A Scale Without Anthropometric Measurements Can Be Used to Identify Low Weight-for-Age in Children Less than Five Years Old

Manuscript received 26 April 1998. Initial reviews completed 27 July 1998. Revision accepted 20 August 1998.

Maribel Orozco^*, Homero Martínez^{*, ,} , Hortensia Reyes^*, and Héctor Guiscafré^*

^* Interinstitutional Health Services Research Group, Mexican Social Security Institute-Ministry of Health, Mexico City, Mexico and  National Institute of Public Health, Cuernavaca, Mexico

Malnutrition and morbidity have a synergistic association that often leads to death. However, malnutrition in children who die is largely underreported, because anthropometry of the deceased child is rarely known. This study had two purposes: i) to develop a scale that would help determine if a child had low weight-for-age (w/a), in the absence of anthropometric measures; and ii) to select an appropriate cut-off that would give the best sensitivity (Se) and specificity (Sp) of the proposed scale when contrasted with actual w/a measurement. The study was designed as a diagnostic test, and carried out in a rural area in central Mexico. We included 132 children under 5 y old with w/a under 2 Z score and 284 children with marginal or no w/a deficit as a control group. The proposed scale included potential predictive variables from clinical, socioeconomic and family factors. The best logistic regression model to predict low w/a included: birth weight less than 2,800 g, introduction of weaning foods after the sixth month of life, introduction of animal protein after the sixth month of life, low socioeconomic status, low w/a in siblings and more than three morbidity episodes in the previous 6 mon. Selecting a cut-off of 4 for this model to identify children with low w/a showed a Se and Sp of 85 and 95%, respectively. We tested the external validity of the scale in a different locale, and included 877 children under 5 y old from 10 rural communities. In this population, the scale showed Se of 84% and Sp of 81% to identify low w/a. Based on these results, we propose that the scale be included as a means of identifying low w/a in children who have died. We believe that this should be done in verbal autopsies, which, based on our previous research, the Ministry of Health adopted as part of the regular activities to monitor problems in the disease to health-seeking to death process.

The Journal of Nutrition Vol. 128 No. 12 December 1998, pp. 2363-2368
Copyright ©1998 by the American Society for Nutritional Sciences