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Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference

  • Rozina Nuruddin (a1) (a2), Meng Kin Lim (a3), Wilbur C Hadden (a4) and Iqbal Azam (a1)
  • DOI: http://dx.doi.org/10.1017/S1368980008002383
  • Published online: 01 May 2009
Abstract
AbstractObjective

To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference.

Design

Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared.

Setting

The data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province.

Subjects

In all, 1533 and 1051 children aged 0–35 months from national and Thatta surveys, respectively.

Results

WHO standard gave a significantly higher prevalence of stunting for both national [36·7 (95 % CI 33·2, 40·2)] and Thatta surveys [52·9 (95 % CI 48·9, 56·9)] compared to the NCHS reference [national: 29·1 (95 % CI 25·9, 32·2) and Thatta: 44·8 (95 % CI 41·1, 48·5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22·9 (95 % CI 20·3, 25·5)] compared to the NCHS reference [15·7 (95 % CI 13·5, 17·8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children.

Conclusions

Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country’s targets for Millennium Development Goal 1 and for monitoring nutritional trends.

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*Corresponding author: Email rozina.nuruddin@aku.edu
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.M de Onis & AW Onyango (2003) The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants. Acta Paediatr 92, 413419.

3.SB Robert & GE Dallal (2001) The new childhood growth charts. Nutr Rev 59, 3136.

5.M de Onis , C Garza & JP Habicht (1997) Time for a New Growth Reference. Pediatrics 100; available at http://www.pediatrics.org/cgi/content/full/100/5/e8

14.WB Owusu , A Lartey , M de Onis , AW Onyango & EA Frongillo (2004) Factors associated with unconstrained growth among affluent Ghanaian children. Acta Paediatr 93, 11151119.

19.M de Onis , TMA Wijnhoven & AW Onyango (2004) Worldwide practices in child growth monitoring. J Pediatr 144, 461465.

24.WC Hadden , G Pappas & AQ Khan (2003) Social stratification, development and health in Pakistan: an empirical exploration of relationships in population-based national health examination survey data. Soc Sci Med 57, 18631874.

33.T Rikimaru , JE Yartey , K Taniguchi , DO Kennedy & FK Nkrumah (1998) Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutr Sci Vitaminol (Tokyo) 44, 391407.

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Public Health Nutrition
  • ISSN: 1368-9800
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