Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries

Abstract

BackgroundWasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of disability-adjusted life years lost in young children. Wasting and stunting tend to be addressed as separate issues despite evidence of common causality and the fact that children may suffer simultaneously from both conditions (WaSt). Questions remain regarding the risks associated with WaSt, which children are most affected, and how best to reach them.MethodsA database of cross-sectional survey datasets containing data for almost 1.8 million children was compiled. This was analysed to determine the intersection between sets of wasted, stunted, and underweight children; the association between being wasted and being stunted; the severity of wasting and stunting in WaSt children; the prevalence of WaSt by age and sex, and to identify weight-for-age z-score and mid-upper arm circumference thresholds for detecting cases of WaSt. An additional analysis of the WHO Growth Standards sought the maximum possible weight-for-age z-score for WaSt children.ResultsAll children who were simultaneously wasted and stunted were also underweight. The maximum possible weight-for-age z-score in these children was below − 2.35. Low WHZ and low HAZ have a joint effect on WAZ which varies with age and sex. WaSt and “multiple anthropometric deficits” (i.e. being simultaneously wasted, stunted, and underweight) are identical conditions. The conditions of being wasted and being stunted are positively associated with each other. WaSt cases have more severe wasting than wasted only cases. WaSt cases have more severe stunting than stunted only cases. WaSt is largely a disease of younger children and of males. Cases of WaSt can be detected with excellent sensitivity and good specificity using weight-for-age.ConclusionsThe category “multiple anthropometric deficits” can be abandoned in favour of WaSt. Therapeutic feeding programs should cover WaSt cases given the high mortality risk associated with this condition. Work on treatment effectiveness, duration of treatment, and relapse after cure for WaSt cases should be undertaken. Routine reporting of the prevalence of WaSt should be encouraged. Further work on the aetiology, prevention, case-finding, and treatment of WaSt cases as well as the extent to which current interventions are reaching WaSt cases is required.

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

“…Following the first ever analysis of aggregate malnutrition (Briend et al 2015;Khara et al, 2017;Myatt et al 2018). The data set out in this paper show there is a clear need to present the full picture of the extent of malnutrition, using a measure like the CIAF, but that it is also important that overlapping groups of malnourished children are not missed; focussing too narrowly, say on just those children who exhibit Wasting and Stunting, which recent analyses estimate a prevalence of around 3% (Khara et al, 2017), may give the impression that serious malnutrition is not very prevalent.…”

“…(Bergeron & Castleman 2012: 247). The provision of evidence about aggregate and multiple malnutrition is therefore an important contribution (Myatt et al 2018) and this paper aims to articulate the rationale for such measures as well as how to construct these measures.…”

The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

“…Indeed, the prevalence of 1.65% obtained in our analysis translates into a quarter-million of under five children affected. These children need particular attention as studies have shown that they are at high risk of dying even when they are moderately wasted [21,46]. Thus, the approach for screening and selecting children for wasting interventions should be adjusted to ensure children with concurrent wasting and stunting are able to access the most effective treatment for their condition.…”

Combined protocol for severe and moderate acute malnutrition in emergencies: Stakeholder perspectives in four countries

“…Interventions have sometimes used the sitting height to standing height ratio (or Cormic index) to correct of weight‐for‐height measurements for the body morphology of some ethnic groups (Roberfroid et al, ; Salama et al, ), but the issue of geographical variations body shape requires further study (Briend et al, ). Evolving understandings of the frequency of multiple anthropomorphic deficits and the overlap and dynamic interactions between wasting and stunting will also influence this debate (Myatt et al, ; Wells et al, ). Although it is beyond the scope of this article to adjudicate the debate around MUAC versus WHZ, greater clarity around the specific conditions under which MUAC is an appropriate diagnostic tool, emphasizing its practicality and ease in difficult field situations, will be needed to assuage stakeholders' observed misgivings.…”