Anthropometric failures and its predictors among under five children in Ethiopia: multilevel logistic regression model using 2019 Ethiopian demographic and health survey data.

BACKGROUND: Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess undernutrition status of children. There is no study on CIAF to identify the real and severe form of under nutrition among Ethiopian children that addressed community level factors. So, this study determined CIAF and identified important factors which helps to design appropriate intervention strategies by using multi-level advanced statistical model. METHODS: The study included 5,530 under five children and utilized a secondary data (EMDHS 2019) which was collected through community-based and cross-sectionally from March 21 to June 28, 2019. Composite index of anthropometric failure among under five children was assessed and a two-stage sampling technique was used to select the study participants. Descriptive summary statistics was computed. A multi-level binary logistic regression model was employed to identify important predictors of CIAF in under five children. Adjusted odds ratio with its 95% CI was estimated and level of significance 0.05 was used to determine significant predictors of CIAF. RESULTS: The prevalence of composite index of anthropometric failure (CIAF) was 40.69% (95% CI: 39.41, 42.00) in Ethiopia. Both individual and community level predictors were identified for CIAF in under five children. Among individual level predictors being male sex, older age, short birth interval, from mothers who have not formal education, and from poor household wealth quintile were associated with higher odds of CIAF among under five children. Low community women literacy and being from agriculturally based regions were the community level predictors that were associated with higher odds of CIAF in under five children in Ethiopia. CONCLUSIONS: The burden of composite index of anthropometric failure in under five children was high in Ethiopia. Age of child, sex of child, preceding birth interval, mother's education, household wealth index, community women literacy and administrative regions of Ethiopia were identified as significant predictors of CIAF. Therefore, emphasis should be given for those factors to decrease the prevalence of CIAF in under five children in Ethiopia.

Spatial data analysis of malnutrition among children under-five years in Ethiopia.

BACKGROUND: Childhood malnutrition is a major cause of child mortality under the age of 5 in the sub-Saharan Africa region. This study sought to identify the risk factors and spatial distribution of the composite index of anthropometric failure (CIAF). METHODS: Secondary data from 2000, 2005, 2011, and 2016 Ethiopian Health and Demographic Survey (EDHS) were used. The generalized geo-additive mixed model was adopted via the Integrated Nested Laplace Approximation (INLA) with a binomial family and logit link function. RESULTS: The CIAF status of children was found to be positively associated with the male gender, the potency of contracting a disease, and multiple births. However, it was negatively associated with family wealth quartiles, parental level of education, place of residence, unemployment status of mothers, improved sanitation, media exposure, and survey years. Moreover, the study revealed significant spatial variations on the level of CIAF among administrative zones. CONCLUSIONS: The generalized geo-additive mixed-effects model results identified gender of the child, presence of comorbidity, size of child at birth, dietary diversity, birth type, place of residence, age of the child, parental level of education, wealth index, sanitation facilities, and media exposure as main drivers of CIAF. The results would help decision-makers to develop and carry out target-oriented programs.

Assessment of undernutrition using Composite Index of Anthropometric Failure among children aged < 5 years in rural Yemen.

BACKGROUND: Impaired nutritional status is a major health problem affecting young children in developing countries that has a significant impact on child morbidity and mortality. AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Decomposition of body mass growth into linear and ponderal growth in children with application to India.

In this paper, we decompose the difference between the weight of a child and the weight of a reference child into the difference between the height of the child and the height of the reference child and the difference between the weight per unit height of the child and the weight per unit height of the reference child. The decomposition provides the theoretical justification to the classification of the nutritional status proposed by Svedberg and by Nandy et al. An application of the decomposition framework to the Indian data shows that the level, depth and severity of the faltering of the growth of the body mass in Indian children are primarily due to the level, depth and severity of the faltering of the ponderal growth.

Risk factors of child malnutrition under 5 years: Evidence from Pakistan using the Composite Index of Anthropometric Failure.

OBJECTIVES: Child malnutrition is a very serious health issue globally, particularly in emerging countries. Among South Asian countries, Pakistan has been observed to have a high prevalence of child malnutrition. In spite of the implementation of many health strategies and preventive measures for vulnerable populations, this issue is still unresolved and needs further investigation. The purpose of this study was to investigate the role of various social-, maternal-, and child-level factors considered to be responsible for nutritional health disparities among children. METHODS: An assessment method of malnutrition, i.e., Composite Index of Anthropometric Failure (CIAF), was used to detect the prevalence of malnutrition among children under 5 years of age in Pakistan in order to present a comprehensive view that was lacking conventional indices of malnutrition. A binary logistic regression model was fitted to assess the link between malnutrition and socioeconomic, maternal, and child attributes based on CIAF data compiled from weight-for-height, weight-for-age, and height-for-age Z-scores using data from the Pakistan Demographic Health Survey (2017-2018). RESULTS: A total of 4224 children under 5 years of age were included in the analysis. Approximately half of the children (45.34%) comprised anthropometric failures for the overall prevalence of undernutrition based on CIAF. The results of this study revealed that the leading determinant associated with CIAF was the child's age in months, small birth size, lack of breastfeeding, lack of maternal education, poor economic status of the household, and poor-quality water sources. The factors associated with stunting comprised the child's age in months, small child birth size, underweight maternal body mass index, and uneducated mothers. Only one factor-low household economic profile-was significantly associated with waste. Sindh, Baluchistan, and Khyber Pakhtunkhwa provinces had a higher risk of having wasted children. On the other hand, children aged 25-36 months had higher, small child birth size, underweight maternal BMI, un-educated mother, un-educated father, low economic profile of household experiencing of being underweight. CONCLUSIONS: The findings of this study reinforce the significance of maternal health, parental education, and household economic profile in the prevention of malnutrition within young children of adequate birth size, as well as better overall health care up to adolescence in Pakistan. Well-nourished individuals are a valuable human resource and a requirement for a nation's progress and prosperity. In emerging nations such evidence-based policies are crucial for fostering children's optimal physical and mental development to ensure a healthier future generation. Therefore, the execution of national health policies aimed at the improvement of maternal and societal factors could result in improved nutrition levels among children below 5 years of age in Pakistan.

Decoding India's Child Malnutrition Puzzle: A Multivariable Analysis Using a Composite Index.

BACKGROUND: This study examines the levels and predictors of malnutrition in Indian children under 5 years of age. METHODS: Composite Index of Anthropometric Failure was applied to data from the India National Family Health Survey 2019-2021. A multivariable logistic regression model was used to assess the predictors. RESULTS: 52.59% of children experienced anthropometric failure. Child predictors of lower malnutrition risk included female gender (adjusted odds ratio (AOR) = 0.881) and average or large size at birth (AOR = 0.729 and 0.715, respectively, compared to small size). Higher birth order increased malnutrition odds (2nd-4th: AOR = 1.211; 5th or higher: AOR = 1.449) compared to firstborn. Maternal predictors of lower malnutrition risk included age 20-34 years (AOR = 0.806), age 35-49 years (AOR = 0.714) compared to 15-19 years, normal BMI (AOR = 0.752), overweight and obese BMI (AOR = 0.504) compared to underweight, and secondary or higher education vs. no education (AOR = 0.865). Maternal predictors of higher malnutrition risk included severe anemia vs. no anemia (AOR = 1.232). Protective socioeconomic factors included middle (AOR = 0.903) and rich wealth index (AOR = 0.717) compared to poor, and toilet access (AOR = 0.803). Children's malnutrition risk also declined with paternal education (primary: AOR = 0.901; secondary or higher: AOR = 0.822) vs. no education. Conversely, malnutrition risk increased with Hindu (AOR = 1.258) or Islam religion (AOR = 1.369) vs. other religions. CONCLUSIONS: Child malnutrition remains a critical issue in India, necessitating concerted efforts from both private and public sectors. A 'Health in All Policies' approach should guide public health leadership in influencing policies that impact children's nutritional status.

Assessment of undernutrition using the composite index of anthropometric failure (CIAF) and its determinants: A cross-sectional study in the rural area of the Bogor District in Indonesia.

BACKGROUND: The Composite Index of Anthropometric Failure (CIAF) can comprehensively identify undernutrition by combining several indicators of nutritional status - namely, weight-for-age, length/height-for-age and weight-for-length/height - to determine the nutritional status of children under five years of age. This study aims to assess undernutrition using the CIAF and its determinants on children under five years of age in the Bogor District, Indonesia. METHODS: A cross-sectional study was conducted during February-May 2019 among 330 mother-children pairs (with children under five), selected by systematic random sampling from four villages as undernutrition pockets in the rural area of Bogor District, Indonesia. The nutritional status of the children was assessed by measuring weight and length/height. Z-score was calculated using WHO Anthro software and was categorized based on conventional indices, including weight-for-age (WAZ), length/height-for-age (HAZ) and weight-for-length/height (WHZ). The CIAF is measured based on a combination of conventional index measurements. In addition, mothers' and childrens' characteristics and clean living behaviour are assessed via structured questionnaires. Environmental sanitation is assessed using the environment meter. Binary logistic regression analysis with SPSS version 22.0 is used to analyse the dominant factors associated with undernutrition. RESULTS: Among children under five, 42.1% experienced anthropometric failure (overall prevalence of undernutrition based on the CIAF), 2.4% experienced wasting only, 5.8% were classified as both wasting and underweight, 2.1% as wasting, underweight and stunting, 16.4% as underweight and stunting, 11.5% as stunting only, and 3.9% as underweight only. Assessment of nutritional status using a conventional anthropometric index shows that respective prevalences of underweight, stunted and wasted were 27.8, 29.7, and 10.6%. The mother's height is the most dominant factor associated with anthropometric failure [p = 0.008; AOR = 1.95; 95% CI: 2.19-3.19]. The most dominant factors associated with the conventional undernutrition indices of underweight, stunted and wasted are, respectively, family income [p = 0.018; AOR = 5.44; 95% CI: 1.34-22.11], mother's height [p = < 0.001; AOR = 3.29; 95% CI:1.83-5.91] and child's age [p = 0.013; AOR = 2.59; 95% CI: 1.22-5.47]. CONCLUSION: Nearly half of children under five experience anthropometric failure. Specific nutrition improvement interventions and specific nutrition interventions during pregnancy and lactation are needed, especially for malnourished mothers, to prevent malnutrition in infant.

Incidence of Asymptomatic Shigella Infection and Association with the Composite Index of Anthropometric Failure among Children Aged 1-24 Months in Low-Resource Settings.

Asymptomatic or subclinical infection by diarrheal enteropathogens during childhood has been linked to poor health and nutritional outcomes. In this study, we aimed to assess the impact of asymptomatic Shigella infection on different forms of childhood malnutrition including the composite index of anthropometric failure (CIAF). We used data from 1715 children enrolled in the multi-country birth cohort study, MAL-ED, from November 2009 to February 2012. Monthly non-diarrheal stools were collected and assessed using TaqMan Array Cards (TAC). Poisson regression was used to calculate incidence rates of asymptomatic Shigella infection. Generalized estimating equations (GEE) were used to assess the association between asymptomatic Shigella infection and nutritional indicators after adjusting for relevant covariates. Incidence rates per 100 child-months were higher in Tanzania, Bangladesh and Peru. Overall, after adjusting for relevant covariates, asymptomatic Shigella infection was significantly associated with stunting (aOR 1.60; 95% CI: 1.50, 1.70), wasting (aOR 1.26; 95% CI: 1.09, 1.46), underweight (aOR 1.45; 95% CI: 1.35, 1.56), and CIAF (aOR 1.55; 95% CI: 1.46, 1.65) in all the study sites except for Brazil. The high incidence rates of asymptomatic Shigella infection underscore the immediate need for Shigella vaccines to avert the long-term sequelae involving childhood growth.

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.

Public Health Implications of Wasting and Stunting Relationship in Children under Five Years Highly Vulnerable to Undernutrition in Guatemala: The REDAC Study.

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.

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

BACKGROUND: Undernutrition 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. METHODS: Secondary 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. RESULT: The 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. CONCLUSIONS: In 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.

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey.

A poor understanding of malnutrition burden is a common reason for not prioritizing the care of small and nutritionally at-risk infants aged under-six months (infants u6m). We aimed to estimate the anthropometric deficit prevalence in infants u6m attending health centres, using the Composite Index of Anthropometric Failure (CIAF), and to assess the overlap of different individual indicators. We undertook a two-week survey of all infants u6m visiting 18 health centres in two zones of the Oromia region, Ethiopia. We measured weight, length, and MUAC (mid-upper arm circumference) and calculated weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age z-scores (WAZ). Overall, 21.7% (95% CI: 19.2; 24.3) of infants u6m presented CIAF, and of these, 10.7% (95% CI: 8.93; 12.7) had multiple anthropometric deficits. Low MUAC overlapped with 47.5% (95% CI: 38.0; 57.3), 43.8% (95% CI: 34.9; 53.1), and 42.6% (95% CI: 36.3; 49.2) of the stunted, wasted, and CIAF prevalence, respectively. Underweight overlapped with 63.4% (95% CI: 53.6; 72.2), 52.7% (95% CI: 43.4; 61.7), and 59.6% (95% CI: 53.1; 65.9) of the stunted, wasted, and CIAF prevalence, respectively. Anthropometric deficits, single and multiple, are prevalent in infants attending health centres. WAZ overlaps more with other forms of anthropometric deficits than MUAC.

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

BACKGROUND/OBJECTIVES: Stunting, 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/METHODS: Using 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. RESULTS: Children 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. CONCLUSIONS: This study provides new insight to programs and policy to better identify children most at risk of malnutrition-related mortality.

The Effect of "Women's Empowerment" on Child Nutritional Status in Pakistan.

Women's empowerment in terms of both involvements in employment activities and with decision-making about household activities is the most evident factors that can affect the nutritional and health status of their children. This paper investigates the effect of women's empowerment (WE) on children's nutritional (CN) status in Pakistan. The Pakistan demographic health survey (PDHS 2012-13) cross-sectional data was used to analyze the impacts of WE on child malnutrition. The composite index of anthropometric failure (CIAF) was used as a dependent variable to measure the children's nutritional status, and the wealth index household size. The number of children in a house and indicators of women empowerment, which included the mother's education, employment status, and the household decision-making, were used as the independent variables. The method of binary logistic regression with marginal effects was used for the empirical analysis of the results. The results of the study showed the indicators of women's empowerment, such as the education of the mother and employment status had a negative relationship with child malnutrition. Women's decision-making about the visits to family, which is an indicator of WE, had an insignificant effect on CN. Similarly, socioeconomic status, which included the wealth index, also caused a reduction in child malnutrition. In addition, an increase in household size had a positive and significant relation to child malnutrition. Women are the primary caretakers of children in the household, and their intra-household dynamics affect the well-being of individuals. The empowerment of women acts as a means to enhance children's nutritional status, which causes important developmental outcomes.

Are we Underestimating the Real Burden of Malnutrition? An Experience From Community-Based Study.

BACKGROUND: Since the inception of childhood nutritional programs in India, underweight has been taken to judge the nutritional status of children; but is it a true indicator of overall prevalence of malnutrition in a community? OBJECTIVE: To estimate the overall prevalence of malnutrition by using Composite Index of Anthropometric Failure (CIAF) and to assess its usefulness over various conventional anthropometric indicators among under 5 children residing in Agra city. MATERIALS AND METHODS: A cross-sectional, community-based study was conducted among under 5 years age children, from June 2012 to July 2013 in an urban slum of Agra. Nutritional status was assessed using anthropometry and clinical examination, and classified as per World Health Organization (WHO) 2006 Growth Standards and CIAF. RESULTS: Of the 458 children studied, 42.8% were underweight, 41.9% had stunting, while 22.7% had wasting. However, 60.04% of children were found to be malnourished as per the CIAF. Unlike three conventional anthropometric indicators of malnutrition, CIAF was observed to have a much consistent association with morbidity like diarrhea episodes in past 3 months (odds ratio (OR) = 2.09), acute respiratory tract infection (ARI) episode in past 3 months (OR = 1.58), and any illness requiring hospitalization (OR = 1.29). CONCLUSION: The CIAF should supplement the conventional indices of malnourishment, to provide a single, aggregated figure of actual number of undernourished children in a given population.

Índice compuesto de fracaso antropométrico y altura geográfica en infantes jujeños (1-5 años) / Composite index of anthropometric failure and geographic altitude in children from Jujuy (1 to 5 years old)

Introducción. El índice compuesto de fracaso antropométrico (ICFA), integrado por los índices antropométricos habituales y sus combinaciones en 7 categorías, propone una medida agregada para ponderar la desnutrición como alternativa a la evaluación independiente del acortamiento, emaciación y bajo peso. Objetivo. Evaluar el ICFA en la población infantil jujeña asentada a distintos niveles altitudinales. Materiales y métodos. El peso y la talla se tomaron de los controles de niños sanos, de 1-5 años, realizados en los Centros de Atención Primaria (CAP) jujeños entre 2005 y 2007. El estado nutricional (bajo peso, acortamiento y emaciado) se caracterizó con el estándar OMS-2007. El ICFA y sus 7 grupos se calcularon agrupando los datos por sexo, edad y nivel altitudinal (tierras altas: > 2500 msnm; tierras bajas: < 2500msnm). Las diferencias porcentuales del ICFA por altura y sexo y edad se verificaron con la prueba chi-cuadrado. Resultados. Se incluyeron 8059 niños. El ICFA de tierras altas (6,1%) duplicó al de tierras bajas (3,4%) (p < 0,05) y la prevalencia de bajo peso (grupo Y) fue significativamente superior en tierras altas (p < 0,05). El ICFA y el acortamiento (grupo F) aumentaron con la edad, pero el aumento fue significativamente mayor en tierras altas. Conclusiones. Las tierras altas presentaron un IFCA significativamente mayor a expensas del acortamiento. No obstante, el índice de fracaso antropométrico no superó el 10% en los dos niveles, lo que da cuenta de un estado sanitario por desnutrición de escasa magnitud en la población infantil jujeña estudiada.

Introduction. The Composite Index of Anthropometric Failure (CIAF) is made up of typical anthropometric indicators and their combination into seven categories, and proposes an additional measure to study malnutrition as an alternative to the evaluation of stunting, wasting and underweight as separate measures. Objective. To assess the CIAF in the child population settled at different altitudinal zones in Jujuy. Population and Methods. Weight and height were obtained from healthy 1 to 5 year-old control children, measured at primary healthcare centers (PHCCs) in Jujuy between 2005 and 2007. Nutritional status indicators such as underweight, stunting and wasting were determined as per the World Health Organization 2007 child growth standards. The CIAF and its seven categories were estimated by grouping data by gender, age and altitudinal zone (highlands: >2500 MASL; lowlands: <2500 MASL). The CIAF percentage differences for height, gender and age were verified using a chi-square test. Results. A total of 8059 children were included. The CIAF for highland children (6.1%) doubled that for lowland children (3.4%) (p < 0.05), and underweight prevalence (group Y) was significantly higher in the highlands (p < 0.05). The CIAF value and stunting (group F) increased with age, but such increase was more significant in the highlands. Conclusions. A significantly higher CIAF was observed in highland children, at the expense of stunting. However, the index of anthropometric failure was not more than 10% at both the highlands and the lowlands, and this accounts for a scarcely significant malnutrition health status in the studied child population of Jujuy.

Indice compuesto de fracaso antropométrico y altura geográfica en infantes jujeños (1-5 años) / Composite index of anthropometric failure and geographic altitude in children from Jujuy (1 to 5 years old)

Introducción. El índice compuesto de fracaso antropométrico (ICFA), integrado por los índices antropométricos habituales y sus combinaciones en 7 categorías, propone una medida agregada para ponderar la desnutrición como alternativa a la evaluación independiente del acortamiento, emaciación y bajo peso. Objetivo. Evaluar el ICFA en la población infantil jujeña asentada a distintos niveles altitudinales. Materiales y métodos. El peso y la talla se tomaron de los controles de niños sanos, de 1-5 años, realizados en los Centros de Atención Primaria (CAP) jujeños entre 2005 y 2007. El estado nutricional (bajo peso, acortamiento y emaciado) se caracterizó con el estándar OMS-2007. El ICFA y sus 7 grupos se calcularon agrupando los datos por sexo, edad y nivel altitudinal (tierras altas: > 2500 msnm; tierras bajas: < 2500msnm). Las diferencias porcentuales del ICFA por altura y sexo y edad se verificaron con la prueba chi-cuadrado. Resultados. Se incluyeron 8059 niños. El ICFA de tierras altas (6,1%) duplicó al de tierras bajas (3,4%) (p < 0,05) y la prevalencia de bajo peso (grupo Y) fue significativamente superior en tierras altas (p < 0,05). El ICFA y el acortamiento (grupo F) aumentaron con la edad, pero el aumento fue significativamente mayor en tierras altas. Conclusiones. Las tierras altas presentaron un IFCA significativamente mayor a expensas del acortamiento. No obstante, el índice de fracaso antropométrico no superó el 10% en los dos niveles, lo que da cuenta de un estado sanitario por desnutrición de escasa magnitud en la población infantil jujeña estudiada.(AU)

Introduction. The Composite Index of Anthropometric Failure (CIAF) is made up of typical anthropometric indicators and their combination into seven categories, and proposes an additional measure to study malnutrition as an alternative to the evaluation of stunting, wasting and underweight as separate measures. Objective. To assess the CIAF in the child population settled at different altitudinal zones in Jujuy. Population and Methods. Weight and height were obtained from healthy 1 to 5 year-old control children, measured at primary healthcare centers (PHCCs) in Jujuy between 2005 and 2007. Nutritional status indicators such as underweight, stunting and wasting were determined as per the World Health Organization 2007 child growth standards. The CIAF and its seven categories were estimated by grouping data by gender, age and altitudinal zone (highlands: >2500 MASL; lowlands: <2500 MASL). The CIAF percentage differences for height, gender and age were verified using a chi-square test. Results. A total of 8059 children were included. The CIAF for highland children (6.1%) doubled that for lowland children (3.4%) (p < 0.05), and underweight prevalence (group Y) was significantly higher in the highlands (p < 0.05). The CIAF value and stunting (group F) increased with age, but such increase was more significant in the highlands. Conclusions. A significantly higher CIAF was observed in highland children, at the expense of stunting. However, the index of anthropometric failure was not more than 10% at both the highlands and the lowlands, and this accounts for a scarcely significant malnutrition health status in the studied child population of Jujuy.(AU)

Proposed New Anthropometric Indices of Childhood Undernutrition

The three conventional anthropometric indicators of childhood undernutrition are stunting (low height-for-age), underweight (low weight-for-age) and wasting (low weight-for-height). Recently a new composite index, namely the Composite Index of Anthropometric Failure (CIAF) has been proposed and utilised to study childhood undernutrition. In this paper, we have attempted to construct three new indices of undernutrition, relative to the CIAF. These three indices are: Stunting Index (SI) = Stunting / CIAF, Underweight Index (UI) = Underweight / CIAF and Wasting Index (WI) = Wasting / CIAF. Furthermore, we have calculated and compared these indices using our dataset as well as other existing datasets. Using our dataset, the sex-combined values of SI, UI and WI were 0.364, 0.866 and 0.684, respectively. The corresponding values among boys were 0.364, 0.866 and 0.729. Among girls, they were 0.380, 0.866 and 0.641, respectively. When applied to the all India dataset, the values of SI, UI and WI were 0.756, 0.788 and 0.266, respectively. Similar values (SI = 0.723, UI = 0.681, WI = 0.294) were observed when they were computed on data available from Coimbatore, South India. In conclusion, we suggest that these three new indices provide additional information on the prevalence of different forms of undernutrition relative to the total level of undernutrition in a particular population.