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Children aged <5 years

- stunted for age (percentage)
- underweight for age (percentage)
- overweight for age (percentage)

Rationale for use

The purpose of these indicators is to measure long-term nutritional imbalance and malnutrition resulting in undernutrition (assessed by underweight and stunting) and overweight. Child growth is the most widely used indicator of nutritional status in a community and is internationally recognized as an important public-health indicator for monitoring health in populations. In addition, children who suffer from growth retardation as a result of poor diets and/or recurrent infections tend to have a greater risk of suffering illness and death.

The percentage of children with low height-for-age reflects the cumulative effects of under-nutrition and infections since birth, and even before birth. This measure, therefore, should be interpreted as an indication of poor environmental conditions and/or long-term restriction of a child's growth potential. The percentage of children with low weight-for-age may reflect the less common ‘wasting’ (i.e. low weight-for-height) indicating acute weight loss, and/or the much more common ‘stunting’. Thus, it is a composite indicator that is difficult to interpret.

Definition

Percentage of underweight (weight-for-age less than -2 standard deviations (SD) of the WHO Child Growth Standards median) among children aged less than 5 years.

Percentage of stunting (height-for-age less than -2 SD of the WHO Child Growth Standards median) among children aged less than 5 years.

Percentage of overweight (weight-for-height greater than +2 SD of the WHO Child Growth Standards median) among children aged less than 5 years.

Associated terms

Severe underweight and stunting are defined as less than -3 standard deviations of the weight-for-age and height-for-age WHO Child Growth Standards median, respectively.

Data sources

National household surveys, subnational nutritional surveys and national nutrition surveillance systems.

Methods of estimation

A well-established methodology for the compilation and standardized analysis of nutritional surveys, as well as robust methods for deriving global and regional trends and forecasting future trends, have been published (de Onis & Blössner, 2003; de Onis et al., 2004a, 2004b).

Disaggregation

By sex, age, and location (urban/rural, major regions/provinces)

References

• Web site of the WHO Child Growth Standards
• The WHO Global Database on Child Growth and Malnutrition: methodology and applications
  de Onis M and Blössner M. The WHO Global Database on Child Growth and Malnutrition: methodology and applications. International Journal of Epidemiology, 200,;32:518–526.
• Estimates of global prevalence of childhood underweight in 1990 and 2015
  de Onis M, Blössner M, Borghi E, Frongillo EA, Morris R. Estimates of global prevalence of childhood underweight in 1990 and 2015. Journal of the American Medical Association, 2004a, 291:2600–2606.
• Methodology for estimating regional and global trends of child malnutrition
  de Onis M, Blössner M, Borghi E, Morris R, Frongillo EA. Methodology for estimating regional and global trends of child malnutrition. International Journal of Epidemiology 2004b, 33:1260–1270.
• WHO Child Growth Standards
  de Onis M, Garza C, Onyango AW, Martorell R, editors. WHO Child Growth Standards. Acta Paediatrica Supplementum,2006, 450:1–101.
• The New WHO Growth Standards for Infants and Young Children
  International Pediatric Association. International Pediatric Association Endorsement. The New WHO Growth Standards for Infants and Young Children. Geneva, IPA, 2006.
• Statement of Endorsement of the WHO Child Growth Standards
  International Union of Nutritional Sciences. Statement of Endorsement of the WHO Child Growth Standards. California, IUNS, 2006.
• SCN Endorses the New WHO Growth Standards for Infants and Young Children
  Standing Committee on Nutrition of the United Nations System. SCN Endorses the New WHO Growth Standards for Infants and Young Children. SCN, 2006.
• WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development
  WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva, World Health Organization, 2006a.
• Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study
  WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatrica Supplementum, 2006b;450:56–65.

Database

• WHO Global Database on Child Growth and Malnutrition

Comments

An international set of standards (i.e. the WHO Child Growth Standards) is used to calculate prevalences for the indicators low weight-for-age, low height-for-age, and high weight-for-height (de Onis et al., 2006; WHO Multicentre Growth Reference Study Group, 2006). The International Pediatric Association (IPA), the Standing Committee on Nutrition of the United Nations System (SCN), and the International Union of Nutritional Sciences (IUNS), have officially endorsed the use of the WHO standards, describing them as an effective tool for detecting and monitoring undernutrition and overweight, thus addressing the double burden of malnutrition affecting populations on a global basis (International Pediatric Association Endorsement; Standing Committee on Nutrition of the United Nations System; International Union of Nutritional Sciences). The WHO standards may be used for all children aged up to 5 years, since the influence of ethnic or genetic factors on young children is considered to be insignificant (WHO Multicentre Growth Reference Study Group, 2006b).