Evaluation of Child Undernutrition Anthropometric Indicators across Low- and Middle-Income Countries

The United Nations’ Sustainable Development Goal Target 2.2 aspires to end all forms of malnutrition by 2030 by meeting targets, along with eliminating stunting and wasting in all children younger than 5 years. These indicators are used to monitor childhood undernutrition but may not supply a complete picture at a population level.

The present study compared 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). It also investigated the association of the conventional indicators, CIAF, and CAF with diarrheal disease as an assessment of the validity of each measure.

The study utilized the data of children from 56 low- and middle-income countries extracted from the nationally representative Demographic and Health Surveys. A total of 530 906 children younger than 5 years were included. 

Undernutrition defined by conventional indicators (stunting, underweight, and wasting), the CIAF, and the proposed CAF classification system was assessed and compared. Six logistic regression models were employed to investigate the association between different classifications of anthropometric failure (AF) and morbidity.

The results were as follows-

• 530 906 children with a mean age of 29.0 months, and 51.3% boys and 48.7% girls from 56 low- and middle-income countries were included in the analysis. 
• Estimates of undernutrition developed using the conventional indicators of stunting, underweight, and wasting were found to be lower than estimates developed using the CIAF in all countries.
• The CAF classification system indicated substantial variation across countries in children with multiple AFs, which does not resemble the overall prevalence of undernutrition. 
• Like, 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. 
• Additionally, children suffering from stunting, underweight, and wasting showed 1.52 times the odds of diarrhea compared to children who exhibited no AFs.

These results highlight the importance of using different approaches to aid understanding of the entire spectrum of AF concerning 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 aid in meeting targets for the Sustainable Development Goal.

Source: JAMA Netw Open. 2022;5(3):e221223. doi:10.1001/jamanetworkopen.2022.1223