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Measuring Malnutrition

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How to Measure Malnutrition

Malnutrition is not always easy to see. Though the signs of severe malnutrition may be clear - such as discolored hair, baggy skin, or a distended belly - a moderately malnourished child at risk of falling into severe malnutrition may appear energetic and normal. For this reason, many parents don't realize when their children are malnourished.

Fortunately, malnutrition is relatively simple to measure. The most common measures of malnutrition require only three key pieces of information: the person's age, weight, and height. From these three, it's possible to determine if a person is:

  • Stunted, meaning the person has a low height for her age - an indication of chronic malnutrition over a long period of time
  • Wasted, meaning the person has a low weight for her height - an indication of acute malnutrition in the child at present
  • Underweight, meaning the person has a low weight for her age - a indication of general malnutrition

The HUNGaMA survey includes weight, height, age, and a fourth measure called mid-upper arm circumference to provide a comprehensive picture of nutrition.

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Start a HUNGaMA - The Hindustan Times, 22 August 2010
"Sit up and Notice" - The Hindu 20 January
2011

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More on measuring malnutrition...

The above measures are taken in reference to a normal, healthy growth path for children, as defined by the World Health Organization (WHO) Child Growth Standards. WHO developed the standard by measuring healthy children from many countries, including India.

When a child is below a normal, healthy growth path (more than two “standard deviations” below average, in statistical terms) the child is considered to be malnourished. If the child is very far below the normal, healthy growth path (by more than three standard deviations) the child is considered to be severely malnourished.

Another metric to assessing malnutrition is the mid-upper arm circumference (MUAC). The circumference of the child’s upper arm half way between their shoulder and elbow provides an indication of acute malnutrition independent of the child's age. If the child’s arm is less than 11.5cm in circumference, she is severely malnourished; if the child’s arm is between 11.5 and 12.5cm in circumference, she is moderately malnourished. These values are appropriate for children from 6 months to 60 months.

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Because of its simplicity, MUAC is an especially useful measurement in situations where other equipment is not available or when birth dates are not precisely known, such as in rapid assessments or disaster relief operations. Specialized strips like the one below have been designed to measure MUAC. This strip is easy to use and can be administered with minimal training.

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The strip is wrapped around the arm halfway between the shoulder and the elbow. The reading for the MUAC is taken through the window, between the black arrows. If the arrows point to the red part of the strip, the child is severely malnourished. Yellow indicates moderate malnutrition and green indicates the child is not malnourished.

Anganwadi centers are charged with regularly measuring the weight of children to determine if they are underweight. The age and weight are plotted on the WHO charts below. Children are severely underweight if their age and weight put them below the line marked “-3”; they are moderately underweight if their age and weight put them between the line marked “-2” and the line marked “-3”

EXAMPLES OF MEASURING MALNUTRITION:

The girl lives in Madhya Pradesh, a state with one of India’s highest rates of malnutrition. She weighs 11 kgs and she is 3 years and 8.5 months old. Plotting these details on the graph below shows that she is moderately malnourished (underweight).

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This infant boy in Madhya Pradesh is almost nine months old and weighs 6.2 kgs. Plotting these details on the graph below shows that he has just crossed the line into being severely malnourished (underweight).

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