Anthropometry Technique of measuring people Measure Index Indicator Reference Information

Measurements Weight Height Length and stature or height Mid Upper Arm Circumference MUAC Characteristics we need: »easy »cheap »acceptable »reproducible

Relation between two measurements weight for age W/A or W//A general appreciation of nutritional status height for age H/A or H//A measure of linear growth deficit or STUNTING weight for height/length W/H or W//H measure of weight deficit according to length WASTING INDEX

Sensitive to changes Changes in two directions up and down Fast change Usually easy to collect Standardisation of scales needed, calibration Small changes are difficult to measure: food intake of the child, urine, dehydration, temp, etc: not very specific community aversion: connotations can be difficult: co-operation of children to nearest 100 gr. WEIGHT

Difficult to measure, accuracy, large variations Differences are small: 24 cm increment in the first year of life, 11 cm second year, 8 third Low sensitivity Large measurement errors Stunted versus stunting –stunted is a heterogeneous group –stunting is the active process: determinants are acting Measure to the nearest mm Below 2 recumbent, above standing Height

Usually the most difficult and inaccurate measurement Less of a problem if a trend in the same child is measured, the mistake is repeated every time and thus cancels out AGE

Growth of a child

Partial quantification of a concept –partial –quantification –concept number or percent of defined group below a cut- off value cut-off : z-scores, -2 and +2,  95% of population z-score = X-Mean / SD below -2 in normal distribution 2.27 % !! Percentages: value = % of the mean percentiles: range from 1 to 100 Indicator

One reference for all?? Reference or standard? Genetic differences –Do they exist –Are they important Reference means operational decisions The reference

1.Measurements should relate to a well-nourished population. 2.Sample : at least 200 individuals in each age and sex group. 3.Sample: cross-sectional, since the comparisons that will be made are of a cross-sectional nature. 4.Sampling procedures should be defined and reproducible. 5.Measurements should be carefully made and recorded by observers trained in anthropometric techniques, using equipment of well tested design and calibrated at frequent intervals. 6.The measurements made on the sample should include all the anthropometric variables that will be used in the evaluation of nutritional status. 7.The data from which reference graphs and tables are prepared should be available for anyone wishing to use them, and the procedures used for smoothing curves and preparing tables should be adequately described and documented. Criteria for a reference

First year of life is up to 11.9 months of age and not O-12 Length and height; change technique at 24 mo Percentage and z-score –80% is -1.5 Z-score at 6 mo and -2 Z score at 2 yrs Lack of distinction between descriptive use and operational use No use of statistics: Confidence intervals and tests to compare prevalence and averages Undernutrition  Wasting  Stunting COMMON ERRORS

Classifications: GOMEZ

Classifications: WATERLOW

Identification serve a purpose, the identified should be dealt with. Capacity of numbers. Sensitivity (Se) is the ability of a test to identify as positive those who are diseased. Specificity (Sp) is the ability of a test to identify as negative those who are healthy. Positive predictive value: If you test positive, what is the chance of really being positive. Negative predictive value is the chance of being healthy whilst being identified as negative. The chance of being really negative is higher when there are no false negatives, i.e. when the sensitivity is higher. Anthropometry is an operational tool

Truly Malnourished YesNo Diagnosed asYesTPFP malnourishedNoFNTN TP= true positive FP= false positive TN= true negative FN= false negative Se= TP/(TP+FN) Sp= TN/(TN+FP) Positive predictive value (PPV) = TP/(TP+FP) Negative predictive value (NPV) = TN/(TN+FN) Se and Sp

PPV= TP /TP +FP PPV= Se*P / (Se*P) + ((1-Sp) * (1-P)) NPP= TN/FN + TN NPP= Sp(1-P) / (Sp * (1-P) + ((1-Se) * P) reformulation

 Individual Level  SCREENING: ONE TIME ASSESSMENT  to immediately decrease case fatality (emergency situations)  in non-emergency situations  GROWTH MONITORING: TREND ASSESSMENT  Population Level  ONE TIME ASSESSMENT  under circumstances of food crisis  for long-term planning  NUTRITIONAL SURVEILLANCE: TREND ASSESSMENT  for long-term planning  for timely warning  for programme management Use of Anthropometry

W/A: combined measurement: –NO individual diagnosis but trend assessment –For growth monitoring and FU W/H indicates degree of wasting –Individual diagnosis –Community diagnosis –Sensitive to change H/A indicates linear growth retardation –not sensitive to change –slow progress –Community diagnosis ALL complex causality Indices

Summary of applications