Bulletin of the World Health Organization

Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality

Linda Vesel, Rajiv Bahl, Jose Martines, Mary Penny, Nita Bhandari, Betty R Kirkwood & the WHO Immunization-linked Vitamin A Supplementation Study Group

Volume 88, Number 1, January 2010, 39-48

Table 4. Infant malnutrition at 6 months of age as a predictor of death between 6 and 12 months of age, Ghana, India and Peru, 1995–1997

Malnutrition indicator at 6 months of agea No. of deaths
 Sensitivity Specificity AUC (95% CI)
among malnourished among non-malnourished
Ghana (n = 1558)
WHO child growth standards
Stuntingb 8 of 274 19 of 1282 29.6 82.6 0.56 (0.47–0.65)
Wastingc 5 of 113 22 of 1441 18.5 92.9 0.56 (0.48–0.63)
Underweight 10 of 283 17 of 1275 37.0 82.2 0.60 (0.50–0.69)
NCHS growth reference
Stuntingb 7 of 153 20 of 1403 25.9 90.5 0.58 (0.50–0.67)
Wastingc 0 of 14 27 of 1540 0.0 99.1 0.5 (0.49–0.50)
Underweight 5 of 144 22 of 1414 18.5 90.9 0.55 (0.47–0.62)
India (n = 1702)
WHO child growth standards
Stuntingb 19 of 631 14 of 1065 57.6 63.2 0.60 (0.52–0.69)
Wastingc 18 of 260 15 of 1436 54.6 85.5 0.70 (0.61–0.79)
Underweight 22 of 660 12 of 1042 64.7 61.8 0.63 (0.55–0.71)
Severe underweightd 17 of 246 17 of 1456 50.0 86.3 0.68 (0.60–0.77)
NCHS growth reference
Stuntingb 18 of 443 15 of 1253 54.6 74.4 0.64 (0.56–0.73)
Wastingc 8 of 53 25 of 1643 24.2 97.3 0.61 (0.53–0.68)
Underweight 20 of 410 14 of 1292 58.8 76.6 0.68 (0.59–0.76)
Peru (n = 1734)
WHO child growth standards
Stuntingb 2 of 129 4 of 1599 33.3 92.6 0.63 (0.42–0.84)
Wastingc 1 of 13 5 of 1715 16.7 99.3 0.58 (0.42–0.74)
Underweight 2 of 38 4 of 1696 33.3 97.9 0.66 (0.45–0.86)
NCHS growth reference
Stuntingb 1 of 70 5 of 1658 16.7 96.0 0.56 (0.40–0.73)
Wastingc 0 of 2 6 of 1726 0.0 99.9 0.50 (0.50–0.50)
Underweight 1 of 14 5 of 1720 16.7 99.3 0.58 (0.42–0.74)

AUC, area under the receiver operating characteristic curve; CI, confidence interval; NCHS, National Center for Health Statistics; WHO, World Health Organization.
a Malnutrition indicators were derived using either WHO child growth standards or the NCHS growth reference.
b Stunting could not be assessed for 2, 6 and 6 infants in Ghana, India and Peru, respectively.
c Wasting could not be assessed for 4, 6 and 6 infants in Ghana, India and Peru, respectively.
d Figures for the severe malnutrition indicator were calculated only when the malnutrition indicator had a high sensitivity and a low specificity.