Double Burden of Malnutrition in Under-Five Children (NFHS-5 Data) Using Extended CIAF: WHO 2006 Growth Standard Versus 2019 Indian Growth References.

This study compared how double burden of malnutrition (malnutrition that includes both undernutrition and overweight) is measured in Indian children under five using two different growth standards: the WHO 2006 standard and India's 2019 growth references. Using data from 196,015 children in the National Family Health Survey-5, the researchers found that applying Indian growth references identified significantly fewer children as malnourished compared to the WHO standard. The study suggests that using locally-developed Indian growth references provides more accurate classification of malnutrition in Indian children and reduces over-diagnosis.

Key points

• 50.1% of children were classified as having no failure using WHO standards versus 74% using Indian standards
• Double burden of malnutrition prevalence was 49.9% with WHO reference versus 26% with Indian references
• Undernutrition failure was 48.4% using WHO standards versus 24.7% using Indian standards
• Overweight failure was 3.5% using WHO standards versus 1.9% using Indian standards
• Using Indian references prevents misclassification of malnutrition in under-five children

Limitations

This is a descriptive comparison study that does not assess which standard is clinically more valid or predictive of child health outcomes. The study does not explain why the Indian growth references differ from WHO standards or examine the implications of these differences for identifying children needing intervention.