Abstract
Background: Undernutrition remains a leading cause of childhood morbidity in developing countries, and growth monitoring with standardized reference charts is central to its early detection. In India, both the World Health Organization (WHO) 2006 growth standards and the Indian Academy of Pediatrics (IAP) growth charts are used, but the two systems can classify the same child differently, creating uncertainty about the true burden of malnutrition.
Objectives: To compare the prevalence of undernutrition and stunting among children aged 1–5 years using WHO and IAP growth references, and to evaluate associations between nutritional status and selected demographic, socioeconomic and biological factors.
Methods: This cross-sectional study was conducted over two years among 689 children aged >1 to <5 years admitted to a tertiary-care hospital in Ahmedabad, India. Weight, height/length and mid-arm circumference (MAC) were measured by standard anthropometric technique and classified using IAP (percentage of Harvard median) and WHO (2006, Z-score) criteria. Categorical variables were compared using the chi-square test, with p<0.05 taken as significant.
Results: Of 689 children (328 male, 47.6%; 361 female, 52.4%), malnutrition (weight-for-age) was present in 44.7% (308/689) by IAP and 42.8% (295/689) by WHO criteria. Severe undernutrition (<−3SD) was identified in 23.4% (161) of children by WHO criteria, compared with 11.1% (76) classified as Grade III/IV by IAP. Stunting was more common by IAP (58.2%, 401/689) than by WHO criteria (35.3%, 243/689). By MAC, 30.6% of children were normal, 55.1% moderately and 14.3% severely malnourished. Malnutrition was significantly more prevalent among female children, in the 1–2-year age group, and among children from lower-income families, with unemployed mothers, low birth weight and higher birth order (p<0.05). Differences between WHO and IAP classification of both weight and height were statistically significant in male and female children (p<0.05).
Conclusion: WHO (2006) growth standards identified more severely malnourished children, while IAP charts identified more stunted children, than the alternative system. The choice of growth reference materially affects the estimated burden and severity of undernutrition in Indian preschool children, supporting the need for a standardized approach to pediatric growth monitoring.
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