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Implications of the WHO Child Growth Standards in rural Honduras

Erin K Nichols1, Joseph S Nichols, Beatrice J Selwyn

  • 1School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA. igd1@cdc.gov

Public Health Nutrition
|January 19, 2012
PubMed

Insights

Comparing growth references impacts malnutrition prevalence calculations in children. The 2006 WHO Child Growth Standards show different results for stunting and overweight compared to the 1977 NCHS reference.

Area of Science:

  • Pediatric Nutrition
  • Public Health Surveillance
  • Anthropometry

Background:

  • Accurate assessment of child malnutrition relies on appropriate growth references.
  • The 2006 WHO Child Growth Standards replaced the 1977 NCHS international growth reference, potentially altering prevalence estimates.
  • Understanding these differences is crucial for effective public health interventions.

Purpose of the Study:

  • To analyze the impact of using the 2006 WHO Child Growth Standards versus the 1977 NCHS reference on chronic malnutrition prevalence in children aged 6.0-59.9 months.
  • To compare anthropometric Z-scores (HAZ, WAZ, WHZ) calculated using both references.
  • To evaluate the agreement and differences in nutritional status classifications between the two references.

Main Methods:

  • Cross-sectional study in rural Honduras involving children aged 6.0-59.9 months.
  • Computation of height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z-scores using both WHO standards and NCHS reference.
  • Statistical comparison using Bland-Altman plots, percentage agreement, kappa statistics, and proportion analysis.

Main Results:

  • WHO standards resulted in lower mean HAZ but higher mean WAZ and WHZ compared to NCHS.
  • Good agreement in Z-score categories was observed, with exceptions for HAZ in specific male age groups and WHZ in older males.
  • WHO standards indicated higher proportions of stunting and overweight, and lower proportions of underweight.

Conclusions:

  • The selection of growth reference/standard significantly influences the calculated prevalence of childhood malnutrition.
  • Methodological and policy implications arise from the choice of growth references.
  • Nutritional data derived from different growth references require cautious interpretation due to potential discrepancies.
Abstract

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