This indicator belongs to a set of indicators whose purpose is to measure nutritional imbalance and malnutrition resulting in undernutrition (assessed by underweight, stunting and wasting) and overweight.
Child growth is the most widely used indicator of nutritional status in a community and is internationally recognized as an important public-health indicator for monitoring health in populations. In addition, children who suffer from growth retardation as a result of poor diets and/or recurrent infections tend to have a greater risk of suffering illness and death.
Definition:
Percentage of (weight-for-height less than -2 standard deviations of the WHO Child Growth Standards median) among children aged 0-5 years
Disaggregation:
Age, Sex, Location (urban/rural), Boundaries : Administrative regions
Method of measurement
Percentage of children aged <5 years wasted = (Number of children aged 0-5 years that fall below minus two standard deviations from the median weight-for-height of the WHO Child Growth Standards / Total number of children aged 0-5 years that were measured) * 100
Children`s weight and height are measured using standard technology, e.g. children less than 24 months are measured lying down, while standing height is measured for children 24 months and older.
The data sources include national nutrition surveys, any other nationally-representative population-based surveys with nutrition modules, and national surveillance systems.
M&E Framework:
Impact
Method of estimation:
WHO maintains the Global Database on Child Growth and Malnutrition, which includes population-based surveys that fulfill a set of criteria. Data are checked for validity and consistency and raw data sets are analysed following a standard procedure to obtain comparable results. Prevalence below and above defined cut-off points for weight-for-age, height-for-age, weight-for-height and body mass index (BMI)-for-age, in preschool children are presented using z-scores based on the WHO Child Growth Standards.
A detailed description of the methodology and procedures of the database including data sources, criteria for inclusion, data quality control and database work-flow, are described in a paper published in 2003 in the International Journal of Epidemiology. (de Onis & Blössner, 2003)
Predominant type of statistics: adjusted
Method of estimation of global and regional aggregates:
A well-established methodology for deriving global and regional trends and forecasting future trends, have been published (de Onis et al., 2004a, 2004b)
Preferred data sources:
Household surveys
Specific population surveys
Surveillance systems
Expected frequency of data dissemination:
Bimonthly
Expected frequency of data collection:
Every 5 years
Comments:
The percentage of children with low height-for-age reflects the cumulative effects of under-nutrition and infections since birth, and even before birth. This measure, therefore, should be interpreted as an indication of poor environmental conditions and/or long-term restriction of a child`s growth potential. The percentage of children with low weight-for-age may reflect the less common ‘wasting’ (i.e. low weight-for-height) indicating acute weight loss, and/or the much more common ‘stunting’ (i.e. low height-for-age). Thus, it is a composite indicator that is difficult to interpret. Overweight (i.e. high weight-for-height) is an indicator of malnutrition at the other extreme. Some country populations are facing a double-burden with high prevalence of under- and overweight simultaneously.
An international set of standards (i.e. the WHO Child Growth Standards) is used to calculate prevalence for the indicators low weight-for-age, low height-for-age, and high weight-for-height. The International Pediatric Association (IPA), the Standing Committee on Nutrition of the United Nations System (SCN), and the International Union of Nutritional Sciences (IUNS), have officially endorsed the use of the WHO standards, describing them as an effective tool for detecting and monitoring undernutrition and overweight, thus addressing the double burden of malnutrition affecting populations on a global basis. The WHO Child Growth Standards, launched in 2006, replaces the NCHS/WHO international reference for the analysis of nutritional surveys.
National nutrition surveys and national nutrition surveillance systems are the preferred primary data sources for child nutrition indicators. If these sources are not available, any random, nationally representative, population-based survey with a sample size of at least 400 children that presents results based on the WHO standards or provides access to the raw data enabling re-analysis could be used.
Generally national surveys are recommended to be conducted about every 5 years. But this also depends on the nutritional status as well as on the change in the economical situation, the perceived change of nutritional status, and the occurrence of human made crisis and natural disasters.
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