3. Intra-uterine Undernutrition: Low
Birth Weight (LBW)
• Cause: Maternal malnutrition:
• Effect:
Malnutrition during intra-uterine life.
Retards the growth and development of the foetus
during pregnancy.
The foetus is born with birth weight lower than
normal.
The cut-off value for birth weight is 2.5 kg(WHO).
Babies born with birth weight <2.5 kg are LBW
babies.
Nutritional Status of Children 3
4. Childhood Malnutrition
• Severe consequences if it occurs early in life.
– Adverse impact on subsequent
growth, morbidity, cognitive
development, educational attainment and
productivity in adulthood.
Nutritional Status of Children 4
5. Nutrition status: Children U5
• Anthropometric Indicators:
Height-for-age (HFA),
Weight-for-age (WFA),
Weight-for-height (WFH), and
MUAC-for-age.
Most sensitive indicators of food security, vulnerability
and overall socio-economic development of a country.
Stunting, Wasting and Underweight.
Z-score classification.
Nutritional Status of Children 5
6. Malnutrition Indicators
Measure the clinical phenomena of malnutrition.
Standard cutoff points are used internationally to define
under nutrition in children 6-59 months.
The cutoff points for nutrition indicators are derived
from the WHO child growth standard population
(WHO standards) or NCHS reference population
(NCHS population).
Nutritional Status of Children 6
7. Stunting (low height-for-age)
• Cause: Chronic under nutrition retards growth of
a child by height.
• Stunting: child is shorter for its age.
• Information requirement: Estimates of height and
age.
Nutritional Status of Children 7
8. Stunting (low height-for-age)
• Low HFA identifies past or chronic under nutrition
(stunting)
• Stunting indicates reduced linear growth
Cannot measure short-term changes in malnutrition
For children <2 yrs of age, the term is length-for-
age/LA
For children > 2 yrs age, the index is referred to as
height-for-age/HA
Nutritional Status of Children 8
9. Stunting: Classification
• Height-for-age up to -2SD = Normal
• Height-for-age <-2SD to -3SD = Moderate
• Height-for-age <-3SD = Severe
Nutritional Status of Children 9
10. Wasting (low weight–for-height)
• Cause: Acute, short-run malnutrition
Affects only body weight.
“Wasting” of the body, i.e. loss of body mass
compared to the body size.
Indicator: Weight-for-height.
Nutritional Status of Children 10
11. Wasting (low weight–for-height)
Weight for-height:
Low WFH identifies current or acute under
nutrition (wasting)
Useful when exact age is difficult to
determine
• - Weight for-length (< 2 yrs) or weight for-
height (in > 2 yrs)
- Appropriate for examining short-term effects
Nutritional Status of Children 11
12. Wasting: Classification
• Normal weight-for-height: If its weight-for-height is
within 2 standard deviations (-2SD) of the median
weight-for-height of a reference population.
• Moderately wasted: If the weight-for-height falls
below 2SD (<-2SD) but within 3 SD below the
reference median (-3SD).
• Severely wasted: If the weight-for-height falls below
3SD of the reference median (<-3SD).
Nutritional Status of Children 12
13. Wasting: Classification
• Weight-for-height up to –2SD = Normal
• Weight-for-height <-2SD to –3SD = Moderate
• Weight-for-height <-3SD = Severe
Nutritional Status of Children 13
14. Underweight (low weight-for-age)
Composite indicator of long-term and acute
short-term malnutrition.
The body weight may be lost from malnutrition
for a long time => low weight-for-age.
Weight may also be lost from acute, short-term
malnutrition => low weight-for-age.
Nutritional Status of Children 14
15. Underweight: Classification
• Normal weight-for-age: If weight-for-age is within 2
standard deviations (-2SD) of the median weight-
for-age of a reference population.
• Moderately underweight: If the weight-for-age falls
below 2SD (<-2SD) but within 3 SD below the
reference median (-3SD).
• Severely underweight: If the weight-for-age falls
below 3SD of the reference median (<-3SD).
Nutritional Status of Children 15
18. Mid- Upper Arm Circumference
(MUAC)
Low MUAC (<12.5 cm) indicates acute
malnutrition among children 6-59 months.
Is relatively easy to measure and a good
predictor of immediate risk of death.
Is used for rapid screening of acute
malnutrition.
Nutritional Status of Children 18
21. Undernutrition trends among <5 children in Bangladesh
80
65.8 68.3
70
60 64.6 57.4
64.2
51
50
51.4 47.8
Percent
43 44.6
48.3
40 43.1
42.4 41
30
20 16.7 16.6
14.4
12 12.7 17
13
10
1989/90 1992 1995 2000 2005 2007 2009
Underweight <5 Stunting <5
Wasting <5 MDG target for underweight
Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA
Nutritional Status of Children 21
22. Food consumption, energy and nutrient
intake and nutritional status in rural
Bangladesh: Changes from 1981 – 1982
to 1995 – 96
Source: Hels et al. (2003) 22
