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Updated: Aug 24, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform
Gloria A Odei Obeng-Amoako1, Heather Stobaugh2,3, Stephanie V Wrottesley4
1Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Insights
Children with a weight-for-age z-score (WAZ) below -3 face higher mortality risks. This study found they have poorer treatment outcomes and require more intensive nutritional support than currently recommended.
Area of Science:
- Pediatric Nutrition
- Global Health
- Public Health Interventions
Background:
- Weight-for-age z-score (WAZ) <-3 indicates severe underweight and high mortality risk in children.
- This critical indicator is underutilized in current nutrition treatment programs.
- Understanding outcomes for children with WAZ <-3 is crucial for refining treatment protocols.
Purpose of the Study:
- To analyze the prevalence, treatment outcomes, and growth patterns of children with WAZ <-3 compared to those with WAZ ≥-3.
- To inform future protocols for managing childhood wasting and nutritional edema.
- To assess the impact of including children with WAZ <-3 in therapeutic feeding programs.
Main Methods:
- Pooled secondary data analysis of children aged 6-59 months from 9 countries.
- Comparison of binary treatment outcomes using logistic regression.
- Defined recovery based on mid-upper-arm circumference, weight-for-height z-score, and absence of edema within 17 weeks.
Main Results:
- 55% of wasted children presented with WAZ <-3.
- Children with WAZ <-3 had significantly lower recovery rates (28.3% vs. 48.7%) and higher mortality risks (1.8% vs. 0.7%).
- Anthropometric gains were similar, but children with WAZ <-3 started and ended care with lower measurements.
Conclusions:
- Children with WAZ <-3 are a highly vulnerable group requiring more intensive nutritional support.
- Current treatment timelines and recovery definitions may need revision for this population.
- Integrating moderately wasted children with WAZ <-3 could increase program caseloads by 32%.
Abstract:
Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review.
