Comparison of under-nutrition among children aged 1-5 years using WHO and NCHS growth charts

Abstract

Introduction: Anthropometric indices are widely used to assess the health and nutritional status of children. National Centre for Health Statistics /World Health Organisation growth reference (NCHS reference) and World Health Organisation (WHO) Growth standards are the two different growth charts used to monitor the growth of under-five children. Since the evaluation of child growth trajectories and the interventions designed to improve child health are highly dependent on the growth charts used, it is important to understand the impact of using the WHO versus the NCHS charts on the assessment of growth and estimates of malnutrition. Objective: The objective was to assess the nutritional status of under-five children based on anthropometry and to compare the under-nutrition rates based on newly developed WHO standards and the older NCHS reference. Materials and Methods: A cross sectional study was undertaken in a Primary Health Centre area comprising of 933 children aged between 1-5yrs and their mothers. Anthropometric measurements i.e. height and weight of each subject were taken according to standard procedures. Children were considered as underweight, stunted and wasted if their weight-for age, height-for-age and weight-for-height z-scores were below -2.0 SD of the NCHS and WHO growth charts. Statistical analysis were performed using EPI INFO version 7.1.4 statistical package. Results: Out of 933 under-five children 453 were boys and 480 were girls. The prevalence of wasting, stunting and underweight (< -2 SD) by WHO standards was 23.7%, 38.2% and 37% respectively and by NCHS reference was 23.5%, 33% and 46.6% respectively. The prevalence of severe wasting, stunting and underweight (< - 3 SD) was 7.4%, 14.3% and 8.8% respectively by WHO standards and 4.1%, 11.8% and 9.8% respectively by NCHS standards. Conclusion: Prevalence of underweight was higher with NCHS reference and that of stunting was higher with WHO standards. However there was no much difference seen with wasting. Severe wasting and stunting was more by WHO classification. The rates of severe wasting, severe stunting were higher in boys and severe underweight was higher in girls WHO classification would be preferred to assess malnutrition among Indian under-five children