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Surveillance of Severe Pediatric Undernutrition: Conceptual and Practical Issues^1,2,

Division of Nutrition, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, GA 30333

Despite a high level of concern among health professionals and the general public, data are inadequate to define and monitor the prevalence of severe pediatric undernutrition (SPUN). The Centers for Disease Control is supporting four state health departments to test the feasibility of surveillance mechanisms for SPUN. These efforts will seek to develop workable case definitions, define prevalence estimates, identify high-risk populations and describe specific demographic, social and medical risk factors. Initial experience with SPUN surveillance indicates that a variety of approaches may prove feasible but that these require attention to issues such as measurement error, data collection burden, confidentiality and data management. SPUN surveillance may prove too costly to be practical for general application, but it can serve as a means to identify needy children and estimate the prevalence of undernutrition in specific high-risk populations.

KEY WORDS: • malnutrition • undernutrition • surveillance • child nutrition

¹ Presented as part of the "Symposium on the Identification and Prevalence of Undernutrition in the United States" during the joint meeting of the American Institute of Nutrition and the American Society for Clinical Nutrition held in conjunction with the 73rd Annual Meeting of the Federation of American Societies for Experimental Biology, New Orleans, LA, March 20, 1989. Supported in part by cooperative agreement HPU 88004-02-1 with the Office of Disease Prevention and Health Promotion, Public Health Service, Department of Health and Human Services.

² Guest editors for this symposium were William H. Dietz, New England Medical Center, Boston, MA, and Frederick L. Trowbridge, Centers for Disease Control, Atlanta, GA.

Manuscript received 6 December 1989. Revision accepted 6 April 1990.