Magnitude of undernutrition in children aged 2 to 4 years using CIAF and conventional indices in the slums of Mumbai city

Abstract

Conventional indicators – weight-for-age, height-for-age, weight-for-height and mid-upper arm circumference (MUAC) reflect different facets of the nutritional status. Weight-for-age is the most commonly used indicator. When used individually or in combination, conventional indices fail to depict the overall magnitude of undernutrition in the population. Composite Index of Anthropometric Failure (CIAF) is an alternative classification system which attempts to fill this lacuna. Thus, we undertook this study with the objective to compare the prevalence of undernutrition using CIAF and the conventional indices. We included 634 children aged between 2 to 4 years from anganwadis located in three areas of Mumbai. Weight, height and MUAC measurements were taken. Z scores were computed for weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) using WHO Anthro software. Children were classified as per the conventional indices and CIAF. The prevalence of underweight, stunting and wasting was 35.7 %, 33.8 % and 18.5 % respectively. None of the children had MUAC < 11.5 cm. About 1 % of the children were moderately wasted according to MUAC. As per CIAF, 47.8 % children were undernourished. According to CIAF, one-third of the undernourished children had single anthropometric failure while half of them had dual failure and 17.1 % had multiple failures. When compared with the conventional indices, CIAF could recognize 12.1 %, 14.0 %, 29.3 % and 46.7 % more undernourished children than WAZ, HAZ, WHZ and MUAC respectively. In conclusion, CIAF is seen to have many advantages over the conventional indices. CIAF is useful in assessing the overall magnitude of undernutrition and identifying children with multiple anthropometric failures. It also recognizes more undernourished children than all the conventional indices. Therefore, CIAF should be used more widely as a tool for nutritional assessment particularly in developing countries where the burden of undernutrition is high.

The burden and correlates of childhood undernutrition in Tanzania according to composite index of anthropometric failure

“…This is higher compared to the prevalence reported by conventional indices of stunting wasting and underweight. In other countries the prevalence of CIAF was 47.8% in India [12]; 48.4% in Ethiopia [17], 48.3% in Bangladesh [15] and 21.7% in China [14].…”

“…Importantly, this model was evaluated and found to better provide the information on the true proportion of undernutrition, and thus helps detect children with multiple anthropometric de cit [7][8][9]. Furthermore, the above model has been used in several studies [10,11], and it has been concluded that CIAF identi es a greater percentage of undernourished children compared to conventional indices [12,13]. Countries such as China, Malawi and others have adopted the CIAF model to rede ne their children's nutrition situation [8,9,[14][15][16][17][18]; but such national wide studies are lacking in Tanzania.…”

Prevalence of Undernutrition and Anemia among Santal Adivasi Children, Birbhum District, West Bengal, India

“…Thus, the conventional indices fail to assess the overall prevalence of undernutrition in a group. The composite index of anthropometric failure (CIAF) better reflects the overall magnitude of undernutrition and also identifies children without any form of anthropometric failure [33,34]. Moreover CIAF detects multiple anthropometric failures, which is of relevance as the concurrence of wasting with stunting, predicts a high risk for child mortality [35,36].…”

“…CIAF prevalence rates of other studies conducted in tribal and rural areas of West Bengal ranged from 43.4% to 73.1% [51,[56][57][58][59][60][61][62]. The CIAF classification provides a holistic picture of the overall prevalence of malnutrition in a population and may be more appropriate to be applied in the scope of national programmatic actions than the conventional indices [33].…”

Composite index of anthropometric failure among under 5 children attending the Immunoprophylaxis clinic in a tertiary care hospital in Nagpur, Maharashtra, India

“…8 Many studies have used this concept in adding up the knowledge of composite index of anthropometric failure in their geographical locations. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] This study will add to the pool of such studies with an objective to study the rates of composite index of anthropometric failure in the children attending the Immunoprophylaxis clinic in a tertiary care hospital of Nagpur and to find associations with the socio demographic variables.…”