 | The Management of Nutrition in Major Emergencies (WHO - OMS, 2000, 250 p.) |
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Annex 3. Nutritional anthropometry in emergencies
Introduction
This annex deals with the technical aspects of anthropometric assessments in emergencies. The parameters used for these assessments are discussed in Chapter 3.
The "gold standard" in anthropometric assessment of children is weight-for-length/height, with the usual practice being to measure the length of children under 2 years of age and the height of older children. It may be preferable, however, to use length measurements consistently. For most purposes, measurements are made on children from 6 months to 5 years (59 months) of age. Infants from birth to 5 months are included if moderate or severe maternal undernutrition or infections are suspected, and infant feeding practices (for infants from birth to 1 year) should in any case be assessed.
For measurements in small children, a weighing scale and a length-board are virtually essential items of equipment. It is possible to measure the height of children under 2 years old but this requires an extra assistant and is difficult to perform accurately. Length-boards are available through various agencies but may not be sufficiently robust for emergency situations. Locally made versions, using a design such as that shown in Fig. A3.2, are preferable. If age is not known exactly, the cut-off length corresponding to 2 years of age is 85 cm in non-stunted populations, but about 80 cm in chronically undernourished populations. For age 5 years, the corresponding cut-offs are 110 and 100 cm, respectively. Length-boards should therefore be at least 120 cm long. If older children are to be measured (for example, up to 10 years, with cut-offs of 137 and 130 cm), the length-boards should be 140 cm long; otherwise height may be determined using an adult height measure.
The internationally accepted WHO/NCHS reference values for weight-for-length/height up to 137 cm (10 years) are given in Table A 3.1 for the two sexes separately and in Table A 3.2 for the sexes combined.1 Use of "combined" reference values will result in a slight underestimate of undernutrition in boys and an overestimate in girls and is therefore not generally recommended. However, under field conditions in emergencies, pressures of time and numbers of people may make it difficult to record sex reliably or to maintain separate records.
1 WHO/NCHS growth reference data for height and weight of US children were originally collected by the National Center for Health Statistics (NCHS) and are recommended by WHO for international use.
Table A3.1 WHO/NCHS normalized reference weight-for-length/height (49-137 cm) by sex
|
Boys' weight (kg) |
Length/height (cm) |
Girls' weight (kg) | ||||||||
|
Median |
-1SD |
-2SD |
-3SD |
-4SD |
|
Median |
-1SD |
-2SD |
-3SD |
-4SD |
|
3.1 |
2.8 |
2.5 |
2.1 |
1.8 |
49 |
3.3 |
2.9 |
2.6 |
2.2 |
1.8 |
|
3.2 |
2.9 |
2.5 |
2.1 |
1.8 |
49.5 |
3.4 |
3.0 |
2.6 |
2.2 |
1.8 |
|
3.3 |
2.9 |
2.5 |
2.2 |
1.8 |
50 |
3.4 |
3.0 |
2.6 |
2.3 |
1.9 |
|
3.4 |
3.0 |
2.6 |
2.2 |
1.8 |
50.5 |
3.5 |
3.1 |
2.7 |
2.3 |
1.9 |
|
3.5 |
3.1 |
2.6 |
2.2 |
1.8 |
51 |
3.5 |
3.1 |
2.7 |
2.3 |
1.9 |
|
3.6 |
3.1 |
2.7 |
2.3 |
1.8 |
51.5 |
3.6 |
3.2 |
2.8 |
2.4 |
1.9 |
|
3.7 |
3.2 |
2.8 |
2.3 |
1.9 |
52 |
3.7 |
3.3 |
2.8 |
2.4 |
2.0 |
|
3.8 |
3.3 |
2.8 |
2.4 |
1.9 |
52.5 |
3.8 |
3.4 |
2.9 |
2.5 |
2.0 |
|
3.9 |
3.4 |
2.9 |
2.4 |
1.9 |
53 |
3.9 |
3.4 |
3.0 |
2.5 |
2.1 |
|
4.0 |
3.5 |
3.0 |
2.5 |
2.0 |
53.5 |
4.0 |
3.5 |
3.1 |
2.6 |
2.1 |
|
4.1 |
3.6 |
3.1 |
2.6 |
2.0 |
54 |
4.1 |
3.6 |
3.1 |
2.7 |
2.2 |
|
4.2 |
3.7 |
3.2 |
2.6 |
2.1 |
54.5 |
4.2 |
3.7 |
3.2 |
2.7 |
2.2 |
|
4.3 |
3.8 |
3.3 |
2.7 |
2.2 |
55 |
4.3 |
3.8 |
3.3 |
2.8 |
2.3 |
|
4.5 |
3.9 |
3.3 |
2.8 |
2.2 |
55.5 |
4.4 |
3.9 |
3.4 |
2.9 |
2.4 |
|
4.6 |
4.0 |
3.5 |
2.9 |
2.3 |
56 |
4.5 |
4.0 |
3.5 |
3.0 |
2.4 |
|
4.7 |
4.1 |
3.6 |
3.0 |
2.4 |
56.5 |
4.6 |
4.1 |
3.6 |
3.0 |
2.5 |
|
4.8 |
4.3 |
3.7 |
3.1 |
2.5 |
57 |
4.8 |
4.2 |
3.7 |
3.1 |
2.6 |
|
5.0 |
4.4 |
3.8 |
3.2 |
2.6 |
57.5 |
4.9 |
4.3 |
3.8 |
3.2 |
2.7 |
|
5.1 |
4.5 |
3.9 |
3.3 |
2.7 |
58 |
5.0 |
4.4 |
3.9 |
3.3 |
2.7 |
|
5.2 |
4.6 |
4.0 |
3.4 |
2.8 |
58.5 |
5.1 |
4.6 |
4.0 |
3.4 |
2.8 |
|
5.4 |
4.8 |
4.1 |
3.5 |
2.9 |
59 |
5.3 |
4.7 |
4.1 |
3.5 |
2.9 |
|
5.5 |
4.9 |
4.2 |
3.6 |
3.0 |
59.5 |
5.4 |
4.8 |
4.2 |
3.6 |
3.0 |
|
5.7 |
5.0 |
4.4 |
3.7 |
3.1 |
60 |
5.5 |
4.9 |
4.3 |
3.7 |
3.1 |
|
5.8 |
5.1 |
4.5 |
3.8 |
3.2 |
60.5 |
5.7 |
5.1 |
4.4 |
3.8 |
3.2 |
|
5.9 |
5.3 |
4.6 |
4.0 |
3.3 |
61 |
5.8 |
5.2 |
4.6 |
3.9 |
3.3 |
|
6.1 |
5.4 |
4.8 |
4.1 |
3.4 |
61.5 |
6.0 |
5.3 |
4.7 |
4.0 |
3.4 |
|
6.2 |
5.6 |
4.9 |
4.2 |
3.5 |
62 |
6.1 |
5.4 |
4.8 |
4.1 |
3.5 |
|
6.4 |
5.7 |
5.0 |
4.3 |
3.7 |
62.5 |
6.2 |
5.6 |
4.9 |
4.2 |
3.6 |
|
6.5 |
5.8 |
5.2 |
4.5 |
3.8 |
63 |
6.4 |
5.7 |
5.0 |
4.4 |
3.7 |
|
6.7 |
6.0 |
5.3 |
4.6 |
3.9 |
63.5 |
6.5 |
5.8 |
5.2 |
4.5 |
3.8 |
|
6.8 |
6.1 |
5.4 |
4.7 |
4.0 |
64 |
6.7 |
6.0 |
5.3 |
4.6 |
3.9 |
|
7.0 |
6.3 |
5.6 |
4.9 |
4.2 |
64.5 |
6.8 |
6.1 |
5.4 |
4.7 |
4.0 |
|
7.1 |
6.4 |
5.7 |
5.0 |
4.3 |
65 |
7.0 |
6.3 |
5.5 |
4.8 |
4.1 |
|
7.3 |
6.5 |
5.8 |
5.1 |
4.4 |
65.5 |
7.1 |
6.4 |
5.7 |
4.9 |
4.2 |
|
7.4 |
6.7 |
6.0 |
5.3 |
4.5 |
66 |
7.3 |
6.5 |
5.8 |
5.1 |
4.3 |
|
7.6 |
6.8 |
6.1 |
5.4 |
4.7 |
66.5 |
7.4 |
6.7 |
5.9 |
5.2 |
4.4 |
|
7.7 |
7.0 |
6.2 |
5.5 |
4.8 |
67 |
7.5 |
6.8 |
6.0 |
5.3 |
4.5 |
|
7.8 |
7.1 |
6.4 |
5.7 |
4.9 |
67.5 |
7.7 |
6.9 |
6.2 |
5.4 |
4.7 |
|
8.0 |
7.3 |
6.5 |
5.8 |
5.1 |
68 |
7.8 |
7.1 |
6.3 |
5.5 |
4.8 |
|
8.1 |
7.4 |
6.6 |
5.9 |
5.2 |
68.5 |
8.0 |
7.2 |
6.4 |
5.6 |
4.9 |
|
8.3 |
7.5 |
6.8 |
6.0 |
5.3 |
69 |
8.1 |
7.3 |
6.5 |
5.8 |
5.0 |
|
8.4 |
7.7 |
6.9 |
6.2 |
5.4 |
69.5 |
8.2 |
7.5 |
6.7 |
5.9 |
5.1 |
|
8.5 |
7.8 |
7.0 |
6.3 |
5.5 |
70 |
8.4 |
7.6 |
6.8 |
6.0 |
5.2 |
|
8.7 |
7.9 |
7.2 |
6.4 |
5.7 |
70.5 |
8.5 |
7.7 |
6.9 |
6.1 |
5.3 |
|
8.8 |
8.1 |
7.3 |
6.5 |
5.8 |
71 |
8.6 |
7.8 |
7.0 |
6.2 |
5.4 |
|
8.9 |
8.2 |
7.4 |
6.7 |
5.9 |
71.5 |
8.8 |
8.0 |
7.1 |
6.3 |
5.5 |
|
9.1 |
8.3 |
7.5 |
6.8 |
6.0 |
72 |
8.9 |
8.1 |
7.2 |
6.4 |
5.6 |
|
9.2 |
8.4 |
7.7 |
6.9 |
6.1 |
72.5 |
9.0 |
8.2 |
7.4 |
6.5 |
5.7 |
|
9.3 |
8.6 |
7.8 |
7.0 |
6.2 |
73 |
9.1 |
8.3 |
7.5 |
6.6 |
5.8 |
|
9.5 |
8.7 |
7.9 |
7.1 |
6.3 |
73.5 |
9.3 |
8.4 |
7.6 |
6.7 |
5.9 |
|
9.6 |
8.8 |
8.0 |
7.2 |
6.4 |
74 |
9.4 |
8.5 |
7.7 |
6.8 |
6.0 |
|
9.7 |
8.9 |
8.1 |
7.3 |
6.5 |
74.5 |
9.5 |
8.6 |
7.8 |
6.9 |
6.1 |
|
9.8 |
9.0 |
8.2 |
7.4 |
6.6 |
75 |
9.6 |
8.7 |
7.9 |
7.0 |
6.2 |
|
9.9 |
9.1 |
8.3 |
7.5 |
6.7 |
75.5 |
9.7 |
8.8 |
8.0 |
7.1 |
6.3 |
|
10.0 |
9.2 |
8.4 |
7.6 |
6.8 |
76 |
9.8 |
8.9 |
8.1 |
7.2 |
6.4 |
|
10.2 |
9.3 |
8.5 |
7.7 |
6.9 |
76.5 |
9.9 |
9.0 |
8.2 |
7.3 |
6.5 |
|
10.3 |
9.4 |
8.6 |
7.8 |
7.0 |
77 |
10.0 |
9.1 |
8.3 |
7.4 |
6.6 |
|
10.4 |
9.5 |
8.7 |
7.9 |
7.1 |
77.5 |
10.1 |
9.2 |
8.4 |
7.5 |
6.6 |
|
10.5 |
9.7 |
8.8 |
8.0 |
7.1 |
78 |
10.2 |
9.3 |
8.5 |
7.6 |
6.7 |
|
10.6 |
9.8 |
8.9 |
8.1 |
7.2 |
78.5 |
10.3 |
9.4 |
8.6 |
7.7 |
6.8 |
|
10.7 |
9.9 |
9.0 |
8.2 |
7.3 |
79 |
10.4 |
9.5 |
8.7 |
7.8 |
6.9 |
|
10.8 |
10.0 |
9.1 |
8.2 |
7.4 |
79.5 |
10.5 |
9.6 |
8.7 |
7.9 |
7.0 |
|
10.9 |
10.1 |
9.2 |
8.3 |
7.5 |
80 |
10.6 |
9.7 |
8.8 |
8.0 |
7.1 |
|
11.0 |
10.1 |
9.3 |
8.4 |
7.6 |
80.5 |
10.7 |
9.8 |
8.9 |
8.0 |
7.2 |
|
11.1 |
10.2 |
9.4 |
8.5 |
7.6 |
81 |
10.8 |
9.9 |
9.0 |
8.1 |
7.2 |
|
11.2 |
10.3 |
9.5 |
8.6 |
7.7 |
81.5 |
10.9 |
10.0 |
9.1 |
8.2 |
7.3 |
|
11.3 |
10.4 |
9.6 |
8.7 |
7.8 |
82 |
11.0 |
10.1 |
9.2 |
8.3 |
7.4 |
|
11.4 |
10.5 |
9.6 |
8.8 |
7.9 |
82.5 |
11.1 |
10.2 |
9.3 |
8.4 |
7.5 |
|
11.5 |
10.6 |
9.7 |
8.8 |
7.9 |
83 |
11.2 |
10.3 |
9.4 |
8.5 |
7.6 |
|
11.6 |
10.7 |
9.8 |
8.9 |
8.0 |
83.5 |
11.3 |
10.4 |
9.5 |
8.6 |
7.7 |
|
11.7 |
10.8 |
9.9 |
9.0 |
8.1 |
84 |
11.4 |
10.5 |
9.6 |
8.7 |
7.7 |
|
11.8 |
10.9 |
10.0 |
9.1 |
8.2 |
84.5 |
11.5 |
10.6 |
9.6 |
8.7 |
7.8 |
|
12.1 |
11.0 |
9.9 |
8.9 |
7.8 |
85 |
11.8 |
10.8 |
9.7 |
8.6 |
7.6 |
|
12.2 |
11.1 |
10.0 |
8.9 |
7.9 |
85.5 |
11.9 |
10.9 |
9.8 |
8.7 |
7.6 |
|
12.3 |
11.2 |
10.1 |
9.0 |
7.9 |
86 |
12.0 |
11.0 |
9.9 |
8.8 |
7.7 |
|
12.5 |
11.3 |
10.2 |
9.1 |
8.0 |
86.5 |
12.2 |
11.1 |
10.0 |
8.9 |
7.8 |
|
12.6 |
11.5 |
10.3 |
9.2 |
8.1 |
87 |
12.3 |
11.2 |
10.1 |
9.0 |
7.9 |
|
12.7 |
11.6 |
10.4 |
9.3 |
8.2 |
87.5 |
12.4 |
11.3 |
10.2 |
9.1 |
8.0 |
|
12.8 |
11.7 |
10.5 |
9.4 |
8.3 |
88 |
12.5 |
11.4 |
10.3 |
9.2 |
8.1 |
|
12.9 |
11.8 |
10.6 |
9.5 |
8.4 |
88.5 |
12.6 |
11.5 |
10.4 |
9.3 |
8.1 |
|
13.0 |
11.9 |
10.7 |
9.6 |
8.4 |
89 |
12.7 |
11.6 |
10.5 |
9.3 |
8.2 |
|
13.1 |
12.0 |
10.8 |
9.7 |
8.5 |
89.5 |
12.8 |
11.7 |
10.6 |
9.4 |
8.3 |
|
13.3 |
12.1 |
10.9 |
9.8 |
8.6 |
90 |
12.9 |
11.8 |
10.7 |
9.5 |
8.4 |
|
13.4 |
12.2 |
11.0 |
9.9 |
8.7 |
90.5 |
13.0 |
11.9 |
10.7 |
9.6 |
8.5 |
|
13.5 |
12.3 |
11.1 |
9.9 |
8.8 |
91 |
13.2 |
12.0 |
10.8 |
9.7 |
8.5 |
|
13.6 |
12.4 |
11.2 |
10.0 |
8.8 |
91.5 |
13.3 |
12.1 |
10.9 |
9.8 |
8.6 |
|
13.7 |
12.5 |
11.3 |
10.1 |
8.9 |
92 |
13.4 |
12.2 |
11.0 |
9.9 |
8.7 |
|
13.9 |
12.6 |
11.4 |
10.2 |
9.0 |
92.5 |
13.5 |
12.3 |
11.1 |
9.9 |
8.8 |
|
14.0 |
12.8 |
11.5 |
10.3 |
9.1 |
93 |
13.6 |
12.4 |
11.2 |
10.0 |
8.8 |
|
14.1 |
12.9 |
11.6 |
10.4 |
9.2 |
93.5 |
13.7 |
12.5 |
11.3 |
10.1 |
8.9 |
|
14.2 |
13.0 |
11.7 |
10.5 |
9.2 |
94 |
13.9 |
12.6 |
11.4 |
10.2 |
9.0 |
|
14.3 |
13.1 |
11.8 |
10.6 |
9.3 |
94.5 |
14.0 |
12.8 |
11.5 |
10.3 |
9.1 |
|
14.5 |
13.2 |
11.9 |
10.7 |
9.4 |
95 |
14.1 |
12.9 |
11.6 |
10.4 |
9.1 |
|
14.6 |
13.3 |
12.0 |
10.8 |
9.5 |
95.5 |
14.2 |
13.0 |
11.7 |
10.5 |
9.2 |
|
14.7 |
13.4 |
12.1 |
10.9 |
9.6 |
96 |
14.3 |
13.1 |
11.8 |
10.6 |
9.3 |
|
14.8 |
13.5 |
12.2 |
11.0 |
9.7 |
96.5 |
14.5 |
13.2 |
11.9 |
10.7 |
9.4 |
|
15.0 |
13.7 |
12.4 |
11.0 |
9.7 |
97 |
14.6 |
13.3 |
12.0 |
10.7 |
9.5 |
|
15.1 |
13.8 |
12.5 |
11.1 |
9.8 |
97.5 |
14.7 |
13.4 |
12.1 |
10.8 |
9.5 |
|
15.2 |
13.9 |
12.6 |
11.2 |
9.9 |
98 |
14.9 |
13.5 |
12.2 |
10.9 |
9.6 |
|
15.4 |
14.0 |
12.7 |
11.3 |
10.0 |
98.5 |
15.0 |
13.7 |
12.3 |
11.0 |
9.7 |
|
15.5 |
14.1 |
12.8 |
11.4 |
10.1 |
99 |
15.1 |
13.8 |
12.4 |
11.1 |
9.8 |
|
15.6 |
14.3 |
12.9 |
11.5 |
10.2 |
99.5 |
15.2 |
13.9 |
12.5 |
11.2 |
9.9 |
|
15.7 |
14.4 |
13.0 |
11.6 |
10.3 |
100 |
15.4 |
14.0 |
12.7 |
11.3 |
9.9 |
|
15.9 |
14.5 |
13.1 |
11.7 |
10.3 |
100.5 |
15.5 |
14.1 |
12.8 |
11.4 |
10.0 |
|
16.0 |
14.6 |
13.2 |
11.8 |
10.4 |
101 |
15.6 |
14.3 |
12.9 |
11.5 |
10.1 |
|
16.2 |
14.7 |
13.3 |
11.9 |
10.5 |
101.5 |
15.8 |
14.4 |
13.0 |
11.6 |
10.2 |
|
16.3 |
14.9 |
13.4 |
12.0 |
10.6 |
102 |
15.9 |
14.5 |
13.1 |
11.7 |
10.3 |
|
16.4 |
15.0 |
13.6 |
12.1 |
10.7 |
102.5 |
16.0 |
14.6 |
13.2 |
11.8 |
10.4 |
|
16.6 |
15.1 |
13.7 |
12.2 |
10.8 |
103 |
16.2 |
14.7 |
13.3 |
11.9 |
10.5 |
|
16.7 |
15.3 |
13.8 |
12.3 |
10.9 |
103.5 |
16.3 |
14.9 |
13.4 |
12.0 |
10.5 |
|
16.9 |
15.4 |
13.9 |
12.4 |
11.0 |
104 |
16.5 |
15.0 |
13.5 |
12.1 |
10.6 |
|
17.0 |
15.5 |
14.0 |
12.6 |
11.1 |
104.5 |
16.6 |
15.1 |
13.7 |
12.2 |
10.7 |
|
17.1 |
15.6 |
14.2 |
12.7 |
11.2 |
105 |
16.7 |
15.3 |
13.8 |
12.3 |
10.8 |
|
17.3 |
15.8 |
14.3 |
12.8 |
11.3 |
105.5 |
16.9 |
15.4 |
13.9 |
12.4 |
10.9 |
|
17.4 |
15.9 |
14.4 |
12.9 |
11.4 |
106 |
17.0 |
15.5 |
14.0 |
12.5 |
11.0 |
|
17.6 |
16.1 |
14.5 |
13.0 |
11.5 |
106.5 |
17.2 |
15.7 |
14.1 |
12.6 |
11.1 |
|
17.7 |
16.2 |
14.7 |
13.1 |
11.6 |
107 |
17.3 |
15.8 |
14.3 |
12.7 |
11.2 |
|
17.9 |
16.3 |
14.8 |
13.2 |
11.7 |
107.5 |
17.5 |
15.9 |
14.4 |
12.8 |
11.3 |
|
18.0 |
16.5 |
14.9 |
13.4 |
11.8 |
108 |
17.6 |
16.1 |
14.5 |
13.0 |
11.4 |
|
18.2 |
16.6 |
15.0 |
13.5 |
11.9 |
108.5 |
17.8 |
16.2 |
14.6 |
13.1 |
11.5 |
|
18.3 |
16.8 |
15.2 |
13.6 |
12.0 |
109 |
17.9 |
16.4 |
14.8 |
13.2 |
11.6 |
|
18.5 |
16.9 |
15.3 |
13.7 |
12.1 |
109.5 |
18.1 |
16.5 |
14.9 |
13.3 |
11.7 |
|
18.7 |
17.1 |
15.4 |
13.8 |
12.2 |
110 |
18.2 |
16.6 |
15.0 |
13.4 |
11.9 |
|
18.8 |
17.2 |
15.6 |
14.0 |
12.3 |
110.5 |
18.4 |
16.8 |
15.2 |
13.6 |
12.0 |
|
19.0 |
17.4 |
15.7 |
14.1 |
12.5 |
111 |
18.6 |
16.9 |
15.3 |
13.7 |
12.1 |
|
19.1 |
17.5 |
15.9 |
14.2 |
12.6 |
111.5 |
18.7 |
17.1 |
15.5 |
13.8 |
12.2 |
|
19.3 |
17.7 |
16.0 |
14.4 |
12.7 |
112 |
18.9 |
17.2 |
15.6 |
14.0 |
12.3 |
|
19.5 |
17.8 |
16.1 |
14.5 |
12.8 |
112.5 |
19.0 |
17.4 |
15.7 |
14.1 |
12.4 |
|
19.6 |
18.0 |
16.3 |
14.6 |
12.9 |
113 |
19.2 |
17.5 |
15.9 |
14.2 |
12.6 |
|
19.8 |
18.1 |
16.4 |
14.8 |
13.1 |
113.5 |
19.4 |
17.7 |
16.0 |
14.4 |
12.7 |
|
20.0 |
18.3 |
16.6 |
14.9 |
13.2 |
114 |
19.5 |
17.9 |
16.2 |
14.5 |
12.8 |
|
20.2 |
18.5 |
16.7 |
15.0 |
13.3 |
114.5 |
19.7 |
18.0 |
16.3 |
14.6 |
12.9 |
|
20.3 |
18.6 |
16.9 |
15.2 |
13.5 |
115 |
19.9 |
18.2 |
16.5 |
14.8 |
13.0 |
|
20.5 |
18.8 |
17.1 |
15.3 |
13.6 |
115.5 |
20.1 |
18.4 |
16.6 |
14.9 |
13.2 |
|
20.7 |
18.9 |
17.2 |
15.5 |
13.7 |
116 |
20.3 |
18.5 |
16.8 |
15.0 |
13.3 |
|
20.9 |
19.1 |
17.4 |
15.6 |
13.9 |
116.5 |
20.4 |
18.7 |
16.9 |
15.2 |
13.4 |
|
21.1 |
19.3 |
17.5 |
15.8 |
14.0 |
117 |
20.6 |
18.9 |
17.1 |
15.3 |
13.6 |
|
21.2 |
19.5 |
17.7 |
15.9 |
14.2 |
117.5 |
20.8 |
19.0 |
17.3 |
15.5 |
13.7 |
|
21.4 |
19.6 |
17.9 |
16.1 |
14.3 |
118 |
21.0 |
19.2 |
17.4 |
15.6 |
13.8 |
|
21.6 |
19.8 |
18.0 |
16.2 |
14.4 |
118.5 |
21.2 |
19.4 |
17.6 |
15.8 |
13.9 |
|
21.8 |
20.0 |
18.2 |
16.4 |
14.6 |
119 |
21.4 |
19.6 |
17.7 |
15.9 |
14.1 |
|
22.0 |
20.2 |
18.4 |
16.6 |
14.7 |
119.5 |
21.6 |
19.8 |
17.9 |
16.1 |
14.2 |
|
22.2 |
20.4 |
18.5 |
16.7 |
14.9 |
120 |
21.8 |
20.0 |
18.1 |
16.2 |
14.3 |
|
22.4 |
20.6 |
18.7 |
16.9 |
15.0 |
120.5 |
22.0 |
20.1 |
18.3 |
16.4 |
14.5 |
|
22.6 |
20.7 |
18.9 |
17.0 |
15.2 |
121 |
22.2 |
20.3 |
18.4 |
16.5 |
14.6 |
|
22.8 |
20.9 |
19.1 |
17.2 |
15.3 |
121.5 |
22.5 |
20.5 |
18.6 |
16.7 |
14.7 |
|
23.0 |
21.1 |
19.2 |
17.4 |
15.5 |
122 |
22.7 |
20.7 |
18.8 |
16.8 |
14.9 |
|
23.2 |
21.3 |
19.4 |
17.5 |
15.6 |
122.5 |
22.9 |
20.9 |
19.0 |
17.0 |
15.0 |
|
23.4 |
21.5 |
19.6 |
17.7 |
15.8 |
123 |
23.1 |
21.1 |
19.1 |
17.1 |
15.1 |
|
23.6 |
21.7 |
19.8 |
17.9 |
16.0 |
123.5 |
23.4 |
21.3 |
19.3 |
17.3 |
15.3 |
|
23.9 |
21.9 |
20.0 |
18.0 |
16.1 |
124 |
23.6 |
21.6 |
19.5 |
17.4 |
15.4 |
|
24.1 |
22.1 |
20.2 |
18.2 |
16.3 |
124.5 |
23.9 |
21.8 |
19.7 |
17.6 |
15.5 |
|
24.3 |
22.3 |
20.4 |
18.4 |
16.4 |
125 |
24.1 |
22.0 |
19.9 |
17.8 |
15.6 |
|
24.5 |
22.5 |
20.5 |
18.6 |
16.6 |
125.5 |
24.3 |
22.2 |
20.1 |
17.9 |
15.8 |
|
24.8 |
22.8 |
20.7 |
18.7 |
16.7 |
126 |
24.6 |
22.4 |
20.2 |
18.1 |
15.9 |
|
25.0 |
23.0 |
20.9 |
18.9 |
16.9 |
126.5 |
24.9 |
22.7 |
20.4 |
18.2 |
16.0 |
|
25.2 |
23.2 |
21.1 |
19.1 |
17.0 |
127 |
25.1 |
22.9 |
20.6 |
18.4 |
16.2 |
|
25.5 |
23.4 |
21.3 |
19.2 |
17.2 |
127.5 |
25.4 |
23.1 |
20.8 |
18.6 |
16.3 |
|
25.7 |
23.6 |
21.5 |
19.4 |
17.3 |
128 |
25.7 |
23.3 |
21.0 |
18.7 |
16.4 |
|
26.0 |
23.8 |
21.7 |
19.6 |
17.5 |
128.5 |
25.9 |
23.6 |
21.2 |
18.9 |
16.5 |
|
26.2 |
24.1 |
21.9 |
19.8 |
17.6 |
129 |
26.2 |
23.8 |
21.4 |
19.0 |
16.7 |
|
26.5 |
24.3 |
22.1 |
19.9 |
17.7 |
129.5 |
26.5 |
24.1 |
21.6 |
19.2 |
16.8 |
|
26.8 |
24.5 |
22.3 |
20.1 |
17.9 |
130 |
26.8 |
24.3 |
21.8 |
19.4 |
16.9 |
|
27.0 |
24.8 |
22.5 |
20.3 |
18.0 |
130.5 |
27.1 |
24.6 |
22.1 |
19.5 |
17.0 |
|
27.3 |
25.0 |
22.7 |
20.4 |
18.2 |
131 |
27.4 |
24.8 |
22.3 |
19.7 |
17.1 |
|
27.6 |
25.2 |
22.9 |
20.6 |
18.3 |
131.5 |
27.7 |
25.1 |
22.5 |
19.9 |
17.2 |
|
27.8 |
25.5 |
23.1 |
20.8 |
18.4 |
132 |
28.0 |
25.4 |
22.7 |
20.0 |
17.4 |
|
28.1 |
25.7 |
23.3 |
21.0 |
18.6 |
132.5 |
28.4 |
25.6 |
22.9 |
20.2 |
17.5 |
|
28.4 |
26.0 |
23.6 |
21.1 |
18.7 |
133 |
28.7 |
25.9 |
23.1 |
20.4 |
17.6 |
|
28.7 |
26.2 |
23.8 |
21.3 |
18.8 |
133.5 |
29.0 |
26.2 |
23.4 |
20.5 |
17.7 |
|
29.0 |
26.5 |
24.0 |
21.5 |
18.9 |
134 |
29.4 |
26.5 |
23.6 |
20.7 |
17.8 |
|
29.3 |
26.7 |
24.2 |
21.6 |
19.1 |
134.5 |
29.7 |
26.8 |
23.8 |
20.8 |
17.9 |
|
29.6 |
27.0 |
24.4 |
21.8 |
19.2 |
135 |
30.1 |
27.0 |
24.0 |
21.0 |
18.0 |
|
29.9 |
27.3 |
24.6 |
22.0 |
19.3 |
135.5 |
30.4 |
27.3 |
24.3 |
21.2 |
18.1 |
|
30.2 |
27.5 |
24.8 |
22.1 |
19.4 |
136 |
30.8 |
27.6 |
24.5 |
21.3 |
18.2 |
|
30.6 |
27.8 |
25.0 |
22.3 |
19.5 |
136.5 |
31.1 |
27.9 |
24.7 |
21.5 |
18.3 |
|
30.9 |
28.1 |
25.3 |
22.4 |
19.6 |
137 |
31.5 |
28.2 |
25.0 |
21.7 |
18.4 |
Notes:1. Length is generally measured in children below 85 cm and height in children 85 cm and above. Recumbent length is on average 0.5 cm greater than standing height; although the difference is of no importance to the individual child, a correction may be made by deducting 0.5 cm from all lengths above 84.9 cm if standing height cannot be measured.
2. SD = standard deviation score (or Z-score). The relationship between the percentage-of-median value and the SD-score or Z-score varies with age and height, particularly in the first year of life, and beyond 5 years. Between 1 and 5 years median -1 SD and median -2 SD correspond to approximately 90% and 80% of median (weight-for-length/height, and weight-for-age), respectively. Beyond 5 years of age or 110 cm (or 100 cm in stunted children) this equivalence is not maintained; median -2SD is much below 80% of median. Hence the use of "percentage-of-median" is not recommended, particularly in children of school age. Somewhere beyond 10 years or 137 cm, the adolescent growth spurt begins and the time of its onset is variable. The correct interpretation of weight-for-height data beyond this point is therefore difficult.
Table A3.2 WHO/NCHS normalized reference weight-for-length/height (58-137 cm) for the sexes combined
|
Length/height (cm) |
Weight (kg) | |
| |
Median |
Median |
|
58 |
3.9 |
3.3 |
|
58.5 |
4.0 |
3.4 |
|
59 |
4.1 |
3.5 |
|
59.5 |
4.2 |
3.6 |
|
60 |
4.4 |
3.7 |
|
60.5 |
4.5 |
3.8 |
|
61 |
4.6 |
4.0 |
|
61.5 |
4.8 |
4.1 |
|
62 |
4.9 |
4.2 |
|
62.5 |
5.0 |
4.3 |
|
63 |
5.1 |
4.4 |
|
63.5 |
5.3 |
4.6 |
|
64 |
5.4 |
4.7 |
|
64.5 |
5.5 |
4.8 |
|
65 |
5.6 |
4.9 |
|
65.5 |
5.8 |
5.0 |
|
66 |
5.9 |
5.2 |
|
66.5 |
6.0 |
5.3 |
|
67 |
6.1 |
5.4 |
|
67.5 |
6.3 |
5.6 |
|
68 |
6.4 |
5.7 |
|
68.5 |
6.5 |
5.8 |
|
69 |
6.7 |
5.9 |
|
69.5 |
6.8 |
6.1 |
|
70 |
6.9 |
6.2 |
|
70.5 |
7.0 |
6.3 |
|
71 |
7.2 |
6.4 |
|
71.5 |
7.3 |
6.5 |
|
72 |
7.4 |
6.6 |
|
72.5 |
7.6 |
6.7 |
|
73 |
7.7 |
6.8 |
|
73.5 |
7.8 |
6.9 |
|
74 |
7.9 |
7.0 |
|
74.5 |
8.0 |
7.1 |
|
75 |
8.1 |
7.2 |
|
75.5 |
8.2 |
7.3 |
|
76 |
8.3 |
7.4 |
|
76.5 |
8.4 |
7.5 |
|
77 |
8.5 |
7.6 |
|
77.5 |
8.6 |
7.7 |
|
78 |
8.7 |
7.8 |
|
78.5 |
8.8 |
7.9 |
|
79 |
8.9 |
8.0 |
|
79.5 |
8.9 |
8.1 |
|
80 |
9.0 |
8.2 |
|
80.5 |
9.1 |
8.2 |
|
81 |
9.2 |
8.3 |
|
81.5 |
9.3 |
8.4 |
|
82 |
9.4 |
8.5 |
|
82.5 |
9.5 |
8.6 |
|
83 |
9.6 |
8.7 |
|
83.5 |
9.7 |
8.8 |
|
84 |
9.8 |
8.9 |
|
84.5 |
9.8 |
8.9 |
|
85 |
9.8 |
8.8 |
|
85.5 |
9.9 |
8.8 |
|
86 |
10.0 |
8.9 |
|
86.5 |
10.1 |
9.0 |
|
87 |
10.2 |
9.1 |
|
87.5 |
10.3 |
9.2 |
|
88 |
10.4 |
9.3 |
|
88.5 |
10.5 |
9.4 |
|
89 |
10.6 |
9.5 |
|
89.5 |
10.7 |
9.6 |
|
90 |
10.8 |
9.7 |
|
90.5 |
10.9 |
9.8 |
|
91 |
11.0 |
9.8 |
|
91.5 |
11.1 |
9.9 |
|
92 |
11.2 |
10.0 |
|
92.5 |
11.3 |
10.1 |
|
93 |
11.4 |
10.2 |
|
93.5 |
11.5 |
10.3 |
|
94 |
11.6 |
10.4 |
|
94.5 |
11.7 |
10.5 |
|
95 |
11.8 |
10.6 |
|
95.5 |
11.9 |
10.7 |
|
96 |
12.0 |
10.8 |
|
96.5 |
12.1 |
10.9 |
|
97 |
12.2 |
10.9 |
|
97.5 |
12.3 |
11.0 |
|
98 |
12.4 |
11.1 |
|
98.5 |
12.5 |
11.2 |
|
99 |
12.6 |
11.3 |
|
99.5 |
12.7 |
11.4 |
|
100 |
12.9 |
11.5 |
|
100.5 |
13.0 |
11.6 |
|
101 |
13.1 |
11.7 |
|
101.5 |
13.2 |
11.8 |
|
102 |
13.3 |
11.9 |
|
102.5 |
13.4 |
12.0 |
|
103 |
13.5 |
12.1 |
|
103.5 |
13.6 |
12.2 |
|
104 |
13.7 |
12.3 |
|
104.5 |
13.9 |
12.4 |
|
105 |
14.0 |
12.5 |
|
105.5 |
14.1 |
12.6 |
|
106 |
14.2 |
12.7 |
|
106.5 |
14.3 |
12.8 |
|
107 |
14.5 |
12.9 |
|
107.5 |
14.6 |
13.0 |
|
108 |
14.7 |
13.2 |
|
108.5 |
14.8 |
13.2 |
|
109 |
15.0 |
13.4 |
|
109.5 |
15.1 |
13.5 |
|
110 |
15.2 |
13.6 |
|
110.5 |
15.4 |
13.8 |
|
111 |
15.5 |
13.9 |
|
111.5 |
15.7 |
14.0 |
|
112 |
15.8 |
14.2 |
|
112.5 |
15.9 |
14.3 |
|
113 |
16.1 |
14.4 |
|
113.5 |
16.2 |
14.6 |
|
114 |
16.3 |
14.7 |
|
114.5 |
16.4 |
14.8 |
|
115 |
16.7 |
15.0 |
|
115.5 |
16.9 |
15.1 |
|
116 |
17.0 |
15.3 |
|
116.5 |
17.2 |
15.4 |
|
117 |
17.3 |
15.6 |
|
117.5 |
17.5 |
15.7 |
|
118 |
17.7 |
15.9 |
|
118.5 |
17.8 |
16.0 |
|
119 |
18.0 |
16.2 |
|
119.5 |
18.2 |
16.4 |
|
120 |
18.3 |
16.5 |
|
120.5 |
18.5 |
16.7 |
|
121 |
18.7 |
16.8 |
|
121.5 |
18.9 |
17.0 |
|
122 |
19.0 |
17.1 |
|
122.5 |
19.2 |
17.3 |
|
123 |
19.4 |
17.4 |
|
123.5 |
19.6 |
17.6 |
|
124 |
19.8 |
17.7 |
|
124.5 |
20.0 |
17.9 |
|
125 |
20.2 |
18.1 |
|
125.5 |
20.3 |
18.3 |
|
126 |
20.5 |
18.4 |
|
126.5 |
20.7 |
18.6 |
|
127 |
20.9 |
18.8 |
|
127.5 |
21.1 |
19.0 |
|
128 |
21.3 |
19.1 |
|
128.5 |
21.5 |
19.3 |
|
129 |
21.7 |
19.4 |
|
129.5 |
21.9 |
19.6 |
|
130 |
22.1 |
19.8 |
|
130.5 |
22.3 |
19.9 |
|
131 |
22.5 |
20.1 |
|
131.5 |
22.7 |
20.3 |
|
132 |
22.9 |
20.4 |
|
132.5 |
23.1 |
20.6 |
|
133 |
23.4 |
20.8 |
|
133.5 |
23.6 |
20.9 |
|
134 |
23.7 |
21.1 |
|
134.5 |
24.0 |
21.2 |
|
135 |
24.2 |
21.4 |
|
135.5 |
24.5 |
21.6 |
|
136 |
24.7 |
21.7 |
|
136.5 |
24.9 |
21.9 |
|
137 |
25.2 |
22.1 |
Table A 3.3 gives the values for one standard deviation of the WHO/NCHS reference median weight-for-length/height for each 0.5 cm of length/height up to 137 cm. The best index of a child's anthropometric status (in an emergency situation) is weight-for-length/height expressed in terms of Z-scores, where Z-score is defined as the deviation of the value for an individual from the median value of the reference population, divided by the standard deviation for the reference population:
Example
A girl of length 65 cm has a weight of 6.0 kg. Table A 3.1 shows that reference median weight for this length is 7.0 kg and that the girl's weight lies between median - 1SD (6.3 kg) and median - 2SD (5.5 kg). Table A 3.3 shows that the standard deviation of the reference median weight for length 65 cm is 0.715. Z-score can therefore be calculated as follows:
(6.0 - 7.0)/0.715 = -1.0/0.715 = -1.40
Table A3.3 Values for one standard deviation of WHO/NCHS reference median weight-for-length/height
|
Length/height (cm) |
One SD of median weight (kg) | |
| |
Male |
Female |
|
49 |
0.341 |
0.365 |
|
49.5 |
0.362 |
0.375 |
|
50 |
0.382 |
0.386 |
|
50.5 |
0.401 |
0.397 |
|
51 |
0.420 |
0.409 |
|
51.5 |
0.438 |
0.420 |
|
52 |
0.455 |
0.431 |
|
52.5 |
0.471 |
0.442 |
|
53 |
0.487 |
0.454 |
|
53.5 |
0.502 |
0.465 |
|
54 |
0.516 |
0.477 |
|
54.5 |
0.529 |
0.488 |
|
55 |
0.542 |
0.499 |
|
55.5 |
0.555 |
0.511 |
|
56 |
0.567 |
0.522 |
|
56.5 |
0.578 |
0.534 |
|
57 |
0.589 |
0.545 |
|
57.5 |
0.599 |
0.556 |
|
58 |
0.608 |
0.568 |
|
58.5 |
0.618 |
0.579 |
|
59 |
0.627 |
0.590 |
|
59.5 |
0.635 |
0.601 |
|
60 |
0.643 |
0.612 |
|
60.5 |
0.651 |
0.623 |
|
61 |
0.658 |
0.634 |
|
61.5 |
0.665 |
0.644 |
|
62 |
0.671 |
0.655 |
|
62.5 |
0.678 |
0.665 |
|
63 |
0.684 |
0.676 |
|
63.5 |
0.689 |
0.686 |
|
64 |
0.695 |
0.696 |
|
64.5 |
0.700 |
0.705 |
|
65 |
0.705 |
0.715 |
|
65.5 |
0.710 |
0.724 |
|
66 |
0.715 |
0.733 |
|
66.5 |
0.720 |
0.742 |
|
67 |
0.724 |
0.751 |
|
67.5 |
0.729 |
0.759 |
|
68 |
0.733 |
0.767 |
|
68.5 |
0.738 |
0.775 |
|
69 |
0.742 |
0.783 |
|
69.5 |
0.747 |
0.791 |
|
70 |
0.751 |
0.798 |
|
70.5 |
0.756 |
0.804 |
|
71 |
0.760 |
0.811 |
|
71.5 |
0.765 |
0.817 |
|
72 |
0.770 |
0.823 |
|
72.5 |
0.774 |
0.829 |
|
73 |
0.779 |
0.834 |
|
73.5 |
0.785 |
0.839 |
|
74 |
0.790 |
0.844 |
|
74.5 |
0.795 |
0.848 |
|
75 |
0.801 |
0.852 |
|
75.5 |
0.806 |
0.856 |
|
76 |
0.812 |
0.860 |
|
76.5 |
0.818 |
0.863 |
|
77 |
0.823 |
0.867 |
|
77.5 |
0.829 |
0.870 |
|
78 |
0.835 |
0.873 |
|
78.5 |
0.841 |
0.876 |
|
79 |
0.847 |
0.879 |
|
79.5 |
0.853 |
0.881 |
|
80 |
0.859 |
0.884 |
|
80.5 |
0.865 |
0.887 |
|
81 |
0.871 |
0.889 |
|
81.5 |
0.877 |
0.892 |
|
82 |
0.884 |
0.894 |
|
82.5 |
0.890 |
0.897 |
|
83 |
0.896 |
0.900 |
|
83.5 |
0.902 |
0.902 |
|
84 |
0.908 |
0.905 |
|
84.5 |
0.914 |
0.908 |
|
85 |
1.087 |
1.069 |
|
85.5 |
1.094 |
1.074 |
|
86 |
1.101 |
1.080 |
|
86.5 |
1.108 |
1.086 |
|
87 |
1.116 |
1.092 |
|
87.5 |
1.124 |
1.099 |
|
88 |
1.132 |
1.106 |
|
88.5 |
1.140 |
1.114 |
|
89 |
1.148 |
1.122 |
|
89.5 |
1.157 |
1.130 |
|
90 |
1.166 |
1.138 |
|
90.5 |
1.175 |
1.147 |
|
91 |
1.184 |
1.156 |
|
91.5 |
1.194 |
1.166 |
|
92 |
1.203 |
1.176 |
|
92.5 |
1.213 |
1.186 |
|
93 |
1.223 |
1.196 |
|
93.5 |
1.233 |
1.206 |
|
94 |
1.243 |
1.217 |
|
94.5 |
1.253 |
1.228 |
|
95 |
1.264 |
1.239 |
|
95.5 |
1.274 |
1.250 |
|
96 |
1.285 |
1.262 |
|
96.5 |
1.296 |
1.273 |
|
97 |
1.306 |
1.285 |
|
97.5 |
1.317 |
1.297 |
|
98 |
1.329 |
1.309 |
|
98.5 |
1.340 |
1.321 |
|
99 |
1.351 |
1.333 |
|
99.5 |
1.362 |
1.345 |
|
100 |
1.374 |
1.358 |
|
100.5 |
1.385 |
1.370 |
|
101 |
1.397 |
1.382 |
|
101.5 |
1.408 |
1.395 |
|
102 |
1.420 |
1.407 |
|
102.5 |
1.431 |
1.419 |
|
103 |
1.443 |
1.432 |
|
103.5 |
1.455 |
1.444 |
|
104 |
1.467 |
1.456 |
|
104.5 |
1.478 |
1.469 |
|
105 |
1.490 |
1.481 |
|
105.5 |
1.502 |
1.493 |
|
106 |
1.513 |
1.505 |
|
106.5 |
1.525 |
1.517 |
|
107 |
1.537 |
1.528 |
|
107.5 |
1.549 |
1.540 |
|
108 |
1.560 |
1.551 |
|
108.5 |
1.572 |
1.563 |
|
109 |
1.584 |
1.574 |
|
109.5 |
1.595 |
1.585 |
|
110 |
1.607 |
1.596 |
|
110.5 |
1.618 |
1.607 |
|
111 |
1.629 |
1.618 |
|
111.5 |
1.641 |
1.629 |
|
112 |
1.652 |
1.640 |
|
112.5 |
1.663 |
1.652 |
|
113 |
1.674 |
1.663 |
|
113.5 |
1.685 |
1.675 |
|
114 |
1.696 |
1.687 |
|
114.5 |
1.707 |
1.700 |
|
115 |
1.717 |
1.713 |
|
115.5 |
1.728 |
1.726 |
|
116 |
1.738 |
1.740 |
|
116.5 |
1.749 |
1.754 |
|
117 |
1.759 |
1.769 |
|
117.5 |
1.770 |
1.784 |
|
118 |
1.780 |
1.800 |
|
118.5 |
1.791 |
1.817 |
|
119 |
1.803 |
1.834 |
|
119.5 |
1.814 |
1.852 |
|
120 |
1.826 |
1.871 |
|
120.5 |
1.838 |
1.891 |
|
121 |
1.851 |
1.911 |
|
121.5 |
1.864 |
1.933 |
|
122 |
1.878 |
1.955 |
|
122.5 |
1.892 |
1.979 |
|
123 |
1.907 |
2.003 |
|
123.5 |
1.923 |
2.029 |
|
124 |
1.940 |
2.056 |
|
124.5 |
1.957 |
2.083 |
|
125 |
1.975 |
2.113 |
|
125.5 |
1.994 |
2.143 |
|
126 |
2.015 |
2.175 |
|
126.5 |
2.036 |
2.207 |
|
127 |
2.058 |
2.242 |
|
127.5 |
2.082 |
2.278 |
|
128 |
2.106 |
2.315 |
|
128.5 |
2.132 |
2.353 |
|
129 |
2.159 |
2.394 |
|
129.5 |
2.188 |
2.435 |
|
130 |
2.218 |
2.479 |
|
130.5 |
2.249 |
2.524 |
|
131 |
2.282 |
2.571 |
|
131.5 |
2.317 |
2.619 |
|
132 |
2.353 |
2.670 |
|
132.5 |
2.391 |
2.722 |
|
133 |
2.430 |
2.776 |
|
133.5 |
2.472 |
2.832 |
|
134 |
2.515 |
2.890 |
|
134.5 |
2.560 |
2.950 |
|
135 |
2.607 |
3.012 |
|
135.5 |
2.656 |
3.076 |
|
136 |
2.707 |
3.142 |
|
136.5 |
2.760 |
3.210 |
|
137 |
2.815 |
3.281 |
Using the Z-score for groups or communities
Calculating the mean Z-score for a community, on the basis of the individual Z-scores of all individuals studied, provides a measure of the severity of protein-energy malnutrition in the community. For this mean Z-score, a standard deviation and standard error of the mean (SEM) can be calculated (using a computer or the usual statistical formulae). The confidence interval, beyond which any values would be significantly different from the mean Z-score, is calculated as (2 x SEM). This provides a simple method for determining whether the Z-scores of two (or more) communities are significantly different from one another, or whether the Z-score of a particular community has changed significantly over a specified period of time.
Example
A community has a mean Z-score of -0.5. Table 20 (page 40) shows that this community will be classed as being in "poor" condition. The calculated SEM was, say, 0.1. Only if an earlier Z-score was outside the range -0.5 ± 0.2, i.e. not between -0.3 and -0.7, has there been any significant change. Moreover, the condition of this community is not significantly different from that of any other community with a mean Z-score in the range -0.3 to -0.7 (and a similar value of SEM).Use of mean Z-scores and SEMs provides more sensitive statistical comparisons of communities than percentages of populations below given cut-off values, and mean Z-score is ultimately a better indicator of the nutritional status of a particular community than the percentage of individuals below a conventional cut-off.
If any of the necessary equipment for determining weight and length/height is unavailable, as it may be in an emergency situation, MUAC measurements may be used instead - either MUAC-for-age or MUAC-for-length/height. Otherwise, use of MUAC for nutritional assessment offers no advantages. At one time, a single cut-off point (or two points at most) was used to cover the whole age interval from 6 months to 5 years. However, because there is normally a perceptible increase in MUAC (of 2 - 3 cm) over this period, many false conclusions were being drawn, with overestimates of undernutrition in younger children and underestimates in older children. (Other shortcomings of MUAC assessments are mentioned in Chapter 3). New WHO/NCHS reference values for MUAC-for-age have been developed; 1 these are presented in Table A 3.4, together with cut-offs at -2SD and -3SD. Table A 3.5 provides reference values for MUAC-for-length/height, also with cut-offs at -2SD and -3SD.2
1 de Onis M, Yip R, Mei Z. The development of MUAC-for-age reference data: recommended by a WHO Expert Committee. Bulletin of the World Health Organization, 1997, 75(1):11-18.2 Mei Z et al. The development of a MUAC-for-height reference, including a comparison to other status screening indicators. Bulletin of the World Health Organization, 1997, 75(4):333-341.
Since the standards for boys and girls differ substantially up to about 1½ years of age, the sex of each child should normally be recorded and the data analysed separately. However, there may be circumstances in which this is not possible, and Tables A3.4 and A3.5 therefore include reference values for boys, for girls, and for the sexes combined.
Table A3.4 WHO/NCHS normalized reference values for MUAC-for-age (6-59 months)
|
Age (months) |
Boys |
Combined sexes |
Girls | ||||||
| |
Median |
-2SD |
-3SD |
Median |
-2SD |
-3SD |
Median |
-2SD |
-3SD |
|
6 |
14.9 |
12.6 |
11.5 |
14.3 |
12.0 |
10.9 |
13.9 |
11.5 |
10.4 |
|
7 |
15.1 |
12.7 |
11.6 |
14.6 |
12.2 |
11.0 |
14.1 |
11.8 |
10.6 |
|
8 |
15.2 |
12.8 |
11.7 |
14.8 |
12.4 |
11.2 |
14.4 |
12.0 |
10.8 |
|
9 |
15.4 |
12.9 |
11.7 |
14.9 |
12.5 |
11.3 |
14.6 |
12.2 |
11.0 |
|
10 |
15.5 |
13.0 |
11.8 |
15.1 |
12.7 |
11.5 |
14.8 |
12.3 |
11.1 |
|
11 |
15.6 |
13.1 |
11.9 |
15.2 |
12.8 |
11.6 |
15.0 |
12.5 |
11.3 |
|
12 |
15.7 |
13.2 |
11.9 |
15.4 |
12.9 |
11.7 |
15.1 |
12.6 |
11.4 |
|
13 |
15.7 |
13.2 |
12.0 |
15.5 |
13.0 |
11.7 |
15.2 |
12.7 |
11.5 |
|
14 |
15.8 |
13.3 |
12.0 |
15.6 |
13.1 |
11.8 |
15.4 |
12.8 |
11.6 |
|
15 |
15.9 |
13.3 |
12.1 |
15.7 |
13.1 |
11.9 |
15.5 |
12.9 |
11.7 |
|
16 |
15.9 |
13.4 |
12.1 |
15.8 |
13.2 |
11.9 |
15.6 |
13.0 |
11.7 |
|
17 |
16.0 |
13.4 |
12.1 |
15.8 |
13.2 |
12.0 |
15.7 |
13.1 |
11.8 |
|
18 |
16.0 |
13.4 |
12.1 |
15.9 |
13.3 |
12.0 |
15.7 |
13.1 |
11.8 |
|
19 |
16.1 |
13.5 |
12.2 |
15.9 |
13.3 |
12.0 |
15.8 |
13.2 |
11.9 |
|
20 |
16.1 |
13.5 |
12.2 |
16.0 |
13.4 |
12.1 |
15.8 |
13.2 |
11.9 |
|
21 |
16.1 |
13.5 |
12.2 |
16.0 |
13.4 |
12.1 |
15.9 |
13.3 |
11.9 |
|
22 |
16.2 |
13.5 |
12.2 |
16.1 |
13.4 |
12.1 |
15.9 |
13.3 |
12.0 |
|
23 |
16.2 |
13.5 |
12.2 |
16.1 |
13.4 |
12.1 |
16.0 |
13.3 |
12.0 |
|
24 |
16.2 |
13.6 |
12.2 |
16.1 |
13.5 |
12.1 |
16.0 |
13.4 |
12.0 |
|
25 |
16.3 |
13.6 |
12.2 |
16.2 |
13.5 |
12.2 |
16.1 |
13.4 |
12.0 |
|
26 |
16.3 |
13.6 |
12.3 |
16.2 |
13.5 |
12.2 |
16.1 |
13.4 |
12.1 |
|
27 |
16.3 |
13.6 |
12.3 |
16.2 |
13.5 |
12.2 |
16.1 |
13.4 |
12.1 |
|
28 |
16.3 |
13.6 |
12.3 |
16.3 |
13.5 |
12.2 |
16.1 |
13.4 |
12.1 |
|
29 |
16.4 |
13.7 |
12.3 |
16.3 |
13.6 |
12.2 |
16.2 |
13.5 |
12.1 |
|
30 |
16.4 |
13.7 |
12.3 |
16.3 |
13.6 |
12.2 |
16.2 |
13.5 |
12.1 |
|
31 |
16.4 |
13.7 |
12.3 |
16.3 |
13.6 |
12.2 |
16.2 |
13.5 |
12.1 |
|
32 |
16.5 |
13.7 |
12.3 |
16.4 |
13.6 |
12.2 |
16.3 |
13.5 |
12.1 |
|
33 |
16.5 |
13.7 |
12.4 |
16.4 |
13.6 |
12.3 |
16.3 |
13.5 |
12.2 |
|
34 |
16.5 |
13.8 |
12.4 |
16.4 |
13.7 |
12.3 |
16.3 |
13.6 |
12.2 |
|
35 |
16.5 |
13.8 |
12.4 |
16.4 |
13.7 |
12.3 |
16.3 |
13.6 |
12.2 |
|
36 |
16.6 |
13.8 |
12.4 |
16.5 |
13.7 |
12.3 |
16.4 |
13.6 |
12.2 |
|
37 |
16.6 |
13.8 |
12.4 |
16.5 |
13.7 |
12.3 |
16.4 |
13.6 |
12.2 |
|
38 |
16.6 |
13.8 |
12.4 |
16.5 |
13.7 |
12.3 |
16.4 |
13.6 |
12.2 |
|
39 |
16.7 |
13.9 |
12.5 |
16.6 |
13.8 |
12.4 |
16.5 |
13.7 |
12.3 |
|
40 |
16.7 |
13.9 |
12.5 |
16.6 |
13.8 |
12.4 |
16.5 |
13.7 |
12.3 |
|
41 |
16.7 |
13.9 |
12.5 |
16.6 |
13.8 |
12.4 |
16.6 |
13.7 |
12.3 |
|
42 |
16.8 |
13.9 |
12.5 |
16.7 |
13.8 |
12.4 |
16.6 |
13.8 |
12.3 |
|
43 |
16.8 |
14.0 |
12.5 |
16.7 |
13.9 |
12.4 |
16.6 |
13.8 |
12.4 |
|
44 |
16.8 |
14.0 |
12.5 |
16.8 |
13.9 |
12.5 |
16.7 |
13.8 |
12.4 |
|
45 |
16.9 |
14.0 |
12.6 |
16.8 |
13.9 |
12.5 |
16.7 |
13.8 |
12.4 |
|
46 |
16.9 |
14.0 |
12.6 |
16.8 |
13.9 |
12.5 |
16.7 |
13.9 |
12.4 |
|
47 |
17.0 |
14.0 |
12.6 |
16.9 |
14.0 |
12.5 |
16.8 |
13.9 |
12.4 |
|
48 |
17.0 |
14.1 |
12.6 |
16.9 |
14.0 |
12.5 |
16.8 |
13.9 |
12.4 |
|
49 |
17.0 |
14.1 |
12.6 |
17.0 |
14.0 |
12.5 |
16.9 |
13.9 |
12.5 |
|
50 |
17.1 |
14.1 |
12.6 |
17.0 |
14.0 |
12.6 |
16.9 |
14.0 |
12.5 |
|
51 |
17.1 |
14.1 |
12.6 |
17.0 |
14.1 |
12.6 |
17.0 |
14.0 |
12.5 |
|
52 |
17.1 |
14.1 |
12.6 |
17.1 |
14.1 |
12.6 |
17.0 |
14.0 |
12.5 |
|
53 |
17.2 |
14.1 |
12.6 |
17.1 |
14.1 |
12.6 |
17.0 |
14.0 |
12.5 |
|
54 |
17.2 |
14.2 |
12.6 |
17.2 |
14.1 |
12.6 |
17.1 |
14.0 |
12.5 |
|
55 |
17.2 |
14.2 |
12.6 |
17.2 |
14.1 |
12.6 |
17.1 |
14.1 |
12.5 |
|
56 |
17.3 |
14.2 |
12.6 |
17.2 |
14.1 |
12.6 |
17.2 |
14.1 |
12.5 |
|
57 |
17.3 |
14.2 |
12.6 |
17.3 |
14.1 |
12.6 |
17.2 |
14.1 |
12.5 |
|
58 |
17.3 |
14.2 |
12.6 |
17.3 |
14.2 |
12.6 |
17.3 |
14.1 |
12.5 |
|
59 |
17.4 |
14.2 |
12.6 |
17.3 |
14.2 |
12.6 |
17.3 |
14.1 |
12.5 |
Table A3.5 WHO/NCHS normalized reference values for MUAC-for-length/height (65-145 cm)
|
Length/heighta (cm) |
Boys |
Combined sexes |
Girls | ||||||
| |
Median |
-2SD |
-3SD |
Median |
-2SD |
-3SD |
Median |
-2SD |
-3SD |
|
65 |
14.6 |
12.7 |
11.7 |
14.3 |
12.4 |
11.5 |
14.0 |
12.1 |
11.2 |
|
65.5 |
14.7 |
12.7 |
11.8 |
14.4 |
12.5 |
11.5 |
14.1 |
12.2 |
11.2 |
|
66 |
14.7 |
12.8 |
11.8 |
14.5 |
12.5 |
11.6 |
14.2 |
12.3 |
11.3 |
|
66.5 |
14.8 |
12.8 |
11.8 |
14.5 |
12.6 |
11.6 |
14.3 |
12.3 |
11.3 |
|
67 |
14.9 |
12.9 |
11.9 |
14.6 |
12.6 |
11.6 |
14.4 |
12.4 |
11.4 |
|
67.5 |
14.9 |
12.9 |
11.9 |
14.7 |
12.7 |
11.7 |
14.4 |
12.4 |
11.4 |
|
68 |
15.0 |
12.9 |
11.9 |
14.7 |
12.7 |
11.7 |
14.5 |
12.5 |
11.5 |
|
68.5 |
15.0 |
13.0 |
12.0 |
14.8 |
12.8 |
11.7 |
14.6 |
12.6 |
11.5 |
|
69 |
15.1 |
13.0 |
12.0 |
14.9 |
12.8 |
11.8 |
14.7 |
12.6 |
11.6 |
|
69.5 |
15.1 |
13.0 |
12.0 |
14.9 |
12.8 |
11.8 |
14.7 |
12.7 |
11.6 |
|
70 |
15.1 |
13.1 |
12.0 |
15.0 |
12.9 |
11.8 |
14.8 |
12.7 |
11.7 |
|
70.5 |
15.2 |
13.1 |
12.0 |
15.0 |
12.9 |
11.9 |
14.8 |
12.8 |
11.7 |
|
71 |
15.2 |
13.1 |
12.1 |
15.1 |
13.0 |
11.9 |
14.9 |
12.8 |
11.7 |
|
71.5 |
15.3 |
13.1 |
12.1 |
15.1 |
13.0 |
11.9 |
15.0 |
12.8 |
11.8 |
|
72 |
15.3 |
13.2 |
12.1 |
15.2 |
13.0 |
12.0 |
15.0 |
12.9 |
11.8 |
|
72.5 |
15.3 |
13.2 |
12.1 |
15.2 |
13.1 |
12.0 |
15.1 |
12.9 |
11.8 |
|
73 |
15.4 |
13.2 |
12.1 |
15.2 |
13.1 |
12.0 |
15.1 |
13.0 |
11.9 |
|
73.5 |
15.4 |
13.2 |
12.2 |
15.3 |
13.1 |
12.0 |
15.2 |
13.0 |
11.9 |
|
74 |
15.4 |
13.3 |
12.2 |
15.3 |
13.1 |
12.1 |
15.2 |
13.0 |
11.9 |
|
74.5 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
15.2 |
13.1 |
12.0 |
|
75 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
15.3 |
13.1 |
12.0 |
|
75.5 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
15.3 |
13.1 |
12.0 |
|
76 |
15.6 |
13.4 |
12.2 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
|
76.5 |
15.6 |
13.4 |
12.3 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
|
77 |
15.6 |
13.4 |
12.3 |
15.5 |
13.3 |
12.2 |
15.4 |
13.2 |
12.1 |
|
77.5 |
15.6 |
13.4 |
12.3 |
15.6 |
13.3 |
12.2 |
15.5 |
13.3 |
12.1 |
|
78 |
15.7 |
13.4 |
12.3 |
15.6 |
13.4 |
12.2 |
15.5 |
13.3 |
12.2 |
|
78.5 |
15.7 |
13.4 |
12.3 |
15.6 |
13.4 |
12.3 |
15.6 |
13.3 |
12.2 |
|
79 |
15.7 |
13.5 |
12.3 |
15.6 |
13.4 |
12.3 |
15.6 |
13.3 |
12.2 |
|
79.5 |
15.7 |
13.5 |
12.4 |
15.7 |
13.4 |
12.3 |
15.6 |
13.4 |
12.2 |
|
80 |
15.8 |
13.5 |
12.4 |
15.7 |
13.4 |
12.3 |
15.6 |
13.4 |
12.3 |
|
80.5 |
15.8 |
13.5 |
12.4 |
15.7 |
13.5 |
12.3 |
15.7 |
13.4 |
12.3 |
|
81 |
15.8 |
13.5 |
12.4 |
15.8 |
13.5 |
12.4 |
15.7 |
13.4 |
12.3 |
|
81.5 |
15.8 |
13.6 |
12.4 |
15.8 |
13.5 |
12.4 |
15.7 |
13.5 |
12.3 |
|
82 |
15.9 |
13.6 |
12.4 |
15.8 |
13.5 |
12.4 |
15.8 |
13.5 |
12.3 |
|
82.5 |
15.9 |
13.6 |
12.5 |
15.8 |
13.6 |
12.4 |
15.8 |
13.5 |
12.4 |
|
83 |
15.9 |
13.6 |
12.5 |
15.9 |
13.6 |
12.4 |
15.8 |
13.5 |
12.4 |
|
83.5 |
15.9 |
13.6 |
12.5 |
15.9 |
13.6 |
12.5 |
15.8 |
13.6 |
12.4 |
|
84 |
15.9 |
13.7 |
12.5 |
15.9 |
13.6 |
12.5 |
15.9 |
13.6 |
12.4 |
|
84.5 |
16.0 |
13.7 |
12.5 |
15.9 |
13.6 |
12.5 |
15.9 |
13.6 |
12.5 |
|
85 |
16.0 |
13.7 |
12.5 |
15.9 |
13.6 |
12.5 |
15.9 |
13.6 |
12.5 |
|
85.5 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.5 |
15.9 |
13.6 |
12.5 |
|
86 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.5 |
15.9 |
13.7 |
12.5 |
|
86.5 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.5 |
|
87 |
16.1 |
13.8 |
12.6 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.5 |
|
87.5 |
16.1 |
13.8 |
12.6 |
16.0 |
13.7 |
12.6 |
16.0 |
13.7 |
12.6 |
|
88 |
16.1 |
13.8 |
12.6 |
16.1 |
13.8 |
12.6 |
16.0 |
13.7 |
12.6 |
|
88.5 |
16.1 |
13.8 |
12.7 |
16.1 |
13.8 |
12.6 |
16.1 |
13.8 |
12.6 |
|
89 |
16.1 |
13.8 |
12.7 |
16.1 |
13.8 |
12.7 |
16.1 |
13.8 |
12.6 |
|
89.5 |
16.2 |
13.9 |
12.7 |
16.1 |
13.8 |
12.7 |
16.1 |
13.8 |
12.7 |
|
90 |
16.2 |
13.9 |
12.7 |
16.2 |
13.9 |
12.7 |
16.1 |
13.8 |
12.7 |
|
90.5 |
16.2 |
13.9 |
12.8 |
16.2 |
13.9 |
12.7 |
16.2 |
13.8 |
12.7 |
|
91 |
16.2 |
13.9 |
12.8 |
16.2 |
13.9 |
12.7 |
16.2 |
13.9 |
12.7 |
|
91.5 |
16.3 |
14.0 |
12.8 |
16.2 |
13.9 |
12.8 |
16.2 |
13.9 |
12.7 |
|
92 |
16.3 |
14.0 |
12.8 |
16.3 |
13.9 |
12.8 |
16.2 |
13.9 |
12.8 |
|
92.5 |
16.3 |
14.0 |
12.9 |
16.3 |
14.0 |
12.8 |
16.2 |
13.9 |
12.8 |
|
93 |
16.3 |
14.0 |
12.9 |
16.3 |
14.0 |
12.8 |
16.3 |
14.0 |
12.8 |
|
93.5 |
16.4 |
14.1 |
12.9 |
16.3 |
14.0 |
12.9 |
16.3 |
14.0 |
12.8 |
|
94 |
16.4 |
14.1 |
12.9 |
16.4 |
14.0 |
12.9 |
16.3 |
14.0 |
12.8 |
|
94.5 |
16.4 |
14.1 |
13.0 |
16.4 |
14.1 |
12.9 |
16.3 |
14.0 |
12.9 |
|
95 |
16.4 |
14.1 |
13.0 |
16.4 |
14.1 |
12.9 |
16.4 |
14.1 |
12.9 |
|
95.5 |
16.5 |
14.2 |
13.0 |
16.4 |
14.1 |
13.0 |
16.4 |
14.1 |
12.9 |
|
96 |
16.5 |
14.2 |
13.0 |
16.5 |
14.1 |
13.0 |
16.4 |
14.1 |
12.9 |
|
96.5 |
16.5 |
14.2 |
13.1 |
16.5 |
14.2 |
13.0 |
16.4 |
14.1 |
13.0 |
|
97 |
16.6 |
14.2 |
13.1 |
16.5 |
14.2 |
13.0 |
16.5 |
14.1 |
13.0 |
|
97.5 |
16.6 |
14.3 |
13.1 |
16.5 |
14.2 |
13.1 |
16.5 |
14.2 |
13.0 |
|
98 |
16.6 |
14.3 |
13.1 |
16.6 |
14.2 |
13.1 |
16.5 |
14.2 |
13.0 |
|
98.5 |
16.6 |
14.3 |
13.2 |
16.6 |
14.3 |
13.1 |
16.5 |
14.2 |
13.1 |
|
99 |
16.7 |
14.3 |
13.2 |
16.6 |
14.3 |
13.1 |
16.6 |
14.3 |
13.1 |
|
99.5 |
16.7 |
14.4 |
13.2 |
16.6 |
14.3 |
13.2 |
16.6 |
14.3 |
13.1 |
|
100 |
16.7 |
14.4 |
13.2 |
16.7 |
14.4 |
13.2 |
16.6 |
14.3 |
13.1 |
|
100.5 |
16.8 |
14.4 |
13.3 |
16.7 |
14.4 |
13.2 |
16.7 |
14.3 |
13.2 |
|
101 |
16.8 |
14.5 |
13.3 |
16.7 |
14.4 |
13.2 |
16.7 |
14.4 |
13.2 |
|
101.5 |
16.8 |
14.5 |
13.3 |
16.8 |
14.4 |
13.3 |
16.7 |
14.4 |
13.2 |
|
102 |
16.9 |
14.5 |
13.4 |
16.8 |
14.5 |
13.3 |
16.7 |
14.4 |
13.2 |
|
102.5 |
16.9 |
14.6 |
13.4 |
16.8 |
14.5 |
13.3 |
16.8 |
14.4 |
13.3 |
|
103 |
16.9 |
14.6 |
13.4 |
16.9 |
14.5 |
13.4 |
16.8 |
14.5 |
13.3 |
|
103.5 |
16.9 |
14.6 |
13.4 |
16.9 |
14.6 |
13.4 |
16.8 |
14.5 |
13.3 |
|
104 |
17.0 |
14.6 |
13.5 |
16.9 |
14.6 |
13.4 |
16.9 |
14.5 |
13.4 |
|
104.5 |
17.0 |
14.7 |
13.5 |
17.0 |
14.6 |
13.4 |
16.9 |
14.6 |
13.4 |
|
105 |
17.0 |
14.7 |
13.5 |
17.0 |
14.6 |
13.5 |
16.9 |
14.6 |
13.4 |
|
105.5 |
17.1 |
14.7 |
13.6 |
17.0 |
14.7 |
13.5 |
17.0 |
14.6 |
13.4 |
|
106 |
17.1 |
14.8 |
13.6 |
17.1 |
14.7 |
13.5 |
17.0 |
14.6 |
13.5 |
|
106.5 |
17.1 |
14.8 |
13.6 |
17.1 |
14.7 |
13.6 |
17.0 |
14.7 |
13.5 |
|
107 |
17.2 |
14.8 |
13.6 |
17.1 |
14.8 |
13.6 |
17.1 |
14.7 |
13.5 |
|
107.5 |
17.2 |
14.8 |
13.7 |
17.2 |
14.8 |
13.6 |
17.1 |
14.7 |
13.6 |
|
108 |
17.3 |
14.9 |
13.7 |
17.2 |
14.8 |
13.6 |
17.1 |
14.8 |
13.6 |
|
108.5 |
17.3 |
14.9 |
13.7 |
17.2 |
14.9 |
13.7 |
17.2 |
14.8 |
13.6 |
|
109 |
17.3 |
14.9 |
13.7 |
17.3 |
14.9 |
13.7 |
17.2 |
14.8 |
13.6 |
|
109.5 |
17.4 |
15.0 |
13.8 |
17.3 |
14.9 |
13.7 |
17.3 |
14.9 |
13.7 |
|
110 |
17.4 |
15.0 |
13.8 |
17.4 |
15.0 |
13.8 |
17.3 |
14.9 |
13.7 |
|
110.5 |
17.4 |
15.0 |
13.8 |
17.4 |
15.0 |
13.8 |
17.3 |
14.9 |
13.7 |
|
111 |
17.5 |
15.1 |
13.9 |
17.4 |
15.0 |
13.8 |
17.4 |
15.0 |
13.8 |
|
111.5 |
17.5 |
15.1 |
13.9 |
17.5 |
15.0 |
13.8 |
17.4 |
15.0 |
13.8 |
|
112 |
17.5 |
15.1 |
13.9 |
17.5 |
15.1 |
13.9 |
17.5 |
15.0 |
13.8 |
|
112.5 |
17.6 |
15.1 |
13.9 |
17.6 |
15.1 |
13.9 |
17.5 |
15.1 |
13.9 |
|
113 |
17.6 |
15.2 |
14.0 |
17.6 |
15.1 |
13.9 |
17.6 |
15.1 |
13.9 |
|
113.5 |
17.7 |
15.2 |
14.0 |
17.6 |
15.2 |
14.0 |
17.6 |
15.2 |
13.9 |
|
114 |
17.7 |
15.2 |
14.0 |
17.7 |
15.2 |
14.0 |
17.7 |
15.2 |
14.0 |
|
114.5 |
17.7 |
15.3 |
14.0 |
17.7 |
15.2 |
14.0 |
17.7 |
15.2 |
14.0 |
|
115 |
17.8 |
15.3 |
14.0 |
17.8 |
15.3 |
14.0 |
17.8 |
15.3 |
14.0 |
|
115.5 |
17.8 |
15.3 |
14.1 |
17.8 |
15.3 |
14.1 |
17.8 |
15.3 |
14.1 |
|
116 |
17.9 |
15.4 |
14.1 |
17.9 |
15.3 |
14.1 |
17.9 |
15.3 |
14.1 |
|
116.5 |
17.9 |
15.4 |
14.1 |
17.9 |
15.4 |
14.1 |
17.9 |
15.4 |
14.1 |
|
117 |
18.0 |
15.4 |
14.1 |
18.0 |
15.4 |
14.1 |
18.0 |
15.4 |
14.1 |
|
117.5 |
18.0 |
15.4 |
14.2 |
18.0 |
15.4 |
14.2 |
18.0 |
15.5 |
14.2 |
|
118 |
18.0 |
15.5 |
14.2 |
18.1 |
15.5 |
14.2 |
18.1 |
15.5 |
14.2 |
|
118.5 |
18.1 |
15.5 |
14.2 |
18.1 |
15.5 |
14.2 |
18.1 |
15.5 |
14.2 |
|
119 |
18.1 |
15.5 |
14.2 |
18.2 |
15.6 |
14.3 |
18.2 |
15.6 |
14.3 |
|
119.5 |
18.2 |
15.6 |
14.2 |
18.2 |
15.6 |
14.3 |
18.2 |
15.6 |
14.3 |
|
120 |
18.2 |
15.6 |
14.3 |
18.3 |
15.6 |
14.3 |
18.3 |
15.7 |
14.3 |
|
120.5 |
18.3 |
15.6 |
14.3 |
18.3 |
15.7 |
14.3 |
18.4 |
15.7 |
14.4 |
|
121 |
18.3 |
15.6 |
14.3 |
18.4 |
15.7 |
14.4 |
18.4 |
15.7 |
14.4 |
|
121.5 |
18.4 |
15.7 |
14.3 |
18.4 |
15.7 |
14.4 |
18.5 |
15.8 |
14.4 |
|
122 |
18.4 |
15.7 |
14.3 |
18.5 |
15.8 |
14.4 |
18.5 |
15.8 |
14.5 |
|
122.5 |
18.5 |
15.7 |
14.4 |
18.5 |
15.8 |
14.4 |
18.6 |
15.9 |
14.5 |
|
123 |
18.5 |
15.8 |
14.4 |
18.6 |
15.8 |
14.5 |
18.7 |
15.9 |
14.5 |
|
123.5 |
18.6 |
15.8 |
14.4 |
18.6 |
15.9 |
14.5 |
18.7 |
16.0 |
14.6 |
|
124 |
18.6 |
15.8 |
14.4 |
18.7 |
15.9 |
14.5 |
18.8 |
16.0 |
14.6 |
|
124.5 |
18.7 |
15.8 |
14.4 |
18.8 |
15.9 |
14.5 |
18.9 |
16.1 |
14.6 |
|
125 |
18.7 |
15.9 |
14.5 |
18.8 |
16.0 |
14.6 |
18.9 |
16.1 |
14.7 |
|
125.5 |
18.8 |
15.9 |
14.5 |
18.9 |
16.0 |
14.6 |
19.0 |
16.1 |
14.7 |
|
126 |
18.8 |
15.9 |
14.5 |
19.0 |
16.1 |
14.6 |
19.1 |
16.2 |
14.7 |
|
126.5 |
18.9 |
16.0 |
14.5 |
19.0 |
16.1 |
14.6 |
19.2 |
16.2 |
14.8 |
|
127 |
18.9 |
16.0 |
14.5 |
19.1 |
16.1 |
14.7 |
19.2 |
16.3 |
14.8 |
|
127.5 |
19.0 |
16.0 |
14.5 |
19.2 |
16.2 |
14.7 |
19.3 |
16.3 |
14.8 |
|
128 |
19.1 |
16.1 |
14.6 |
19.2 |
16.2 |
14.7 |
19.4 |
16.4 |
14.9 |
|
128.5 |
19.1 |
16.1 |
14.6 |
19.3 |
16.3 |
14.7 |
19.5 |
16.4 |
14.9 |
|
129 |
19.2 |
16.1 |
14.6 |
19.4 |
16.3 |
14.8 |
19.5 |
16.5 |
14.9 |
|
129.5 |
19.3 |
16.2 |
14.6 |
19.4 |
16.3 |
14.8 |
19.6 |
16.5 |
15.0 |
|
130 |
19.3 |
16.2 |
14.6 |
19.5 |
16.4 |
14.8 |
19.7 |
16.6 |
15.0 |
|
130.5 |
19.4 |
16.2 |
14.6 |
19.6 |
16.4 |
14.9 |
19.8 |
16.6 |
15.1 |
|
131 |
19.5 |
16.3 |
14.7 |
19.7 |
16.5 |
14.9 |
19.9 |
16.7 |
15.1 |
|
131.5 |
19.5 |
16.3 |
14.7 |
19.8 |
16.5 |
14.9 |
20.0 |
16.7 |
15.1 |
|
132 |
19.6 |
16.3 |
14.7 |
19.8 |
16.6 |
14.9 |
20.1 |
16.8 |
15.2 |
|
132.5 |
19.7 |
16.4 |
14.7 |
19.9 |
16.6 |
15.0 |
20.2 |
16.8 |
15.2 |
|
133 |
19.8 |
16.4 |
14.7 |
20.0 |
16.7 |
15.0 |
20.2 |
16.9 |
15.2 |
|
133.5 |
19.8 |
16.5 |
14.8 |
20.1 |
16.7 |
15.0 |
20.3 |
17.0 |
15.3 |
|
134 |
19.9 |
16.5 |
14.8 |
20.2 |
16.8 |
15.0 |
20.4 |
17.0 |
15.3 |
|
134.5 |
20.0 |
16.5 |
14.8 |
20.3 |
16.8 |
15.1 |
20.5 |
17.1 |
15.3 |
|
135 |
20.1 |
16.6 |
14.8 |
20.4 |
16.9 |
15.1 |
20.6 |
17.1 |
15.4 |
|
135.5 |
20.2 |
16.6 |
14.9 |
20.5 |
16.9 |
15.1 |
20.7 |
17.2 |
15.4 |
|
136 |
20.3 |
16.7 |
14.9 |
20.6 |
17.0 |
15.2 |
20.8 |
17.2 |
15.5 |
|
136.5 |
20.4 |
16.7 |
14.9 |
20.7 |
17.0 |
15.2 |
20.9 |
17.3 |
15.5 |
|
137 |
20.5 |
16.8 |
14.9 |
20.8 |
17.1 |
15.2 |
21.1 |
17.4 |
15.5 |
|
137.5 |
20.5 |
16.8 |
15.0 |
20.9 |
17.1 |
15.3 |
21.2 |
17.4 |
15.6 |
|
138 |
20.7 |
16.9 |
15.0 |
21.0 |
17.2 |
15.3 |
21.3 |
17.5 |
15.6 |
|
138.5 |
20.8 |
16.9 |
15.0 |
21.1 |
17.2 |
15.3 |
21.4 |
17.6 |
15.7 |
|
139 |
20.9 |
17.0 |
15.0 |
21.2 |
17.3 |
15.4 |
21.5 |
17.6 |
15.7 |
|
139.5 |
21.0 |
17.0 |
15.1 |
21.3 |
17.4 |
15.4 |
21.6 |
17.7 |
15.7 |
|
140 |
21.1 |
17.1 |
15.1 |
21.4 |
17.4 |
15.4 |
21.7 |
17.8 |
15.8 |
|
140.5 |
21.2 |
17.2 |
15.2 |
21.5 |
17.5 |
15.5 |
21.9 |
17.8 |
15.8 |
|
141 |
21.3 |
17.2 |
15.2 |
21.7 |
17.6 |
15.5 |
22.0 |
17.9 |
15.9 |
|
141.5 |
21.5 |
17.3 |
15.2 |
21.8 |
17.6 |
15.6 |
22.1 |
18.0 |
15.9 |
|
142 |
21.6 |
17.4 |
15.3 |
21.9 |
17.7 |
15.6 |
22.2 |
18.0 |
15.9 |
|
142.5 |
21.7 |
17.5 |
15.3 |
22.0 |
17.8 |
15.7 |
22.4 |
18.1 |
16.0 |
|
143 |
21.9 |
17.5 |
15.4 |
22.2 |
17.9 |
15.7 |
22.5 |
18.2 |
16.0 |
|
143.5 |
22.0 |
17.6 |
15.4 |
22.3 |
17.9 |
15.8 |
22.7 |
18.3 |
16.1 |
|
144 |
22.1 |
17.7 |
15.5 |
22.5 |
18.0 |
15.8 |
22.8 |
18.4 |
16.1 |
|
144.5 |
22.3 |
17.8 |
15.5 |
22.6 |
18.1 |
15.9 |
22.9 |
18.4 |
16.2 |
|
145 |
22.4 |
17.9 |
15.6 |
22.8 |
18.2 |
15.9 |
23.1 |
18.5 |
16.2 |
a Length below 85 cm, height at or above 85 cm.
For adults aged 20-59 years, as indicated in Chapter 3, body mass index (BMI) - calculated as weight in kilograms divided by the square of height in metres - provides a measure of thinness or underweight. The proportion of the population with low BMI that would define a public health problem is closely linked to available resources for correcting the problem, the stability of the environment, and government priorities. About 3 - 5% of a healthy adult population have a BMI below 18.5, and the following classification of the public health problem of low BMI has been suggested on the basis of BMI distribution in adult populations worldwide:1
|
Low prevalence (warning sign, monitoring required): |
5-9% of population with BMI <18.5 |
|
Medium prevalence (poor situation): |
10-19% of population with BMI <18.5 |
|
High prevalence (serious situation): |
20-39% of population with BMI <18.5 |
|
Very high prevalence (critical situation): |
³40% of population with BMI <18.5 |
This classification is somewhat arbitrary, but reflects the distribution of BMI in many populations of developing countries and endeavours to take into consideration the societal consequences of the functional impairments commonly associated with low BMI. The proportion of underweight adults in a community is commonly (but not necessarily) similar to that of underweight individuals as a whole. If the proportion of all underweight is much lower than that for children, it is probably that the group most affected by undernutrition is children; this is likely to be because of recurrent infections or poor infant feeding practices. If both adults and children are affected, an overall food shortage in the community is the most likely cause.
The internationally accepted cut-offs for various levels of underweight are given in Table A 3.6. It should be noted that there is commonly some increase in BMI between the ages of 20 and 24 years, particularly in developing countries. It has been a common practice to extrapolate data collected on adults to the elderly, yet it is not known to what extent BMI in the elderly has the same significance, because of the age-related decrease in height.1
1 Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva, World Health Organization, 1995 (Technical Report Series, No. 854).
For adolescents (aged 10-18 years), a WHO Expert Committee has recommended BMI-for-age as the best indicator of thinness. However, rapid changes in somatic growth in adolescence, problems of dealing with variations in maturation rate, and the difficulties involved in separating normal variations from those associated with health risks have been deterrents to developing a body of scientific knowledge linking adolescent anthropometry with determinants and health outcomes.2 When nutritional oedema exists, malnutrition should be diagnosed in this age group. For stunting or low height-for-age the cut-off value is <3rd percentile or below -2SD of the median NCHS/WHO reference values.
2 de Onis M, Habicht J-P. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. American journal of clinical nutrition, 1996, 64:650-658.
Table A3.6 Adult weights and heights corresponding to specified values of body mass index
|
Height (cm) |
Body weight (kg) | ||
| |
BMI 18.5 |
BMI 17.0 |
BMI 16.0 |
|
140 |
36.2 |
33.3 |
31.4 |
|
141 |
36.8 |
33.8 |
31.8 |
|
142 |
37.3 |
34.3 |
32.3 |
|
143 |
37.8 |
34.8 |
32.7 |
|
144 |
38.4 |
35.3 |
33.2 |
|
145 |
38.9 |
35.7 |
33.6 |
|
146 |
39.4 |
36.2 |
34.1 |
|
147 |
40.0 |
36.7 |
34.6 |
|
148 |
40.5 |
37.2 |
35.0 |
|
149 |
41.1 |
37.7 |
35.5 |
|
150 |
41.6 |
38.2 |
36.0 |
|
151 |
42.2 |
38.8 |
36.5 |
|
152 |
42.7 |
39.3 |
37.0 |
|
153 |
43.3 |
39.8 |
37.5 |
|
154 |
43.9 |
40.3 |
37.9 |
|
155 |
44.4 |
40.8 |
38.4 |
|
156 |
45.0 |
41.4 |
38.9 |
|
157 |
45.6 |
41.9 |
39.4 |
|
158 |
46.2 |
42.4 |
39.9 |
|
159 |
46.8 |
43.0 |
40.4 |
|
160 |
47.4 |
43.5 |
41.0 |
|
161 |
48.0 |
44.1 |
41.5 |
|
162 |
48.3 |
44.6 |
42.0 |
|
163 |
49.2 |
45.2 |
42.5 |
|
164 |
49.8 |
45.7 |
43.0 |
|
165 |
50.4 |
46.3 |
43.6 |
|
166 |
51.0 |
46.8 |
44.1 |
|
167 |
51.6 |
47.4 |
44.6 |
|
168 |
52.2 |
48.0 |
45.2 |
|
169 |
52.8 |
48.6 |
45.7 |
|
170 |
53.5 |
49.1 |
46.2 |
|
171 |
54.1 |
49.7 |
46.8 |
|
172 |
54.7 |
50.3 |
47.3 |
|
173 |
55.4 |
50.9 |
47.9 |
|
174 |
56.0 |
51.5 |
48.4 |
|
175 |
56.7 |
52.1 |
49.0 |
|
176 |
57.3 |
52.7 |
49.6 |
|
177 |
58.0 |
53.3 |
50.1 |
|
178 |
58.6 |
53.9 |
50.7 |
|
179 |
59.3 |
54.5 |
51.3 |
|
180 |
59.9 |
55.1 |
51.9 |
|
181 |
60.6 |
55.7 |
52.4 |
|
182 |
61.3 |
56.3 |
53.0 |
|
183 |
62.0 |
57.0 |
53.6 |
|
184 |
62.6 |
57.6 |
54.2 |
|
185 |
63.3 |
58.2 |
54.8 |
|
186 |
64.0 |
58.8 |
55.5 |
|
187 |
64.7 |
59.5 |
56.0 |
|
188 |
65.4 |
60.1 |
56.6 |
|
189 |
66.1 |
60.7 |
57.1 |
|
190 |
66.8 |
61.4 |
57.8 |
Interpretation
|
BMI < 16.0 |
indicates severe thinness |
|
BMI 16.0-16.99 |
indicates moderate thinness |
|
BMI 17.0-18.49 |
indicates marginal thinness |
|
BMI 18.5-24.99 |
is the normal range for an individual |
Note: A normal range of population median BMI of 21-23 has been suggested (see Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva, World Health Organization, 1998; unpublished document WHO/NUT/NCD/98.1, available from Programme of Nutrition, World Health Organization, 1211 Geneva 27, Switzerland.)
Body measurement techniques
Responsible personnel should be trained to measure and record weight, height, and/or arm circumference as described in the following paragraphs; see also Figs A3.1-A3.4 and the accompanying instructions.
Weight
Weight should be measured to the nearest 100 g (0.1 kg). Although various types of scales are used for weighing infants in the field, the most commonly used is the hanging spring balance scale, which can weigh up to 25 kg (see Fig. A3.1). The scale is hung from a branch, beam, tripod or - in the absence of other possibilities - from a pole supported on the shoulders of two adults. The infant is suspended from the scale in the specially designed pants or in a basket or sling, depending on local custom. If a basket or sling is used, the scale must be recalibrated to zero to adjust for the greater weight of the container.
Hanging scales of this type are robust, cheap, and easy to carry. Beam balances may be acceptable alternatives, although they are less portable. Bathroom scales are too inaccurate for field assessments, and bar scales are too bulky for mobile teams and more difficult to handle because they are less stable.
Calibration of the scales should be checked immediately before, and during, each session, using the same two known weights; the scales should first be set at zero with the weighing pants or basket attached. Suitable items for the calibration process include a lump of metal or rock, a 5-10 kg standard weight, or 5-10 litres of water. Spring balance scales should be replaced whenever the springs are so stretched that readings are incorrect. More details of the weighing procedure are appended to Fig. A3.1.
If a beam balance with a tray is to be used, it is important to ensure that the child sits properly and is not holding on to another person or to the static part of the balance. A beam balance should be placed on a stable, horizontal surface, such as a wide board or a table.
Weighing procedure
Note: If the parent or carer or other untrained person is acting as the assistant, the measurer should carry out the weighing and record the weight on the record form.1. Measurer or assistant: Hang the scale from a tree branch, ceiling beam, tripod, or pole held by two people, using a rope if necessary, so that the scale is at eye level. Make sure that it is secure. Ask the parent or carer to undress the child.
2. Measurer: Attach a pair of weighing pants (or infant sling or basket) to the hook of the scale and adjust the scale to zero; then remove the pants.
3. Measurer Put your arms through the leg holes of the weighing pants (if used) (arrow 1). While the parent or carer holds the child, grasp the child's feet and pull his or her legs through the leg holes (arrow 2); make certain that the strap of the pants is in front of the child.
4. Measurer Attach the strap of the pants to the hook of the scale. Do not carry the child by the strap alone. Gently lower the child and allow him or her to hang free (arrow 3).
5. Assistant: Stand behind and to one side of the measurer ready to record the weight (arrow 4). Have the record form and a pencil ready to hand.
6. Measurer or assistant: Check the child's position; make sure he or she is hanging free and not touching anything.
7. Measurer: Hold the scale and read the weight to the nearest completed 0.1 kg (arrow 5). Call out the measurement when the child is still and the scale needle has stopped moving; even the most active child will eventually become still long enough for a reading to be taken.
8. Assistant: Immediately record the weight and show your record to the measurer.
9. Measurer Take hold of the child in one arm and gently lift him or her; release the strap from the hook of the scale with your free hand. Do not lift the child by the strap of the weighing pants.
10. Measurer; Check the recorded weight on the form for accuracy and legibility. If there are any errors, instruct the assistant to erase and correct them.
Fig. A3.1 Use of the hanging spring balance for weighing infants1
1 Adapted, with permission, from Assessing the nutritional status of young children: preliminary version. New York, United Nations Department of Technical Co-operation for Development and Statistical Office, 1990.
Height or length
Every effort should be made to measure children's height or length accurately, to the nearest 0.1 cm if possible. Measurement errors of 2-3 cm can easily occur and cause significant errors in classifying nutritional status. Shoes and other footwear should be removed before measurements are made.
Length. A child under 2 years old or shorter than 80 cm (or 85 cm in a population that is not chronically undernourished) should be measured lying on its back. The child should be quiet, relaxed, and lying straight, with the head resting against a fixed head-board; the child should be looking vertically upwards. The help of the child's parent or carer is often valuable. Using one hand, the measurer should keep the legs straight by applying gentle pressure to both knees of the child and ensure that the movable slide is in contact with the surface of the soles and heels of the child's feet (not just the toes). More details of the procedure are appended to Fig. A3.2.
Height. A child over 2 years old (or taller than 80 or 85 cm) should normally stand to be measured. The child's heels should be together, at the back of the fixed foot-board. The buttocks, the backs of the heels, the upper back, and the head should touch the measuring board, which should have a metal tape-measure attached. The child's knees should not be bent. The movable head-board, which must be horizontal, should be slowly lowered until it rests firmly on the crown of the head (not just lightly on the hair). The vertical tape-measure is read opposite the highest point of the head when the child is looking straight ahead. More details of the procedure are appended to Fig. A3.3.
Measuring procedure
Note: If the parent or carer or other untrained person is acting as the assistant, the measurer should carry out and record the measurement.1. Measurer or assistant: Place the measuring board on a hard, flat surface, e.g. the ground or a steady table.
2. Assistant: Place the record form and a pencil on the ground, close to hand (arrow 1). If the measuring board is on the floor or the ground, kneel down with both knees behind the base of the board (arrow 2).
3. Measurer: Kneel on the child's right side so that you can hold the foot-piece of the measuring board with your right hand (arrow 3).
4. With the help of the child's parent or carer:
Assistant: Support the back of the child's head with your hands and gradually lower the child onto the board.
Measurer: Support the child's body at the trunk.5. Measurer or assistant: If the parent/carer is not also acting as your assistant, ask him or her to kneel on the opposite side of the board, facing you, to help keep the child calm.
6. Assistant: Cup your hands over the child's ears (arrow 4). With your arms comfortably straight (arrow 5), place the child's head against the base of the head-board so that the child is looking straight up. The child's line of sight should be perpendicular to the ground (arrow 6). Your head should be directly above the child's head. Look directly into the child's eyes.
7. Measurer: Make sure the child is lying flat, In the middle of the board (arrows 7). Place your left hand on the child's knees (arrow 8) and press them firmly against the board. With your right hand place the foot-piece firmly against the child's heels (arrow 9); the soles of the feet should be exactly vertical.
8. Measurer and assistant: Check the child's position (arrows 1-9) and correct if necessary.
9. Measurer: When the child's position is correct, take the measurement of length to the nearest completed 0.5 cm and call out the result to the assistant. Remove the foot-piece, release your left hand from the child's knees and support the child while the measurement is being recorded.
10. Assistant: Immediately release the child's head, record the measurement and show the record form to the measurer.
11. Measurer: Check the recorded measurement for accuracy and legibility. If there are any errors, instruct the assistant to erase and correct them.
A height arch can be used for selecting children shorter than 100 cm (or 110 cm in a population that is not chronically undernourished). This can be constructed simply, and should consist of a horizontal bar fixed 100 cm above the ground at right-angles to a vertical pole (or between two vertical poles). Any child who can walk under this horizontal bar without hitting it and without stooping should be referred (or included in the sample) for further measuring.
Arm circumference
Arm circumference is measured on the upper left arm. To locate the correct point for measurement, the child's elbow is flexed to 90°, with the palm facing up wards. A measuring tape is used to find the midpoint between the end of the shoulder (acromion) and the tip of the elbow (olecranon); this point should be marked. The arm is then allowed to hang freely, palm towards the thigh, and the measuring tape is placed snugly around the arm at the midpoint mark. The tape should not be pulled too tight. Further details of the procedure are appended to Fig. A3.4.
Fig. A3.2 Measuring a child's length1
1 Adapted, with permission, from Assessing the nutritional status of young children: preliminary version. New York, United Nations Department of Technical Co-operation for Development and Statistical Office, 1990.
Measuring procedure
Note: If the parent or carer or other untrained person is acting as the assistant, the measurer should carry out and record the measurement.1. Measurer or assistant: Place the measuring board against a hard, flat surface, such as a wall, table, or tree, and make sure it is stable.
2. Measurer or assistant: Ask the child's parent or carer to remove the child's shoes, remove ribbons, and undo topknots etc. from the child's hair if these would interfere with measurement, walk the child to the board, and - if not acting as the assistant - kneel down in front of the child.
3. Assistant: Place the record form and a pencil on the ground, close to hand (arrow 1). Kneel with both knees on the child's right side (arrow 2).
4. Measurer: Kneel (on one knee only, for maximum stability) on the child's left side (arrow 3).
5. Assistant: Place the child's feet flat and together in the centre of and against the back and base of the board. Place your right hand on the child's shins, just above the ankles (arrow 4), your left hand on the child's knees (arrow 5) and push against the board. Make sure that the child's legs are straight and that the heels and calves are against the board (arrows 6 and 7). Tell the measurer when you have completed the positioning of feet and legs.
6. Measurer Tell the child to look straight ahead at the parent or carer; make sure the child's line of sight is parallel with the ground (arrow 8). Place your open left hand on the child's chin and gradually close your hand (arrow 9). Do not cover the child's mouth or ears. Make sure the child has shoulders level (arrow 10), hands at the side (arrow 11), and head, shoulders, buttocks, and heels against the board (arrows 12, 13, 14). With your right hand, lower the head-piece on to the top of the child's head, making sure that you flatten the hair to the head (arrow 15).
7. Measurer and assistant: Check the child's position (arrows 1-15) and correct if necessary.
8. Measurer When the child's position is correct, read and call out the measurement to the nearest completed 0.5 cm. Remove the head-piece from the child's head and your left hand from the child's chin; support the child while the measurement is recorded.
9. Assistant: Record the measurement and show the record form to the measurer.
10. Measurer: Check the recorded measurement for accuracy and legibility. If there are any errors, instruct the assistant to erase and correct them.
Fig. A3.3 Measuring a child's height1
1 Adapted, with permission, from Assessing the nutritional status of young children: preliminary version. New York, United Nations Department of Technical Co-operation for Development and Statistical Office, 1990.
For rapid assessment of nutritional status, the measured arm circumference can be related to a child's height by use of a special measuring stick - the WHO-modified QUAC stick.
Construction and use of the modified QUAC stick. To construct A QUAC stick like that illustrated in Fig. A3.5, use a piece of wood about 150 cm long and 3 x 3 cm in cross-section. On one face mark each 0.5 cm, from 0 at the bottom to, say, 145 cm near the top; write on it length/height for each full cm. On an adjacent face, mark the corresponding reference values for median -2SD of MUAC-for-height (Table A3.5). Two sticks are preferable, one for boys and one for girls; otherwise, enter the values for the sexes combined. On the other face adjacent to the height markings, enter the values for median -3SD of MUAC-for-height. Place the stick firmly and uprightly on a platform against a vertical wall. First measure the arm circumference as described in Fig. A3.4. Then have the child stand straight with his or her back flat against the stick and measure the height using a flat head-board. Note whether the arm circumference is less than that given on the "median - 3SD" face; if below it, record as severe deficit, and if above it, look on the "median -2SD" face. If the measurement is below this value, record as moderate deficit; if above it, record as no deficit. All children can be identified in this way as having severe, moderate, or no deficit.
Measuring procedure
Note: If the parent or carer or other untrained person is acting as the assistant, the measurer should carry out and record the measurement.1. Measurer: Keep your work at eye-level and sit down when possible. A very young child can be held during the procedure by the parent or carer, who should also remove any clothing that covers the child's left arm.
2. Measurer Calculate the midpoint of the left upper arm by first locating the tip of the child's shoulder (arrows 1 and 2) with your fingertips. Bend the child's elbow to make a right angle (arrow 3), Place a measuring tape at zero (indicated by two arrows) on the tip of the shoulder (arrow 4) and pull it straight down past the tip of the elbow (arrow 5); read the number at the tip of the elbow to the nearest 1 cm. Divide this number by 2 to find the midpoint, which you or your assistant should mark on the arm with a pen (arrow 6).
3. Measurer: Straighten the child's arm and wrap the measuring tape around the arm at the midpoint (ensuring that the numbers are right-side up). Make sure the tape is flat against the skin (arrow 7),
4. Measurer and assistant: Check that the tape around the child's arm is neither too tight nor too loose (arrows 8 and 9); correct if necessary.
5. Assistant: Make sure that the record form is ready and to hand.
6. Measurer When the tape is correctly positioned and under the correct tension, read the measurement to the nearest 0.1 cm and call it out to your assistant.
7. Assistant: Immediately record the measurement.
8. Measurer: While the assistant records the measurement, loosen the tape from the child's arm.
9. Measurer: Check the recorded measurement for accuracy and legibility. Instruct the assistant to erase any errors and correct them.
10. Measurer: Remove the tape from the child's arm.
Fig. A3.4 Measuring child's mid-upper-arm circumference1
1 Adapted, with permission, from Assessing the nutritional status of young children: preliminary version. New York, United National Department of Technical Co-operation for Development and Statistical Office, 1990.
Fig. A3.5 The WHO-modified QUAC stick
|
|