Research Paper

Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference

Rozina Nuruddin^a1a2 c1, Meng Kin Lim^a3, Wilbur C Hadden^a4 and Iqbal Azam^a1

^a1 Department of Community Health Sciences, The Aga Khan University, Karachi-74800, Pakistan

^a2 Pakistan and Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore 117597, Singapore

^a3 Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore

^a4 National Institute on Aging, Bethesda, MD 20892, USA

Abstract

Objective To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference.

Design Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared.

Setting The data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province.

Subjects In all, 1533 and 1051 children aged 0–35 months from national and Thatta surveys, respectively.

Results WHO standard gave a significantly higher prevalence of stunting for both national [36·7 (95 % CI 33·2, 40·2)] and Thatta surveys [52·9 (95 % CI 48·9, 56·9)] compared to the NCHS reference [national: 29·1 (95 % CI 25·9, 32·2) and Thatta: 44·8 (95 % CI 41·1, 48·5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22·9 (95 % CI 20·3, 25·5)] compared to the NCHS reference [15·7 (95 % CI 13·5, 17·8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children.

Conclusions Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country’s targets for Millennium Development Goal 1 and for monitoring nutritional trends.

(Received April 10 2007)

(Accepted April 03 2008)

Keywords

• NCHS growth reference;
• Pre-school children;
• Pakistan;
• Under-nutrition prevalence;
• WHO growth standard

Correspondence:

^c1 Corresponding author: Email rozina.nuruddin@aku.edu