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Health or nutritional status of a child is usually assessed in three ways: through measurement of growth and body composition (anthropometric indicators); through analysis of the biochemical content of blood and urine (biochemical indicators); and through clinical examination of external physical signs of nutrient deficiencies (clinical indicators). Among the three method of assessment, anthropometric measurement is a common and easy way to assess health and nutrition status. The other two methods are less practical because of the logistical difficulties and because data collection and analysis is expensive and time consuming.
The following explanation focuses on the anthropometric indicators of nutritional status. Anthropometric information is useful because it provides: 1) a practical way of describing the problem; 2) the best general proxy measure of human welfare of the poorest, reflecting dietary inadequacies, infectious diseases and other environmental health risks; 3) strong and feasible predictors, at individual and community levels, of subsequent ill health, functional impairment and/or mortality; 4) an appropriate indicator of the success or failure of interventions directed toward the many economic and environmental factors underlying nutrition deprivation (UN-ACC/SCN, 1992).
6.1 Understanding the uses of Anthropometric indicators
Anthropometric indices are combination of measurements related to body size and composition. At the individual level, anthropometry is used to assess the person as being in need of special interventions. In population, anthropometric data is used to make decisions about the need for intervention, and what type of interventions is needed and to whom it should be delivered.
To do the anthropometric measurement, four variables need to be collected: age, weight, height (or length of babies) and gender. Each of these variables provides one piece of information about a person. When they are used together, they can provide important information about the personís nutritional status. When two of these variables are used together they are called an index. There are three indexes that are commonly used in assessing the nutritional status: weight for age, height (length) for age, and weight for height (length). When these indexes are compared to a reference standard of anthropometry to assess the magnitude, distribution and severity of a nutritional problem in a country they are called an anthropometric indicator.
There are several possibilities of anthropometric classification by comparison with a reference population. Weight for age is often used to tell if a child is normal, overweight or underweight. When a child weighs less than expected for their age, they are underweight, and when they weigh more than they should for their age, they are overweight. Height (or length) for age is used to tell if a child is the normal height for their age. A child who is not as long or tall as expected may be stunted, meaning that a child did not grow to its full potential. Weight for height helps to identify children who are wasted, meaning that children do not weight as much as they should for their height.
Underweight, stunting, and wasting, are the nutritional status conditions are concerned in anthropometric assessment.
Underweight (Weight for age) is the most common assessment of child nutrition status. It is routinely collected in growth promotion programs, and is a good indicator for children under 24 months because of the need to do precise measurements of weight for these age groups. Weight for age (WFA) is a simple index, but this index does not take height into account. Children who are taller would be expected to weigh more than other children, just as children who are shorter would be expected to weigh a little less and still be healthy
Stunting (Height for age) is a measure of linear growth. Stunting refers to shortness, and reflects linear growth achieved pre- and postnatal; with its deficits it is generally assumed to indicate long-term, cumulative effects of inadequate nutrition and poor health status. Height for age (HFA) is considered a measure of past nutrition, because a child who is short today, maybe did not have adequate nutritional intake at some point in the past.
Wasting (Weight for Height) is a measure of acute or short-term exposure to a negative environment. It is sensitive to changes in calorie intake or the effects of disease. Wasting can be calculated without knowing the age of a child. Weight for height (WFH) is a measure of current body mass. It is the best index to use to reflect wasting malnutrition, when it is difficult to determine the exact ages of the children being measured.
A child is considered malnutrient if any of these indexes fall below refers two standard deviations (<-2SD) of the median value of the National Center for Health Statistics/World Health Organization (NCHS/WHO) international reference(WHO, 1995). Severe malnutrition is when the indexes fall below 3 SD of the median value.
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