Professional Documents
Culture Documents
1017/PHN20062005
Abstract
Objectives: To compare growth patterns and estimates of malnutrition based on the
World Health Organization (WHO) Child Growth Standards (‘the WHO standards’)
and the National Center for Health Statistics (NCHS)/WHO international growth
reference (‘the NCHS reference’), and discuss implications for child health
programmes.
Design: Secondary analysis of longitudinal data to compare growth patterns (birth to
12 months) and data from two cross-sectional surveys to compare estimates of
malnutrition among under-fives.
Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North
America and Northern Europe.
Subjects: Respectively 4787, 10 381 and 226 infants and children.
Results: Healthy breast-fed infants tracked along the WHO standard’s weight-for-age
mean Z-score while appearing to falter on the NCHS reference from 2 months
onwards. Underweight rates increased during the first six months and thereafter
decreased when based on the WHO standards. For all age groups stunting rates
were higher according to the WHO standards. Wasting and severe wasting were
substantially higher during the first half of infancy. Thereafter, the prevalence of
severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The
increase in overweight rates based on the WHO standards varied by age group, with
Keywords
an overall relative increase of 34%.
Growth standards
Conclusions: The WHO standards provide a better tool to monitor the rapid and Anthropometry
changing rate of growth in early infancy. Their adoption will have important Underweight
implications for child health with respect to the assessment of lactation performance Stunting
and the adequacy of infant feeding. Population estimates of malnutrition will vary by Wasting
age, growth indicator and the nutritional status of index populations. Overweight
In April 2006 the World Health Organization (WHO) children should grow rather than merely describing how
released new standards for assessing the growth and children grew at a specified time and place3.
development of children from birth to 5 years of age1,2. The WHO standards were developed to replace the
The WHO Child Growth Standards (hereafter referred to National Center for Health Statistics (NCHS)/WHO
as the WHO standards) are the product of a detailed international growth reference4,5 (hereafter referred to
process initiated in the early 1990s involving various as the NCHS reference), whose limitations have been
reviews of the uses of anthropometric references and described in detail elsewhere6.
alternative approaches to developing new tools to assess The NCHS reference is currently used in the national
growth. The new standards adopt a fundamentally programmes of about 100 countries7. Since the evaluation
prescriptive approach designed to describe how all of child growth trajectories and the interventions designed
to improve child health are highly dependent on the
† Members of the WHO Multicentre Growth Reference Study Group
growth charts used, it is important to understand
are listed in the Appendix. the impact of using the WHO versus the NCHS charts on
% below cut-off
25
%
40
30 20
20
15
10
0 10
0–5 6–11 12–23 24–35 36–47 48–60 0–60
5
Age (months)
0
Fig. 2 Prevalence of underweight (below 22 standard deviations 0–5 6–11 12–23 24 – 35 36 – 47 48 – 60
from the median for weight-for-age) by age based on the World Age (months)
Health Organization (WHO) standards and the National Center for
Health Statistics (NCHS) reference in Bangladesh Fig. 4 Prevalence of wasting (below 22 standard deviations (SD)
from the median for weight-for-length/height) and severe wasting
(below 23SD from the median for weight-for-length/height) by
age based on the World Health Organization (WHO) standards
60.1% (95% CI: 58.7 –61.4%) when using the WHO and the National Center for Health Statistics (NCHS) reference in
standards, or a relative increase of about 10%. Bangladesh
40 8
30 6
20 4
10 2
0 0
0–5 6 –11 12 – 23 24 – 35 36 – 47 48 – 60 0 – 60 0–5 6–11 12–23 24–35 36–47 48–60 0–60