Classification of Dual Burden of Malnutrition in Young Children

Abstract

Introduction: Available classifications and indices for assessment of malnutrition are limited to deficiencies. Societies with transitional nutrition have children suffering not only deficiencies, but also excess or both (dual burden). This paper proposes a classification of nutritional status for identifying normal and failure conditions due to deficiency, excess and dual burden as well as of their components. Methods: One nutritional condition was considered normal and 12 malnutrition conditions were used for the proposed Malnutrition Anthropometric Index (MAI) as the summation of malnutrition conditions shares and comprising sub-indices of deficiencies (MAD), of excess (MAE) or dual burden (MADB). These indices and 95% CI for comparisons were computed utilizing data from 426 children from six to 59 months of age derived from household surveys of 14 rural bordering communities from Central America in 2013-2015, 9144 sampled national Guatemalan children, 3311 urban and 5833 rural in 2008-2009, and 5892 sampled national Burkina Faso children, 1311 urban and 4581 rural in 2010. Results: Shares and 95% confidence intervals estimated for proposed indices were able to differentiate dual burden as well as other indices among study populations. Conclusions: MAI was better estimate of malnutrition and sub-indices MAD, MAE and MADB and their components provided breakdown of malnutrition conditions as inputs for a better understanding of malnutrition and better decision-making. Recommendations: Consider malnutrition conditions due to deficiencies as well as excess and dual burden in nutritional assessments of children. Use MAI as well as sub-indices MAD, MAE and MADB and their components in the analysis of results from anthropometric surveys in children for monitoring and evaluation purposes in actions and policies with impact on food and nutrition security.