Using the WHO 2006 child growth standard to assess the growth and nutritional status of rural south Indian infants

Background: The WHO 2006 child growth standard is advocated in India, although the conformity of the growth of Indian infants to the WHO standard has only been assessed at cross-sectional points. Aim: To assess the implications of using the WHO standard in rural India and to investigate the factors responsible for any departure from optimal growth, as shown in the WHO standard. Subjects and methods: Mixed-effects models were applied to serial weight and length data from 384 rural south Indian infants. Unadjusted and adjusted (for, among other things, breastfeeding and maternal education) estimates were converted to Z-scores and the risks of underweight, wasting and stunting using the WHO standard compared to the NCHS 1977 child growth reference were calculated. Results: Weight growth was more similar to the WHO standard than the NCHS reference and in late infancy the WHO standard was less likely to classify underweight (RR at 15 months = 0.45; 95% CI = 0.31-0.65). Adjusting the serial data shifted the curves 0.25 Z-scores closer to the median of either chart; variations in household socioeconomic status and morbidity were largely responsible for this shift. Conclusion: In late infancy, the WHO standard will allow a more focused intervention effort and use of resources for targeting programmes at infants most at risk of malnutrition.