A scale without anthropometric measurements can be used to identify low weight-for-age in children less than five years old

Malnutrition and morbidity have a synergistic association that often leads to death. However, malnutrition in children who die is largely underreporte d, because anthropometry of the deceased child is rarely known. This study had two purposes: i) to develop a scale that would help determine if a chil d had low weight-for-age (w/a), in the absence of anthropometric measures; and ii) to select an appropriate cut-off that would give the best sensitivi ty (Se) and specificity (Sp) of the proposed scale when contrasted with act ual w/a measurement. The study was designed as a diagnostic test, and carri ed out in a rural area in central Mexico. We included 132 children under 5 y old with w/a under -2 Z score and 284 children with marginal or no w/a de ficit as a control group. The proposed scale included potential predictive variables from clinical, socioeconomic and family factors. The best logisti c regression model to predict low w/a included: birth weight less than 2,80 0 g, introduction of weaning foods after the sixth month of life, introduct ion of animal protein after the sixth month of life, low socioeconomic stat us, low w/a in siblings and more than three morbidity episodes in the previ ous 6 mon. Selecting a cut-off of 4 for this model to identify children wit h low w/a showed a Se and Sp of 85 and 95%, respectively. We tested the ext ernal validity of the scale in a different locale, and included 877 childre n under 5 y old from 10 rural communities. In this population, the scale sh owed Se of 84% and Sp of 81% to identify low w/a, Based on these results, w e propose that the scale be included as a means of identifying low w/a in c hildren who have died. We believe that this should be done in verbal autops ies, which, based on our previous research, the Ministry of Health adopted as part of the regular activities to monitor problems in the disease to hea lth-seeking to death process.