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A scale without anthropometric measurements can be used to identify low weight-for-age in children less than five
M Orozco1, H Martinez, H Reyes
1Interinstitutional Health Services Research Group, Mexican Social Security Institute-Ministry of Health, Mexico City, Mexico.
Insights
A new scale helps identify low weight-for-age in children without measurements, aiding malnutrition reporting in child mortality. This tool is crucial for accurate data collection in public health initiatives.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Malnutrition and morbidity are linked to child mortality, but malnutrition is underreported in deceased children due to lack of anthropometric data.
- Accurate assessment of nutritional status in deceased children is essential for understanding mortality causes and informing public health interventions.
Purpose of the Study:
- To develop a predictive scale for identifying low weight-for-age (w/a) in children lacking anthropometric measurements.
- To determine an optimal cut-off point for the scale, maximizing sensitivity (Se) and specificity (Sp) in identifying low w/a.
Main Methods:
- A diagnostic test study was conducted in rural Mexico, comparing a proposed scale against actual w/a measurements.
- The scale incorporated clinical, socioeconomic, and family factors, including birth weight, feeding practices, socioeconomic status, sibling health, and morbidity history.
- Logistic regression identified key predictors, and a cut-off value was selected to optimize Se and Sp. External validity was tested in a separate population.
Main Results:
- The logistic regression model identified significant predictors of low w/a: low birth weight, delayed introduction of weaning foods and animal protein, low socioeconomic status, low sibling w/a, and high morbidity episodes.
- A scale cut-off of 4 demonstrated high diagnostic accuracy in the initial study population, with Se of 85% and Sp of 95%.
- External validation in a different rural population yielded Se of 84% and Sp of 81%, confirming the scale's utility.
Conclusions:
- The developed scale effectively identifies children with low weight-for-age in the absence of anthropometric data.
- The scale demonstrates good sensitivity and specificity, making it a valuable tool for estimating malnutrition in deceased children.
- Integrating this scale into verbal autopsies can improve the reporting of malnutrition in child mortality data, supporting public health monitoring.
Abstract:
Malnutrition and morbidity have a synergistic association that often leads to death. However, malnutrition in children who die is largely underreported, because anthropometry of the deceased child is rarely known. This study had two purposes: i) to develop a scale that would help determine if a child had low weight-for-age (w/a), in the absence of anthropometric measures; and ii) to select an appropriate cut-off that would give the best sensitivity (Se) and specificity (Sp) of the proposed scale when contrasted with actual w/a measurement. The study was designed as a diagnostic test, and carried out in a rural area in central Mexico. We included 132 children under 5 y old with w/a under -2 Z score and 284 children with marginal or no w/a deficit as a control group. The proposed scale included potential predictive variables from clinical, socioeconomic and family factors. The best logistic regression model to predict low w/a included: birth weight less than 2,800 g, introduction of weaning foods after the sixth month of life, introduction of animal protein after the sixth month of life, low socioeconomic status, low w/a in siblings and more than three morbidity episodes in the previous 6 mon. Selecting a cut-off of 4 for this model to identify children with low w/a showed a Se and Sp of 85 and 95%, respectively. We tested the external validity of the scale in a different locale, and included 877 children under 5 y old from 10 rural communities. In this population, the scale showed Se of 84% and Sp of 81% to identify low w/a. Based on these results, we propose that the scale be included as a means of identifying low w/a in children who have died. We believe that this should be done in verbal autopsies, which, based on our previous research, the Ministry of Health adopted as part of the regular activities to monitor problems in the disease to health-seeking to death process.