Does the 65 cm height cut-off as age proxy exclude children eligible for nutritional assessment in Bangladesh?

Area of Science:

• Public Health
• Pediatric Nutrition
• Anthropometry

Background:

• Accurate age determination is crucial for nutritional surveys in children aged 6-59 months.
• Length/height cut-offs are often used as proxies for age when direct age measurement is challenging.
• Stunting is prevalent in many low-resource settings, complicating the use of height-for-age.

Purpose of the Study:

• To assess the proportion of children excluded from nutritional assessment using a height cut-off of 65 cm as a proxy for age (≥6 months).
• To evaluate the impact of this proxy method on identifying children within the 6-59 month age range in a specific urban slum setting.

Main Methods:

• Secondary data analysis of primary health center records in Kamrangirchar slum, Dhaka, Bangladesh.
• Inclusion criteria: children aged 6-59 months with recorded age and height.
• Statistical analysis to determine the number and characteristics of children excluded by the height cut-off.

Main Results:

• 2060 children were analyzed (median age 24 months, median height 78 cm).
• 12% (240 children) aged 6-29 months had height <65 cm.
• Of those excluded, 97.5% were aged 6-17 months, and 59% were female.

Conclusions:

• The 65 cm height cut-off excludes a significant number of young, vulnerable children from nutritional assessment in this setting.
• This exclusion can lead to an underestimation of malnutrition prevalence in nutritional surveys.
• Rethinking proxy measures is essential for accurate nutritional surveillance in populations with high stunting rates.