wasting). 2012. p. 1–8. Eur J Soc Sci. Evidence from 47 developing countries. This calculation results in GHI scores on a 100-point scale where 0 is the best score (no hunger) and 100 the worst. height-for-age and weight-for-age). Each year, approximately 800,000 deaths are attributed to wasting (60% of which are attributable to severe wasting) and over 1 million to stunting. Google Scholar. We found that the results were similar when the models were run on the subgroups of children who were stunted and nonstunted at baseline. Guideline: Updates on the management of severe acute malnutrition in infants and children. The real-world impacts of stunting ripple well beyond linear growth. Islamabad and Calverton: NIPS and ICF International; 2013. 2015;3(4):e229–39. Stuntd growth: many sectors acting jointly can … The sum of the children in groups B to (low height-for-age) and wasting (low weight for height) F provides the CIAF. PLoS One. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. In conclusion, our study found that both maternal and child related factors are associated with malnutrition in Pakistani children and most of them are preventable. Maternal height and child growth patterns. Wasted and overweightc. Social, economic, health and environmental determinants of child nutritional status in three central Asian republics. PubMed  Child-level factors were sex of child, child age, child size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status. Changes in child survival are strongly associated with changes in malnutrition in developing countries. Risk factors for child malnutrition in Bangladesh: a multilevel analysis of a nationwide population-based survey. The double burden of malnutrition: policy brief. Malnutrition contributes to about one-third of the 9.7 million child deaths that occur each year.1,2 Recently, the World Health Organization (WHO) introduced new child growth standards for use in deriving indicators of nutritional status, such as stunting, wasting and underweight. There have been efforts in the past to address nutritional issues among young girls, pregnant and lactating women in country with different nutrition programs such as “Tawana Pakistan Project” [40]. Additionally, there is a need for national nutritional policy, focused on improving both the maternal nutritional status (through adequate food and micronutrients supplementation) and the better care for infants and young children [45]. Wasting, based on a child’s weight and height, is a measure of acute nutritional deficiency. Part of Underweight and overweight for age2) Mean z-score for height-for-age, weight-for-height, and weight-for-age. In ever-married women samples, the data in the IR file are augmented with data from the PR file for never-married women to provide nutritional status estimates for all women. However, different forms of malnutrition can also occur concurrently in … Article  "Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis." Number of children aged 0–59 months who are stunted. 2017;36(1):17. In Pakistan, the high trend of stunting in urban areas may be due to the rapid urbanization of people migrating from rural areas for work and better living conditions. Raj A, Saggurti N, Winter M, Labonte A, Decker MR, Balaiah D, Silverman JG. In practice, neither of these extremes is reached. Descriptive statistics were used to generate frequencies and to describe the study variables. 2017;4(10):88. In order to reduce the burden of early malnutrition in the country, strategies which are focused on poverty eradication, improvement of both mother’s educational and nutritional level and accessibility to basic health care facilities are needed. WHO Anthro Software for Stunting and Wasting. malnutrition in the form of wasting, stunting and underweight, and the latter resulting in overweight and obesity. 2009;89(4):1125–31. Talukder A. Different forms of malnutrition among under five children in Bangladesh: a cross sectional study on prevalence and determinants. Lancet. b19_01 exists in DHS-7 surveys. However, the female adolescent nutrition in Pakistan is very recent and needs a greater focus. In some surveys, only a subsample of these women were selected for anthropometry. The later DHS surveys (DHS-V onwards) included height and weight measurements of all children born in the 5 years preceding the survey and listed in the Household Questionnaire, irrespective of the interview status of their mother. if waz06==. Food Nutr Bull. https://www.dhsprogram.com/data/available-datasets.cfm, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12889-019-6688-2. This finding was in line with previous cross-sectional studies carried out in countries such as Bangladesh, Nepal and Peru [15, 16, 31]. Fenn B, Sangrasi GM, Puett C, Trenouth L, Pietzsch S. The REFANI Pakistan study—a cluster randomised controlled trial of the effectiveness and cost-effectiveness of cash-based transfer programmes on child nutrition status: study protocol. Correlation between CD4% and growth indices was obtained using Pearson’s … Jama. 2014;3(2):71. Briefly, mean age of the children was 2.1 years (SD 1.4) of which majority were males (50.7%), lived in rural areas (56.7%) and had mothers with no formal education (52.3%). 2018;5(5):60. and concurrence of wasting and stunting. The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016 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). Google Scholar. The United Nations Children’s Fund. replace below3_waz=. Google Scholar. 1986. 2017;9(1):44. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012–2013. Stunting was the most serious problem that was impeding child growth and development. Article  Analysis was done by descriptive statistics and logistic regressions. About 20.6% of the children were from poorest households, whereas, 19.9% of the children were from richest households. Due to natural variations in a well-nourished population, 2.2 percent of children will be between ‑2.0 and ‑2.99 SD below the mean, and 0.1 percent will be ‑3.0 or more SD below the mean. Determinants of stunting and severe stunting among under-fives: evidence from the 2011 Nepal demographic and health survey. Using the PR file would result in a slightly larger sample size, but the MR file is chosen for consistency with other men’s indicators, and as some of the men’s characteristics used in presenting the results are only available for men with completed interviews. In medicine, wasting, also known as wasting syndrome, refers to the process by which a debilitating disease causes muscle and fat tissue to "waste" away. Grummer-Strawn. CAS  Kavosi E, Rostami ZH, Kavosi Z, Nasihatkon A, Moghadami M, Heidari M. Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars province, Iran. Background Wasting and stunting are global public health problems that frequently co-exist. New York: The United Nations Children’s Fund; 2015. 2014;16(3):e161–70. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Height and weight allow calculating measures of stunting (long-run nutritional deprivation) and wasting (short-run nutritional deprivation), which are [...] central data in health [...] measurement in poor countries. Stunting and wasting were measured for children aged 0–59 mo, whereas anemia/hemoglobin was only measured for children aged 6–59 mo. 2015;385(9966):430–40. Lancet. 1)     Percentage of men age 15–49 by nutritional status based on specific body mass index (BMI) levels. J Afr Econ. Prevalence of stunting increased but wasting declined from post- to pre-harvest seasons. Multivariate analysis with the addition of maternal and child related factors (Model 1 and Model 2) indicated that children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33–9.82). Data were grouped by the geographic … As per Global hunger index 2019, Indian rank is 102nd out of 117 countries having 30.3 scores and is … Google Scholar. Bhutta ZA, Soofi SB, Zaidi SSH, Habib A. Pakistan National Nutrition Survey, 2011; 2011. Prior to DHS-7 if any of the three sets of z-scores (height-for-age, weight-for-height, and weight-for-age) was flagged for a child, all were considered flagged and excluded from the numerators and denominators of the indicators. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post–2015 priorities: an updated systematic analysis. PLoS One. The z-scores are calculated using software based on the WHO Anthro program and the macros for statistical packages at http://www.who.int/childgrowth/software/en/. Article  2016;11(6):e0157814. How to obtain z scores in SPSS is illustrated. Kureishy S, Khan GN, Arrif S, Ashraf K, Cespedes A, Habib MA, Hussain I, Ullah A, Turab A, Ahmed I, Zaidi S. A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol. Childhood malnutrition is a critical public health concern in Pakistan. Sand A, Kumar R, Shaikh BT, Somrongthong R, Hafeez A, Rai D. Determinants of severe acute malnutrition among children under five years in a rural remote setting: a hospital based study from district Tharparkar-Sindh, Pakistan. PubMed  How to weigh and measure children: Assessing the nutritional status of young children in household surveys. Mei, Z., and L.M. It is therefore possible to track global and regional changes in these two conditions over time. 19 Height-for-age z score, weight-for-age z score, and weight-for-height z score were calculated by comparing the child’s measurements with the median value in the reference population of the National … We also used continuous variables … Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, Horta BL, Kuzawa CW, Lee N, Norris SA, Prabhakaran P, Richter LM. Donner A.J., M. Ezzati; Nutrition Impact Model Study Group (Child Growth). Barros. 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. Also know as global chronic malnutrition, this variable was used to include both moderate and severe chronic malnutrition. AN_NUTS_W_SHT, AN_NUTS_W_NRM, AN_NUTS_W_THN, AN_NUTS_W_TH1, AN_NUTS_W_TH2, AN_NUTS_W_OWT, AN_NUTS_W_OVW, AN_NUTS_W_OBS, AN_NUTS_W_BMI, GNMF Indicator 10: Proportion of overweight and obese women 18+ years of age (body mass index ≥25 kg/m2). Furthermore, interventions that can address these factors are required such as community based education and targeted nutritional interventions. calculated assuming there are reductions in the prevalence of country-specific nutrition indicators, such as iron deficiency anemia, low birth weight, vitamin A deficiency, iodine deficiency, suboptimal breastfeeding practices, and childhood chronic and acute malnutrition (i.e., stunting, underweight, and . PubMed Central  WHO child growth standards: length/height-for-age, weight-for-length, weight-for-height and body mass index-forage: methods and development. Stunting was the most serious problem that was impeding child growth and development. Therefore, policies which are focused on poverty alleviation and improving the nutritional status of poorer children (either through cash or food support program [32, 33]) are needed to address the under-five malnutrition issue in Pakistan. Brhane G, Regassa N. Nutritional status of children under five years of age in Shire Indaselassie, North Ethiopia: examining the prevalence and risk factors. The sum of the children in groups B to (low height-for-age) and wasting (low weight for height) F provides the CIAF. This study highlights both maternal and child factors, associated with stunting, that should be thoroughly investigated for implementing appropriate interventions to reduce the burden of stunting in Pakistan. PubMed  Though both wasting and stunting are manifestations of undernutrition caused by disease and poor diet, there are critical gaps in our understanding of the physiological … Mother’s height was significantly associated with child stunting as children whose mothers had short stature (< 145 cm) were more likely to be stunted (cOR = 3.05, 95%CI 1.68–5.55). Men whose calculated BMI is below 12.0 or above 60.0 are flagged as out of range and are excluded from both the denominator and the numerators. Age, place of residence, sex, socioeconomic status. child’s morbidity and mortality [3, 4]. 1995;73:443–8. 2014;14(1):239. Article  Sadaf Khan. These indicators could be presented based on the MR file or the PR file. Subramanian. Felisbino-Mendes MS, Villamor E, Velasquez-Melendez G. Association of maternal and child nutritional status in Brazil: a population based cross-sectional study. Moreover, they make comparative choices of available health services over traditional practices for improved healthcare of their children [24]. Aguayo VM, Nair R, Badgaiyan N, Krishna V. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra's comprehensive nutrition survey. BMC Public Health. Kothari, and T.Pullum. Negash C, Whiting SJ, Henry CJ, Belachew T, Hailemariam TG. Prevalence of wasting, weight for height, male (% of children under 5) Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (per 100,000 population) Suicide mortality rate, female (per 100,000 female population) Children with Z-scores, below -2SD from the WHO reference population median, for height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) were considered stunted, wasted and underweight respectively [26]. Our analysis showed that children of mothers with no formal education were more prone to be acutely malnourished (wasted and underweight) as compared to children of educated mothers. If stunting is a low height for a child’s weight, wasting is low weight for a child’s height. Malnutrition significantly contributes to the global burden of several diseases. Finucane, C.J. These standards are based on the growth of infants from six different regions of the world who were fed according to WHO and United Nations Children’s Fund (UNICEF) feeding recommendations, had a non-smoking mother, had access t… Article  Undernourishment and child mortality each contribute one-third of the GHI score, while the child undernutrition indicators—child wasting and child stunting—each contribute one-sixth of the score. 12 (2017): e1249-e1257, https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30418-7/fulltext, Stevens G.A., M.M. The authors would like to thank Dow University of Health Sciences (DUHS) for all the support and assistance to conduct this study. 380(9844): p824-34. Univariate and multivariate binary logistic regressions were used to examine the determinants of all three indices of child nutritional status. Geneva: World Health Organization; 2013. This survey collected the information of Pakistani households related to socio-demographic, maternal and child health indicators [26]. year, approximately 800,000 deaths are attributed to wasting (60% of which are attributable to severe wasting) and over 1 million to stunting. In ever-married samples, never-married women are assumed to not be pregnant nor to have had a recent birth. Since mother’s nutritional and health status has critical importance in early child growth and development [39], mother’s nutritional status should be considered when making policies for reducing the child malnutrition. All comparisons between surveys, either over time or between countries, should take into account the possible differences in the defined population base and in the reference standard used. 10.65). Children within the age group of 24–35 months (aOR = 3.65, 95%CI 2.23–5.95) and children that were of smaller than average size at the time of birth (aOR = 1.48, 95%CI 1.02–2.16) were more likely to be stunted (Table 4). PubMed Central  This showed that the prevalence of stunting in Pakistan remains consistently high over past 20 years. CAS  2015;15(1):1044. Prevalence and Determinants of Stunting, Wasting, and Underweight Among School-Age Children Aged 6–12 Years in South Gondar Zone, Ethiopia . Our study also found that the odds of stunting significantly increased with child’s age. In earlier survey the NCHS/CDC/WHO international reference standards was used and results published in the earlier survey reports will differ from those using the newer standard. About 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Now let us use the Recode Manual to learn about stunting, a measure of child malnutrition derived from a child’s height and age. While stunting and wasting indicates chronic and acute malnutrition respectively, underweight is a composite indicator and includes both acute (wasting) and chronic (stunting) malnutrition [5]. AN_NUTS_M_NRM, AN_NUTS_M_THN, AN_NUTS_M_TH1, AN_NUTS_M_TH2, AN_NUTS_M_OWT, AN_NUTS_M_OVW, AN_NUTS_M_OBS, AN_NUTS_M_BMI, Mei, Z., and L.M. Nutr Res. BMC Pediatr. Abstract; Fulltext; Metrics; Get Permission; Cite this article; Authors Yisak H, Tadege M, Ambaw B, Ewunetei A. The country-specific information that is . Wasting in all 3 time periods appeared to have less of a detrimental effect on LAZ than wasting in the 12- to 17-mo time period. Wasting Rate Calculation Worksheet Subject: This form does the calculation of wasting rate in an activateed sludge treatment system Author: Minnesota Pollution Control Agency - Gene Erickson (Gail Skowronek) Keywords: Minnesota Pollution Control Agency,pond discharge,calculation Description : Color an exception on this form so that it helps the user to input their information. Prevalence of stunting, height for age, female (% of children under 5) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Maternal mortality ratio (modeled estimate, per 100,000 live births) Births attended by skilled health staff (% of total) Prevalence of wasting, weight for height, male (% of children under 5) … stunting, wasting and underweight amongst Grade 1-learners in the North West Province of South Africa and, secondly, to determine whether this status is related to gender, race and BMC Nutr. These indicators could be presented based on the IR file or the PR file. The assignment of anthropometric z-scores based on the WHO Child Growth Standards is done through a complicated interpolation function that takes into account sex, age (measured by difference in date of birth and date of interview, both precise to day of month), height in centimeters, and weight in kilograms (precise to 100 grams). 2)     Number of non-pregnant, non-postpartum women age 15-49 with a body mass index (BMI) with the following values: a)      Normal: 18.5 to 24.9 (v445 in 1850:2499), b)     Total thin: less than 18.5 (v445 in 1200:1849), c)      Mildly thin: 17.0 to 18.4 (v445 in 1700:1849), d)     Moderately and severely thin: less than 17.0 (v445 in 1200:1699), e)     Total overweight or obese (>=25.0) (v445 in 2500:6000), f)       Overweight: 25.0 to 29.9 (v445 in 2500:2999), g)      Obese: 30.0 or more (v445 in 3000:6000), 3)     Mean BMI: Sum of BMI for non-pregnant, non-postpartum women age 15–49 who were weighed and measured (∑ v445/100, if v445 in 1200:6000), 1)     Number of women age 15–49 with a valid height measurement (v438 in 1300:2200), 2)     Number of women age 15–49, excluding women who are pregnant or who gave birth in the 2 months preceding the date of the interview (v213 ≠ 1 and (v208 = 0 or b19_01 >= 2)), with a valid BMI (v445 in 1200:6000), Current age of child in months (months since birth for dead children) (01 is last birth). Bomela NJ. PubMed  PubMed  Children within the age group of 12–59 months were more likely to be stunted compared to younger children (less than 12 months). This may lead to increased susceptibility to stunting among male children. An Assessment of the Quality of DHS Anthropometric Data. In order to assess trends in nutritional status, the earlier DHS nutrition indicators should be re-calculated using the 2006 WHO Child Growth Standards. Demissie S, Worku A. Asim M, Nawaz Y. Iqbal S, Zakar R, Zakar MZ, Fischer F. Factors associated with infants’ and young children’s (6–23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012–13. However, no formal ethical clearance was obtained because the study involved secondary analysis of publically available data. This reference table helps in the interpretation of anthropometric measurements through the Weight-for-Height/Length percentage (W/H %) or Standard Deviation score (Z-score). © 2021 BioMed Central Ltd unless otherwise stated. Nutrients. UNICEF (2016), The state of the World’s children 2016: a fair chance for every child, United Nations, New York, https://doi.org/10.18356/4fb40cfa-en. The finding was consistent with the previous research reported that male children are more vulnerable to develop malnutrition because they require comparatively more calories for growth and development [46, 50]. BMJ. Department of Biochemistry, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan, Dow Research Institute of Biotechnology and Biomedical Sciences, Dow University of Health Sciences, Karachi, Pakistan, School of Public Health, Dow University of Health Sciences, Karachi, Pakistan, You can also search for this author in Akombi BJ, Agho KE, Merom D, Hall JJ, Renzaho AM. The percentage of children stunted, wasted, and underweight are equal to the specific numerators divided by the appropriate denominators and multiplied by 100. Large numbers of children are concurrently wasted and stunted Our analysis shows that a signiQcant proportion of children under Qve years of age are concurrently wasted and stunted; up to 8% at country level, with far higher proportions (up to 12%) recorded sub-nationally. To examine the factors linked with nutritional status of the children less than 5 years of age, dependent variables were expressed as dichotomous variables. Wasting Rate Calculation Worksheet Author: Minnesota Pollution Control Agency - Gene Erickson (Gail Skowronek) Subject: This form does the calculation of wasting rate in an activateed sludge treatment system Keywords: Minnesota Pollution Control Agency,pond discharge,calculation Created Date: 2/26/2013 3:14:18 PM 2018;14(2):e12516. The magnitude of stunting was only reduced by 5% when compared with the country’s previous demographic health survey conducted in 1990–1991 [30]. Based … Children from poor households have limited access to food and health services, which makes them more susceptible to growth failures [19]. Emphasis on reproductive health of adolescent females is now being considered very important in developing countries, particularly for the outcome of improved nutrition of children < 5 years of age [39, 40]. The extent of malnutrition in a population should be taken by the extent the proportions moderate and severe exceed these percentages that occur in a well-fed population of children. This study presents the risk factors associated with child malnutrition in terms of stunting, underweight and wasting among under-five Pakistani children using the 2012–2013 PDHS data.