Malnutrition: The silent crisis: Collation of anthropometric measures of nutritional status in children under 2 years of age: A hospital-based case-control study.

Background: Even if malnourishment is a life-threatening condition, there is not a single 'gold standard' anthropometric measurement to diagnose child undernutrition. Hence, this case-control study compared different anthropometric measurements to assess child malnutrition.

Methodology: Using WHO's MGRS Criteria 2006, cases and controls were selected and matching was done for age and sex. The calculated sample size was 154 (77 cases and 77 controls), assuming a two-sided confidence level of 95%, power of the study 80% and a case-control ratio of 1:1, 10% nonresponse rate and lack of exclusive breastfeeding taken as an exposure factor. The Z-scores (WFH, HFA, WFA) were calculated using WHO Anthro software. The sensitivity, specificity, and accuracy were calculated for each anthropometric measure. Multiple linear regressions for comparison of MUAC against WFA and HFA Z-scores were performed. The Composite Index of Anthropometric Failure (CIAF) was also calculated.

Results: Even among controls, 26% were severely stunted and 14.2% were severely underweight. The sensitivity MUAC to diagnose severely underweight and severely stunted children was 84.2% and 58.5%, respectively. Multiple Linear regression found positive association of WAZ and MUAC. Out of 154 children, 114 (74%) had anthropometric failure.

Conclusions: The combined anthropometric measurements approach to screen chronic malnutrition in the community is strongly recommended. There is a need to develop software in the local language that is simple and feasible to use by grass route workers for early diagnosis of SAM children.