Estimated burden of aggregate anthropometric failure among Malawian children

Background: The prevalence and trends of undernutrition among children below the age of five in Malawi are well known from a conventional (stunting, wasting and underweight) but not aggregate indicator perspective.Objective: A study was undertaken to estimate the burden of undernutrition among Malawian children below the age of five, using the Composite Indicator of Anthropometric Failure (CIAF), which enables determination of an aggregate burden of malnutrition.Setting: The study used secondary data from the Malawi Demographic and Health Surveys (MDHS) of 1992, 2000, 2004 and 2010.Subjects: The subjects were caregivers and under-five children as sampled in the respective MDHS years considered for this study.Method: The study employed CIAF as an alternative approach to describe undernutrition in four cohorts of Malawian children, in contrast to the more common evaluation of stunting, wasting and underweight. CIAF identifies seven mutually exclusive groups of possible anthropometric status in a population of children, with six of them representing potential anthropometric failure and the seventh group encompassing children not affected by any form of undernutrition. CIAF was calculated by difference, taking into account those children who did not reflect any form of undernutrition. CIAF was applied on four data sets from the Malawi Demographic and Health Surveys (MDHS) of 1992 (n = 3 174), 2000 (n = 10 102), 2004 (n = 8 934) and 2010 (n = 4 586) to generate anthropometric failure values.Results: Until the 2010 MDHS, which registered a 51% value, the prevalence of CIAF approximated 59% in 1992, and 57% in both 2000 and 2004. These values are much higher than the prevalence of underweight (< 24%, in all years), a conventional indicator currently used as a proxy aggregate measure of undernutrition.Conclusions: Compared with CIAF, conventional anthropometric indicators seriously underestimated the prevalence of anthropometric failure among Malawian children. This is due to the fact that CIAF gives an aggregate estimate of anthropometric failure, hence it is a better indicator of the magnitude of undernutrition. There is need for CIAF to be integrated in routine nutrition assessments, and it is suggested that cut-off values to assess the degree of its severity be developed to make it more relevant.Keywords: anthropometric failure, composite, underestimatio