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Counting the stunted children in a population: a criticism of old and new approaches and a conciliatory proposal

Counting the stunted children in a population: a criticism of old and new approaches and a conciliatory proposal

Bulletin of the World Health Organization 69(6): 761-766

The classical method of determining the prevalence of stunted children consists of calculating the proportion of children whose heights are 2 standard deviations (SD) below the expected mean of the anthropometric standard. Since it assumes modest rates of stunting, it underestimates stunting in most populations. In fact, several simulated population analyses show that the classical method indeed only detects children with severe growth retardation. Another problem is that a considerable reduction of relative differentials between more and less exposed strata occur. Mora has suggested a new method which takes into consideration whole height distribution of observed and reference populations, false positives, and false negatives. A controversy exists, however, in his method of estimating the false negatives. False negatives include the excess proportion of cases in the observed population above the cut off point compared with that is the reference population. A problem with this definition is that the area of no overlapping depicts only some of the false negatives. So Mora's method reduces some of the constraints, but does not eliminate them. Monteiro proposes a minimum prevalence of growth deficits method which is also based on the whole height distribution of both populations. When it is applied to hypothetical populations, the degree of underestimation is smaller than the Mora methods. Further since the degree of underestimation is not dependent on prevalence level, it maintains the true prevalence gradients between populations. Thus this method tends to detect values that are very close to being real. Monteiro suggests that any cross sectional studies to assess growth should included the complete Z-score distribution, percentage of individuals 2 SD below the cut off (stunted), and the percentage of individuals given by 100-2 (% of Z-scores0) (nonoptimal growth).

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Accession: 007165977

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PMID: 1786626

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