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Double Burden of Malnutrition in Under-Five Children (NFHS-5 Data) Using Extended CIAF: WHO 2006 Growth Standard

Nimisha S Dange1, Vaman Khadilkar1,2, Ketan Gondhalekar1

  • 1Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India.

Indian Pediatrics
|April 2, 2025
PubMed

Insights

Using Indian references for the extended composite index of anthropometric failure (eCIAF) in under-five children prevents misclassification of the double burden of malnutrition (DBM). This ensures accurate assessment of nutritional status in young children.

Area of Science:

  • Pediatrics
  • Public Health
  • Nutrition Science

Background:

  • The double burden of malnutrition (DBM) encompasses both undernutrition and overnutrition, posing a significant public health challenge globally.
  • Accurate assessment of DBM in under-five children is crucial for effective intervention strategies.
  • The extended composite index of anthropometric failure (eCIAF) is a tool used to assess various forms of malnutrition.

Purpose of the Study:

  • To compare the prevalence of DBM in under-five children using the eCIAF, applying both World Health Organization (WHO) 2006 and 2019 Indian growth standards.
  • To evaluate the impact of different reference standards on the classification of malnutrition in young children.

Main Methods:

  • Analysis of data from 1,96,015 under-five children from the National Family Health Survey-5.
  • Application of the extended composite index of anthropometric failure (eCIAF) using WHO 2006 and 2019 Indian standards.
  • Categorization of children into 'no failure,' 'underfailure' (UF), and 'overfailure' (OF) based on anthropometric measurements.

Main Results:

  • A significantly higher proportion of children were categorized as 'no failure' using Indian standards (74%) compared to WHO standards (50.1%) (P < 0.001).
  • The prevalence of DBM, UF, and OF was significantly higher when assessed using WHO references compared to Indian references.
  • Specifically, DBM prevalence was 49.9% (WHO) vs. 26% (Indian), UF was 48.4% (WHO) vs. 24.7% (Indian), and OF was 3.5% (WHO) vs. 1.9% (Indian).

Conclusions:

  • The use of Indian reference standards for eCIAF in under-five children is essential to prevent the misclassification of the double burden of malnutrition.
  • Employing appropriate national growth references ensures more accurate epidemiological assessments and targeted public health interventions for childhood malnutrition.
Abstract

Keywords:
Composite index of anthropometric failureNFHS-5National Family Health SurveyOvernutritionUndernutrition

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