Children under 5 years who are wasted
Percent of wasted (moderate and severe) children aged 0–59 months (moderate = weight-for-height below -2 standard deviations of the WHO Child Growth Standards median; severe = weight-for-height below -3 standard deviations of the WHO Child Growth Standards median).
Number of children aged 0–59 months who are wasted.
Total number of children aged 0–59 months.
Age, place of residence, sex, socioeconomic status.
Percentage of children aged < 5 years wasted = (number of children aged 0–59 months whose z-score falls below -2 standard deviations from the median weight-for-height of the WHO Child Growth Standards/total number of children aged 0–59 months who were measured) x 100.
Children’s weight and height are measured using standard equipment and methods (e.g. children under 24 months are measured lying down, while standing height is measured in children aged 24 months and older.
WHO maintains the Global Database on Child Growth and Malnutrition, which includes population-based surveys that fulfil a set of criteria. Data are checked for validity and consistency and raw data sets are analysed according to a standard procedure to obtain comparable results. Prevalence below and above defined cut-off points for weight-for-age, height-for-age, weight-for-height and BMI-for-age, in pre-school children are presented using z-scores based on the WHO Child Growth Standards.
A detailed description of the methodology and procedures of the database – including data sources, criteria for inclusion, data quality control and database workflow – are described in a paper published in 2003 in the International Journal of Epidemiology (de Onis M, Blössner M).
National nutrition surveys.
Population-based health surveys with nutrition modules, national surveillance systems.
This indicator is used to measure nutritional imbalance resulting in undernutrition (i.e. wasting). Child growth is internationally recognized as an important indicator of nutritional status and health in populations.
Weight-for-height is an index that reflects body weight relative to height. Low weight-for-height helps to identify children suffering from current or acute undernutrition or wasting. Wasting is the result of a weight falling significantly below the weight expected of a child of the same length or height. Wasting in children is a symptom of acute undernutrition, usually as a consequence of insufficient food intake or a high incidence of infectious diseases, especially diarrhoea. Wasting in turn impairs the functioning of the immune system and can lead to increased severity and duration of and susceptibility to infectious diseases and an increased risk for death.
In general, weight-for-length (in children under two years of age) or weight-for-height (in children over two years of age) is appropriate for examining short-term changes, such as seasonal changes in food supply or short-term nutritional stress brought about by illness.
This indicator is simple to calculate and is useful when exact ages are difficult to determine. Low weight-for-height can be used as a screening or targeting indicator, for example to identify infants/children who need supplementary or therapeutic food and/or treatment for diseases, particularly diarrhea. In emergency settings, weight-for-height is a useful indicator for screening and surveillance. In humanitarian assistance activities, wasting or thinness in children aged 6-59 months, combined with nutritional edema, is an indicator of acute malnutrition and should be used to reflect the overall severity of a crisis. Percentage of the reference median should be reported as well, as it is used as an entry criterion for feeding programs.
The main limitation of this indicator is that weight and height can be difficult to obtain, leading to problems of validity of measurement. The most frequent problems in height measurement are inadequate positioning of the child’s head and feet, a reading done in an oblique position, and not facing the reading point of the measuring board or height-measuring apparatus. If repeated measurements are different from each other, the measurements should be disregarded and the measuring should start again. Enumerator variability in weight measurement can be reduced through good training and supervision.
Because wasting in individual children and population groups can change rapidly, the indicator is responsive to short-term program influences. However, the indicator is also highly susceptible to seasonal variations in food availability so that weight-for-height is not recommended for evaluating change in anthropometric status in non-emergency situations.
Pediatric care, Nutrition, Child health, Morbidity
World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf
World Health Organization. Nutrition Landscape Information System (NLIS). Country Profile Indicators: Interpretation Guide. Geneva, Switzerland; 2010. http://apps.who.int/iris/bitstream/10665/44397/1/9789241599955_eng.pdf
WHO. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD), Geneva, Switzerland. http://www.who.int/nutgrowthdb/en/
Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf
Further information and related links
A draft framework for the global monitoring of the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition. Informal Consultation with Member States and UN Agencies on a Proposed Set of Indicators for the Global Monitoring Framework for Maternal, Infant and Young Child Nutrition, 30 September to 1 October 2013. Geneva: World Health Organization; 2013 (Retrieved from http://www.who.int/nutrition/events/2013_consultation_indicators_globalmonitoringframework_WHO_MIYCN.pdf).
Countdown to 2015 decade report (2000−2010): taking stock of maternal, newborn and child survival. Geneva and New York (NY): World Health Organization/United Nations Children’s Fund; 2010 (Retrieved from http://www.countdown2015mnch.org/reports-and-articles/previous-reports/2010-decadereport).
de Onis M, Blössner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Int J Epidemiol 2003;32(4):518-26.
Decision WHA67(9). Maternal, infant and young child nutrition. In: Sixty-seventh World Health Assembly, Geneva, 19-24 May 2014. Resolutions and decisions, annexes. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA67-REC1/A67_2014_REC1-en.pdf, page 62).
Document A67/15. Maternal, infant and young child nutrition. The Global Strategy and the Comprehensive Implementation Plan. Report by the Secretariat. Sixty-seventh World Health Assembly, Geneva, 19–24 May 2014. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_15-en.pdf).
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization; 1995 (WHO Technical Report Series, No. 854).
WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006 (Retrieved from http://www.who.int/childgrowth/standards/technical_report/en/).
World health statistics 2014. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1).
