Prevalence of moderate malnutrition in infants

Summary of en-net discussion

By Tamsin Walters, en-net coordinator

Contributors: Nina Berry, Mike Golden, Mark Myatt, Marie McGrath

A recent discussion on en-net concerning availability of data on prevalence of malnutrition in infants under 6 months and comparison with children 6-59 months, provoked a discussion on the challenges of both measurement and interpretation of nutritional status of infants less than 6 months old.

While contributors suggested that these data is rarely available, there was acknowledgement of the importance of identifying growth faltering in this age group and responding appropriately to their needs. Both actions may entail very different modalities than are employed for children aged 6-59 months.

Infants under 6 months of age can be difficult to measure accurately, particularly if staff have not had sufficient training in anthropometric measurements and because babies' legs may not straighten, making it difficult to measure length. A very small error makes a big difference in weight-for-height z-score. In January 2008, ENN reported on an evaluation of anthropometric training of emergency nutrition staff which found that, while 88% of national nursing and nutritional staff said they felt very competent at undertaking weight measurements for children aged between 6 months and 5 years, this fell to 29% for infants less than 6 months¹.

New WHO training materials note, "it is not possible to straighten the knees of newborns to the same degree as older children. Their knees are fragile and could be injured easily, so apply minimum pressure".²

New WHO training materials note, "it is not possible to straighten the knees of newborns to the same degree as older children. Their knees are fragile and could be injured easily, so apply minimum pressure".2 However, data on anthropometric indices of this age group are not easy to interpret since the aetiology of growth faltering may be complex. For example, it is preferable to have longitudinal data on an infant, as a low birth weight infant may be gaining weight and healthy but show low weight-for-age. Issues concerning feeding methods, health of baby and mother and infant care practices need to be explored in depth to get to the root of the problem.

Further, interventions in response to identified malnutrition in infants need to be carefully planned: lack of awareness of the risks associated with supplementary feeding for this age group and lack of expertise in infant feeding, including breastfeeding assessment, management and support, can compound the problem.

Entry criteria to nutrition programmes for infants under 6 months of age may more effectively be based on failure to breastfeed or inadequate infant feeding, rather than anthropometric indices, with the aim of capturing infants as growth faltering starts. Response comprising intensive support to mothers and their infants to re-establish appropriate and successful feeding.

See http://www.en-net.org.uk/question/18.aspx for more details.

The Management of Acute Malnutrition in Infants (MAMI) Project Report is due out end July 2009. See updates at www.ennonline.net/research

en-net is a free online technical forum operated by the ENN, to help access technical answers to operational challenges. It is funded by USAID/OFDA. Visit www.en-net.org.uk

¹An investigation of anthropometric training by NGOs, Naomi Tilley, Field Exchange Issue 32, January 2008

²Training Course on Child Growth Assessment, WHO Child Growth Standards, B Measuring a Child's Growth, WHO Department of Nutrition for Health and Development