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Stunting screening and disability

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Antony

Normal user

14 Feb 2013, 12:05

Hello all.

I work for a disability focussed international organization and we are currently trying to respond to an area that is said to have a high stunting rate - around 40% according to sample surveys.

We have been hoping to screen development milestones in children with severe stunting who we imagine would be the most "at risk" for developmental disabilities. We don't have the manpower to be able to assess every single child in the region, so wanted to link with the main health and nutrition actors who are undertaking population growth monitoring.

The problem we face is that only weight for age is measured by growth monitoring organizations as routine. If the children's z score is <-2, they would have height to weight measured also and put on a feeding programme if this is indicated. So, no height for age scores at all meaning we cannot ask to refer children with severe stunting scores on this scale.

As a physiotherapist, this is all a fairly new area to me, but I wondered if one criteria could be to refer children who have <-3 z score on weight to height but >-1 on height to weight. I guess this would not pick up those with wasting and stunting, but may identify the others.

Thoughts and advice very welcome!

Antony

Mark Myatt

Consultant Epideomiologist

Frequent user

14 Feb 2013, 13:15


I think there a few possible solutions to your problem ...

(1) Examination of the growth curve. A stunted child will track the growth curve somewhere below the median. A stunting child will show a slow divergence away from the curve in a flat or very slightly downward direction.

(2) Elimination. A low W/A could be a low H/A or a low W/H (or both). If a child has a low W/A and a reasonable W/H then they will probably have a low H/A. You could use MUAC to determine wasting. Any child with a low W/A without wasting will probably be stunted.

(3) Use the data you have. You have weight and age (needed for W/A) and have added height (needed for W/H). This means you have height and age and can calculate H/A z-score.

I hop this helps.

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