Title of Paper: WHO child growth standards and the identification of severe acute malnutrition in infants and children: a Joint Statement by the World Health Organization and the United Nations Children’s Fund.
Type of Paper: A Joint Statement by the World Health Organization (WHO) and the United Nations Children’s Fund
Purpose: To define the cutoffs for diagnosing severe acute malnutrition (SAM), including severe wasting, kwashiorkor, or marasmic kwashiorkor. Specifically, diagnostic criteria for defining severe wasting were updated.
Diagnostic Criteria for SAM in Children Ages 6-60 Months:
- Severe wasting is defined by either:
- Weight-for-height below -3 z-scores (WHO standards).
- Mid-upper arm circumference (MUAC) below 115 mm.
- Bilateral edema
- Weight-for-height and MUAC should be used as independent diagnostic criteria for SAM.
The Rationale for Using These Criteria:
- The prevalence of SAM is similar whether using the diagnostic criteria for weight-for-height (3.22%) or MUAC (3.27%) (however, children diagnosed with SAM using the MUAC criterion are younger than those identified by the weight-for-height criterion).
- These cutoffs were chosen because:
- There is an increased risk for dying in children below these cutoffs for weight-for-height and MUAC.
- The cutoffs are highly specific to identifying SAM. There are almost no children below the cutoff in well-nourished populations.
- Children below the cutoff respond well (e.g., have higher weight gain and faster recovery) when receiving therapeutic foods.
- There are no known risks or negative consequences associated with giving these children therapeutic diets.
Implications of Using the WHO Standards:
- The new criteria are based on the 2006 WHO standards. Two to four times more children are identified as having SAM by the 2006 WHO standards compared to the older National Center for Health Statistics (NCHS) reference.
- Recommended discharge criteria following therapeutic feeding programs include a 15% weight gain or a weight for height of -1 z-score.
- Use of the new standards to track growth may show slower weight gains during therapeutic feeding programs.
World Health Organization, United Nations Children’s Fund. WHO child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva: World Health Organization and UNICEF; 2009.