Malnutirion/Underweight prevalence

For reliable assessment of the nutritional status of children, a representative sample of the population of children should be used rather than the children seen at health facilities. Large household survey programmes such as DHS and MICS collect anthropometric data from children. Well-nourished young children of all populations follow very similar growth patterns. Thus the World Health Organization (WHO) recommends that the nutritional status of children sampled in surveys be compared with an international reference population defined by the U.S. National Center of Health Statistics (NCHS). The nutritional status of a child is thus expressed as the standard deviation units (z-scores) from the median for the reference population. Those children found to be more than 2 standard deviations below the median for the reference population are considered to be underweight. Typically, household surveys have only measured malnutrition for children below the age of 5; however, because most orphans are older, the sample size of orphans in this age range are often too small to compare with non-orphans. In the pilot surveys in Jamaica and Malawi, weight and age data were collected and analysed for children up to and including age 8 to avoid this limitation. (Children older than 8 were excluded because once they reach pre-adolescence their growth is erratic and because internationally agreed-upon cut-offs for boys over 10 and girls over 8 are not available.) The pilot surveys showed, however, that as children get older, the variations in underweight are small, and thus comparing children ages 5–8 is not useful.