Public Health Nutrition

Research Paper

WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references

Norbert G Schwarza1a2, Martin P Grobuscha1a3, Marie-Luise Deckera1a2, Julia Goescha1a2, Marc Poetschkea1a2, Sunny Oyakhiromea1, Davy Kombilaa1, Julien Fortina1, Bertrand Lella1a2, Saadou Issifoua1, Peter G Kremsnera1a2 and Kerstin Klipstein-Grobuscha4 c1

a1 Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon

a2 Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Germany

a3 Infectious Diseases Unit, CMID and NHLS, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

a4 School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, York Road 7, Parktown, Johannesburg 2193, South Africa

Abstract

Objectives To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references.

Design and setting Prospective birth cohort in Lambaréné, Gabon.

Subjects Two hundred and eighty-nine children from birth to 15 months of age.

Methods Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below –2 sd of the corresponding reference median (Z score ≤−2) were classified as stunted or underweight-for-age, respectively.

Results With the new WHO 2006 standards a higher proportion (4·0 %) of 3-month-old infants were underweight compared with the CDC (1·0 %) or the NCHS (0·7 %) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20 %) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months.

Conclusions The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.

(Received March 30 2007)

(Accepted October 24 2007)

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