Objective: To devise a strategy for assessing the nutritional status of a h
ousehold and specifying the major needs in combating childhood wasting, dis
tinguishing between inadequate food availability, poor parental care and/or
the need for improved public health measures.
Design: An evaluation of the relationship between children's wasting, stunt
ing, or underweight and mothers' or adult women's body mass indexes (BMIs)
in the same household. A household was designated as 'malnourished' on the
basis of a single child's weight/height of <-2.0 s.d. or at risk of being m
alnourished if the Z-score was below-1.5. Adult women's BMI was taken to si
gnify adequate household food availability. Sibling concordance of anthropo
metric measures was investigated.
Results: A wide variety of prevalence of severe (BMI<16.0), moderate (BMI 1
6.0-16.9) and marginal (17.0-18.4) malnutrition existed in the various stud
y areas. The worst condition was recorded in India, while 18% of the women
in Zimbabwe were classified as obese. Similarly wide variation in the preva
lence of child wasting and stunting was observed, with the Indian children
again faring worst and those in Zimbabwe the best. The within-household ana
lysis of concordance gave higher concordance for height than for weight bet
ween siblings. Mothers' BMI was highly correlated with the BMI of all other
adult women in the same household and the BMI of all the women was found t
o be as useful as that of the mother for relating to children's anthropomet
ry. Households with mothers of normal body weight but wasted children were
designated as in need of public health measures and improved parental care
rather than of enhanced food security. The distribution of households on th
is combined basis of maternal BMI and child nutritional status highlighted
very diverse situations in the various study areas, with higher proportions
of combined maternal and child malnutrition in India and in some areas of
Ethiopia, while in Zimbabwe only 1-2% presented this condition. On this bas
is, the principal problem in India was food security; in Zimbabwe household
security was rarely apparent, so public health measures and maternal care
were designated as problems. In three Ethiopian communities there was a mix
ture of needs.
Conclusions: A relatively simple household-based approach is proposed to di
scriminate the most pressing needs in combating childhood malnutrition, and
a policy-making tool is suggested for setting priorities in community acti
on.
Sponsorship: Funds from ENI, IFPRI, DGXII of the European Community and the
Italian government contributed to the surveys. The analysis was supported
by the Scottish Office Agriculture, Engineering and Fisheries Department, b
y an FAO grant to WPTJ, and by STD2 Programme of the European Community-Con
tract No. TS2-M-0154-I provided to AFL.