The potential use of maternal size in priority setting when combating childhood malnutrition

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.