compared with other approaches, the CIAF identifies more malnourished children (63%). The results of binary logistic regression illustrate that all the explanatory variables indicate a more significant empirical association with CIAF than conventional indices, BMI-for-age, and MUAC. Conclusion: CIAF is a more reliable tool for assessing child nutrition because it not only demonstrates more accurate estimates of malnutrition but also recognizes children with multiple anthropometric failures.

Maternal Underweight and Its Association with Composite Index of Anthropometric Failure among Children under Two Years of Age with Diarrhea in Bangladesh.

Malnutrition in women has been a long-standing public health concern, with serious effects on child survival and development. Maternal body mass index (BMI) is an important maternal nutritional indicator. There are few published studies although child anthropometric failures do not occur in isolation and identifying children with single versus several co-occurring failures can better capture cases of growth failure in combination: stunting, wasting, and underweight. In the context of multiple anthropometric failures, traditional markers used to assess children’s nutritional status tend to underestimate overall undernutrition. Using the composite index of anthropometric failure (CIAF), we aimed to assess the association between maternal undernutrition and child undernutrition among children with diarrhea under the age of two and to investigate the correlates. Using 1431 mother-child dyads from the Antibiotic for Children with Diarrhea (ABCD) trial, we extracted children’s data at enrollment and on day 90 and day 180 follow-ups. ABCD was a randomized, multi-country, multi-site, double-blind, placebo-controlled clinical trial. The Bangladesh site collected data from July 2017 to July 2019. The outcome variable, CIAF, allows combinations of height-for-age, height-for-weight, and weight-for-age to determine the overall prevalence of undernutrition. The generalized estimating equation was used to explore the correlates of CIAF. After adjusting all the potential covariates, maternal undernutrition status was found to be strongly associated with child undernutrition using the CIAF [aOR: 1.4 (95% CI: 1.0, 1.9), p-value = 0.043] among the children with diarrhea under 2 years old. Maternal higher education had a protective effect on CIAF [aOR: 0.7 (95% CI: 0.5, 0.9), p-value = 0.033]. Our study findings highlight the importance of an integrated approach focusing on maternal nutrition and maternal education could affect a reduction in child undernutrition based on CIAF.

Comparison of Child Undernutrition Anthropometric Indicators Across 56 Low- and Middle-Income Countries

The United Nations' Sustainable Development Goal Target 2.2 seeks to end all forms of malnutrition by 2030 by meeting targets, including the elimination of stunting and wasting in all children younger than 5 years. Such indicators are used to monitor childhood undernutrition but may not provide a complete picture at a population level. To compare global estimates of the prevalence of undernutrition using conventional indicators of anthropometric failure (AF; stunting, underweight, and wasting); the Composite Index of Anthropometric Failure (CIAF); and a proposed classification system called Categories of Anthropometric Failure (CAF) as well as to investigate the association of the conventional indicators, CIAF, and CAF with diarrheal disease as an assessment of the validity of each measure. Cross-sectional study of the prevalence of undernutrition among children in 56 low- and middle-income countries using data from the nationally representative Demographic and Health Surveys. The study included 530 906 children younger than 5 years. Data were collected from June 2005 to December 2018 and analyzed from September 27, 2020, to February 4, 2021. Undernutrition identified according to conventional indicators (stunting, underweight, and wasting), the CIAF, and the proposed CAF classification system was estimated and compared. Six logistic regression models were used to examine the association between different classifications of anthropometric failure (AF) and morbidity. A total of 530 906 children (mean [SD] age, 29.0 [17.2] months; 272 355 [51.3%] boys and 258 551 [48.7%] girls) from 56 low- and middle-income countries were included in the analysis. Estimates of undernutrition generated using the conventional indicators of stunting, underweight, and wasting were lower than estimates generated using the CIAF in all countries. The CAF classification system pointed to considerable variation across countries in children with multiple AFs, which does not correspond to the overall prevalence of undernutrition. For example, 7.5% of children in Niger and 7.1% of children in Timor-Leste were stunted, underweight, and wasted, while 56.0% of children in Niger and 71.1% of children in Timor-Leste were undernourished according to the CIAF. In addition, children who had stunting, underweight, and wasting had 1.52 (95% CI, 1.45-1.61) times the odds of diarrhea compared with children who exhibited no AFs. The results of this study highlight the importance of using different approaches to aid understanding of the entire spectrum of AF with regard to research and development of policies and programs to address AF. The use of the CIAF and the CAF classification system may be useful for treatment to prevent AFs and could accelerate progress in meeting targets for the Sustainable Development Goal.

Associations of single versus multiple anthropometric failure with mortality in children under 5 years: A prospective cohort study

Background/objectivesStunting, underweight, and wasting are used to monitor nutritional status in children, but they do not identify children with concurrent anthropometric failures (AF). Our study estimates the association between AF and mortality in children with single versus multiple failures, then calculates the percentage of child deaths attributable to AF. Subjects/methodsUsing data from a prospective, longitudinal study of 3605 children from age 1 to age 5 years in Ethiopia and India, we estimate the association between AF and mortality using conventional definitions (stunting, underweight, and wasting) and the mutually exclusive categories of stunted only underweight only, wasted only, stunted and underweight (SU), underweight and wasted, and stunted, underweight, and wasted (SUW), adjusting for socioeconomic status and other demographic variables. Last, we calculate the population attributable fraction. ResultsChildren who were SU and SUW had 3.20 (95% CI: 1.69, 6.06; p < 0.001) and 5.52 (95% CI: 2.25, 13.56; p < 0.001) times the odds of death in fully adjusted models by Round 2 compared to children with no failure, while no increased mortality risk was found among children with other categories of failure. We estimate that 42.69% of child deaths can be attributed to children who are SUW (17.02%) or SU (25.67%), accounting for nearly 80% of child deaths from AF. ConclusionsThis study provides new insight to programs and policy to better identify children most at risk of malnutrition-related mortality.

Assessment of Risk Factors and Prevalence of under Nutrition Using Composite Index of Anthropometric Failure (CIAF) among under 5 Children in a Tertiary Care Center

Background: Under nutrition is a major health problem in the developing countries especially India. It has a significant impact to child morbidity and mortality.&#x0D; Objective: To assess the risk factor and prevalence of under nutrition among children under 5 years of age, using conventional indices and the Composite Index of Anthropometric Failure (CIAF), and then comparing their estimated results.&#x0D; Materials and Methods: This cross-sectional study was carried out in the pediatrics department (outpatient and inpatient) from January 2021 to March 2021 using sample size of 300. Attendants of Toddler’s were interviewed with semi structured proforma and height and weight of toddler were measured by measuring tape and weighing machine respectively. Informed consent was obtained. MS excel was used for data analysis after compilation.&#x0D; Results: CIAF identified 96% of childrens to have under nutrition. By using conventional indices it was seen that 62.8% of the children were underweight, 50% were stunted and 44.4% were wasted.&#x0D; Conclusion: CIAF gives a better estimate of under nutrition than currently used conventional indices; and identifies more children with multiple anthropometric failures.

Socio-economic inequality in anthropometric failure among children aged under 5\u2009years in India: evidence from the Comprehensive National Nutrition Survey 2016\u201318

BackgroundConventional indicators used to access the nutritional status of children tend to underestimate the overall undernutrition in the presence of multiple anthropometric failures. Further, factors contributing to the rich-poor gap in the composite index of anthropometric failure (CIAF) have not been explored. This study aims to estimate the prevalence of CIAF and quantify the contribution of factors that explain the rich-poor gap in CIAF.MethodsThe present study used data of 38,060 children under the age of five years and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey of children and adolescents aged 0–19 years in India. The CIAF outcome variable in this study provide an overall prevalence of undernutrition, with six mutually exclusive anthropometric measurements of height-for-age, height-for-weight, and weight-for-age, calculated using the World Health Organization (WHO) Multicenter Growth Reference Study. Multivariate regression and decomposition analysis were used to examine the association between covariates with CIAF and to estimate the contribution of different covariates in the existing rich-poor gap.ResultsAn overall CIAF prevalence of 48.2% among children aged aged under 5 years of age was found in this study. 6.0% children had all three forms of anthropometric failures. The odds of CIAF were more likely among children belonging to poorest households (AOR: 2.41, 95% CI: 2.12–2.75) and those residing in urban area (AOR: 1.06, 95% CI 1.00–1.11). Children of underweight mothers and those with high parity were at higher risk of CIAF (AOR: 1.51, 95% CI: 1.42–1.61) and (AOR: 1.15, 95% CI: 1.08–1.22), respectively. Children of mother exposed to mass media were at lower risk of CIAF (AOR: 0.87, 95% CI: 0.81–0.93).ConclusionThis study estimated a composite index to assess the overall anthropometric failure, which also provides a broader understanding of the extent and pattern of undernutrition among children. Findings show that maternal covariates contribute the most to the rich-poor gap. As well, the findings suggest that intervention programs with a targeted approach are crucial to reach the most vulnerable groups and to reduce the overall burden of undernutrition.

Tracking progress in anthropometric failure among under-five children in Ethiopia: a geospatial and multilevel analysis

BackgroundUndernutrition is a major public health concern among under-five children in many developing countries. This work evaluated the overall prevalence of under-nutrition by using a composite index of anthropometric failure (CIAF), which helps in the detection of children with multiple anthropometric failures. This research also includes the Spatio-temporal distribution of childhood anthropometric failures across time.MethodsSecondary data was obtained from the Ethiopian Demographic and Health Survey for the survey 2005, 2011, and 2016 years. Data included 23,864 samples of children between the ages of 0–59 months, which is a nationally representative sample in Ethiopia. Other than descriptive statistics, the multivariate multilevel logistic regression was used to identify associated factors, and Getis-Ord spatial statistical tools were employed to identify high and low hotspots areas of anthropometric failures.ResultThe prevalence obtained with CIAF in 2005, 2011, and 2016 was, 53.5 %, 51 %, and 46.2 % of children were suffering from under-nutrition respectively. The spatial analysis revealed areas that are at a higher risk of anthropometric failures consistently were found in northern parts of the country, largely in the Amhara, Tigray, and Afar regions. Multilevel logistic regression analysis showed that the risk of anthropometric failure was higher among older children, had low birth weight, had a mother with low BMI, was in a rural area, had mothers and fathers without formal education.ConclusionsIn addition to identifying wasted, stunted, and underweight children, CIAF also identified children with multiple conditions, which are often overlooked in nutritional surveys. As revealed by this composite index, the prevalence of anthropometric failure remains considerably high and its spatial distribution also significantly varied across the regions in the country. The established socio-demographic characteristics and districts with a higher risk of anthropometric failure can be used to develop localized intervention and prevention strategies to improve Ethiopian children’s nutritional status and healthcare.

The burden of anthropometric failure and child mortality in India

The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015–16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household’s economic wellbeing, mother’s educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother’s educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.

Prevalence and correlates of the composite index of anthropometric failure among children under 5years old in Bangladesh.

The prevalence of stunting, wasting, and underweight are reported separately. However, the data of the multiple anthropometric failures combinations of these conventional indicators are scant. This study attempted to estimate the overall burden of undernutrition among children under 5 years old, using the composite index of anthropometric failure (CIAF), and to explore the correlates. The study used secondary data from the Bangladesh demographic and health surveys (BDHS), undertaken in 2014. CIAF provides an overall prevalence of undernutrition, which gives six mutually exclusive anthropometric measurements of height‐for‐ age, height‐for‐weight, and weight‐for‐age. Multivariable logistic regression was used to explore the correlates of CIAF. The overall prevalence of undernutrition using the CIAF was 48.3% (95% CI [47.1%, 49.5%]) among the children under 5 years old. The prevalence of anthropometric failure due to a combination of both stunting and underweight was 18.2%, wasting and underweight was 5.5%, and wasting, underweight, and stunting was 5.7%. The odds of CIAF were higher among young maternal age, having the poorest socio‐economic status, living in rural areas, higher order of birth, and received no vaccination compared with other counterparts. In Bangladesh, one out of two children has undernutrition, which is preventing the potential of the millions of children. Mothers who gave birth before age 20 living in the rural areas with belonging to lower socio‐economic status and whose children had a higher order of birth and receive no vaccination were observed as the main determinants of undernutrition. Nutrition sensitive interventions along with social protection programmes are crucial to deal the underlying causes of undernutrition.

Assessing Progress towards SDG2: Trends and Patterns of Multiple Malnutrition in Young Children under 5 in West and Central Africa

The co-occurrence of different forms of malnutrition in young children is known to carry differential risks of morbity and mortality. Despite this, there are few, if any, systematic analyses of the prevalence of multiple anthropometric failures (or deficits) in young children under 5. This paper presents the results of the first such an analysis done on data from one of the poorest geographic regions of the world – West and Central Africa. Using data from the demographic and health surveys (DHS) and UNICEF’s Multiple Indicator Cluster Surveys (MICS), the paper details the prevalence and patterning of child malnutrition using a combination of conventional measures and the Composite Index of Anthropometric Failure (CIAF) for the period 1990–2015. It shows the advantages of the CIAF indicator for gauging the full extent of malnutrition and the ability of an indicator of ‘Multiple Malnutrition’ to identify children under 5 with higher risk of mortality. It also shows how relatively little progress has been made in reducing the extent of malnutrition and emphasises the importance of tracking progress by looking at both rates and total number of affected children. Malnutrition across the region remains strongly associated with household wealth and education. Poorer, rural households are much more likely to experience malnutition, but the widespread prevalence of poor living conditions in urban areas has the potential to undermine any gains made in reducing malnutrition.

The Interaction between Morbidity and Nutritional Status among Children under Five Years Old in Cambodia: A Longitudinal Study.

Even though limited evidence is available, the relationship between morbidity and under-nutrition among children under-five is likely to be a strong two-way association. This study aims to explore this vicious cycle by employing longitudinal data of four periods within a 24 month follow-up, whereby morbidity was captured between two subsequent anthropometric measures. Malnutrition was classified according to z-scores of anthropometric measures and morbidity by number of sick days experienced in between. Mixed-effects models were used to assess this relation, where dependency of morbidity and nutritional status were interchanged; models were adjusted for province, age, gender, wealth index score, maternal education level, diet, and Water, Sanitation, and Hygiene indicators. Stunting and wasting prevalence were 29.9% and 8.9%, respectively, where 21.3% of the children had multiple anthropometric failures. Children identified as wasted were 35% more likely to experience prolonged illness periods (OR: 1.35, 95% CI: 1.02–1.56). Those experiencing high proportion of sick days were found to be 64% more likely to become stunted (OR: 1.64, 95% CI: 1.18–2.29). This study suggests that the link between wasting and stunting could be partly explained by acute illness, where wasting increases the likelihood of prolonged episodes of illness, which increases the risk of stunting.

Composite Index of Anthropometric Failure (CIAF) among Sonowal Kachari tribal preschool children of flood effected region of Assam, India

Undernutrition is considered to be a serious public health problem in most of the developing countries. Globally, the anthropometric measures are widely used to estimate the magnitude of undernutrition in children. The Composite Index of Anthropometric Failure (CIAF) provides the overall magnitude of undernutrition as an aggregate single measure over the conventional anthropometric indices and helps in identification of single or double or multiple anthropometric failures in preschool children. The present investigation assesses the age-sex specific prevalence of undernutrition using both conventional anthropometric measures and CIAF among Sonowal Kachari tribal preschool children of Assam, India. This cross-sectional investigation was carried out among 362 (162 boys and 190 girls) Sonowal Kachari tribal children younger than 5 years of flood affected regions of Lakhimpur district of Assam, India. Anthropometric measurements of height and weight were measured using standard procedures. Age-sex specific Z-score value of weight-for-age, height-for-age and weight-for-height were calculated by using WHO-Anthro, v. 3.2.2. A child Z-score &lt;−2.00 of any anthropometric indices was considered to be undernourished and the standard CIAF classification was used to calculate the prevalence of undernutrition. The overall prevalence of wasting, underweight, stunting and CIAF was observed to be 11.6%, 22.9%, 36.2%, and 48.6%, respectively. The sex-specific prevalence of wasting (15.8% vs. 6.9%), underweight (30.5% vs. 14.5%) and stunting (42.1% vs. 29.6%) observed to be significantly higher among girls than boys (p&lt;0.05). The girls (61.05%) were found to be more affected than boys (34.9%) by CIAF (p&lt;0.01). The present investigation reported higher magnitude of undernutrition using CIAF over conventional anthropometric measures, hence the CIAF is relatively better indicator that reflects higher magnitude of undernourishment as compared to any conventional anthropometric indices in children. This research investigation has also reinforced the importance of appropriate intervention programme and strategies needed to reduce the prevalence of undernutrition in childhood and in population as a whole.

Are household food security, nutrient adequacy, and childhood nutrition clustered together? A cross-sectional study in Bankura, West Bengal

Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. A cross-sectional study was conducted during 2016-2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. Overall, 74 (29.1%) households had "food security," whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A "Composite Index of Food Scarcity" comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose-response relationship with grades of anthropometric failure of under-five children. An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Multiple anthropometric failures and early child development in 34 low- and middle-income countries

Multiple anthropometric failures and early child development in 34 low- and middle-income countries

Assessment of undernutrition using Composite Index of Anthropometric Failure among children aged &lt; 5 years in rural Yemen

Impaired nutritional status is a major health problem affecting young children in developing countries that has a significant impact on child morbidity and mortality. This study aimed to assess the prevalence of undernutrition among children aged < 5 years, using conventional indices and the Composite Index of Anthropometric Failure (CIAF), and then comparing their estimated results. A community-based cross-sectional study was conducted and information was collected through house-tohouse visits using precoded structured records. We analysed data from 1292 children aged 6-59 months, from Ahwar and Al-Mahfed rural districts in Abyan Governate, South Yemen, with reference to the 2006 World Health Organization growth standards. CIAF identified undernutrition in 70.1% of children, while conventional anthropometric indices revealed 38.5% stunting, 39.9% wasting, and 55.1% underweight. Compared with conventional indices, CIAF aggregate recognized 31.6%, 30.2% and 15% more undernourished children than stunting, wasting and underweight separately. According to CIAF, 21% had a single anthropometric failure and 49.2% exhibited multiple failures. Stunting Index, Wasting Index and Underweight Index were 0.55, 0.57 and 0.79, respectively. CIAF gives a better estimate of undernutrition than currently used conventional indices; identifies more children with multiple anthropometric failures; and reflects a wider view of the extent and pattern of undernutrition of children living in communities with limited resource settings.

Community management of acute malnutrition (CMAM) programme in Pakistan effectively treats children with uncomplicated severe wasting.

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6–59 months who were admitted to the programme with a mid‐upper arm circumference (MUAC) < 115 mm (January 1–December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6–23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight‐for‐height (WHZ) < −3 and/or height‐for‐age (HAZ) < −2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ −2 at admission. The odds of recovery on the basis of WHZ ≥ −2 were significantly higher among children with WHZ ≥ −3 and/or HAZ < −2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population‐level impact could be increased by giving priority to children 6–23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.

Assessment of undernutrition using composite index of anthropometric failure among children less than 5 years in an urban slum, Visakhapatnam

Background: Under nutrition continues to be a major public health problem in India despite years of incessant preventive measures. Composite index of anthropometric failure (CIAF) provides the burden of under nutrition as a single measure and helps in detection of children with multiple anthropometric failures. The objectives of this study are to assess the prevalence of under nutrition using CIAF as compared to conventional indicators and to identify the risk factors associated with Anthropometric Failure.Methods: This was a community based, cross sectional descriptive study on Under 5 children done in the urban slum area under Allipuram Urban Health Centre, Visakhapatnam, A.P. Anthropometric measurements (height, weight and mid upper arm circumference) were taken and mothers of the study children were interviewed to obtain relevant information. WHO Z-score system and the CIAF were used to estimate the magnitude of under-nutrition.Results: Out of 100 children, 56 children were suffering from under nutrition according to CIAF. Analysis of various factors showed that low birth weight, lesser duration of breast feeding, low education level of mother, over crowding and low socio economic status were significantly associated with under nutrition assessed by CIAF.Conclusions: CIAF provides the actual prevalence or proportion of undernourished children in a community. So CIAF must be included in regular recordings of health status of children. The study also reinforces the importance of appropriate maternal care, proper infant and child feeding practices and family planning services in prevention of under nutrition.