The Composite Index of Anthropometric Failure (CIAF): An Alternative Indicator for Malnutrition in Young Children



Malnutrition is a serious problem in many developing countries. It is one of the main causes of child morbidity and contributes significantly to premature mortality. This chapter discusses the design and use of an alternative indicator of malnutrition – the composite index of anthropometric failure (CIAF). It argues the three most commonly used anthropometric indicators of stunting, wasting and underweight, while providing valuable information about distinct biological processes, are individually unable to provide a comprehensive picture of the overall burden of malnutrition among young children in a population. They are frequently used to predict health and mortality risk, but provide quite limited information on the relationship between malnutrition and disease. The CIAF, however, can also be used to predict morbidity risk, and in its disaggregated form provides a more useful picture of the relationship between ill health and malnutrition. It can also be used to examine the relationship between different forms of malnutrition and poverty. Using the new World Health Organization (WHO) reference population norms and recent anthropometric data on 45,377 Indian children aged under 5 years, the prevalence of stunting, wasting and underweight are calculated and compared to prevalence estimates by the CIAF. Age adjusted logistic regression is used to see how well different indicators predict morbidity risk. Analysis of variance is used to see the relationship between groups of anthropometric failure and poverty. This chapter also provides information on how reliable, nationally representative anthropometric data from household surveys can be freely accessed by researchers to pursue their own study.


Celiac Disease Acute Respiratory Infection Anthropometric Data Acute Malnutrition Household Survey Data 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Acute Respiratory Infection


Composite Index of Anthropometric Failure


Demographic and Health Survey


Height for Age


Living Standards Measurement Study


Millennium Development Goals


Multiple Indicator Cluster Surveys


National Center for Health Statistics


National Family Health Survey


Pan Arab Project for Family Health


United Nations Children’s Fund


World Health Organization


Weight for Age


Weight for Height


  1. ACC/SCN. Nutrition and poverty: papers from the ACC/SCN 24th session symposium, Kathmandu. Geneva, United Nations Administrative Committee on Coordination (ACC), Sub-Committee on Nutrition (SCN), World Health Organization; 1997.Google Scholar
  2. Baschieri A, Falkingham J. Child poverty in Tajikistan: report for the UNICEF Country Office. Southampton, UK: University of Southampton; 2007.Google Scholar
  3. Caulfield LE, de Onis M, Blossner M, Black RE. Am J Clin Nutr. 2004;80:193–8.PubMedGoogle Scholar
  4. Cunha A. Acta Paediatrica. 2000;89:608–9.PubMedCrossRefGoogle Scholar
  5. Eveleth P, Tanner J. Worldwide variations in human growth. Cambridge: Cambridge University Press; 1990.Google Scholar
  6. Falkingham J, Namazie C. Measuring health and poverty: a review of approaches to identifying the poor. London: DFID Health Systems Resource Centre; 2002.Google Scholar
  7. Fernald LC, Neufeld LM. Eur J Clin Nutr. 2007;61:623–32.PubMedGoogle Scholar
  8. Filmer D, Pritchett LH. Demography. 2001;38:115–32.PubMedGoogle Scholar
  9. Gordon D, Nandy S, Pantazis C, Pemberton S, Townsend P. Child poverty in the developing world. Bristol, UK: Policy; 2003.Google Scholar
  10. Howe L, Hargreaves JR, Huttly SRA. Emerg Themes Epidemiol. 2008;5.Google Scholar
  11. IIPS & Macro International. National Family Health Survey (NFHS-3) 2005–06: India: Volume 1. Mumbai, India: International Institute for Population Sciences (IIPS); 2007.Google Scholar
  12. Montgomery M, Gragnolati M, Burke K, Paredes E. Demography. 2000;37:155–74.PubMedCrossRefGoogle Scholar
  13. Nandy S, Miranda JJ. Soc Sci Med. 2008 66:1963–6.PubMedCrossRefGoogle Scholar
  14. Nandy S, Irving M, Gordon D, Subramanian SV, Davey-Smith G. Bull World Health Org. 2005;83:210–6.PubMedGoogle Scholar
  15. Rice A, Sacco L, Hyder A, Black R. Bull WHO. 2000;78:1207–21.PubMedGoogle Scholar
  16. Schroeder D, Brown K. Bull World Health Org. 72:569–79.Google Scholar
  17. Seetharaman N, Chacko TV, Shankar SLR, Matthew AC. Indian J Comm Med. 2007;32.Google Scholar
  18. Smith TA, Lehmann D, Coakley C, Spooner V, MP A. Am J Clin Nutr. 1991;53:963–70.PubMedGoogle Scholar
  19. Svedberg P. Poverty and undernutrition: theory, measurement and policy. Oxford: Oxford University Press; 2000.Google Scholar
  20. Svedberg P. Can indicators of child malnutrition be improved – and for what purposes? Taking action for the world’s poor and hungry people. Beijing, China; 2007.Google Scholar
  21. Tomkins A, Watson F. Malnutrition and infection; a review. Geneva: World Health Organization/ACC/SCN; 1989.Google Scholar
  22. UNPOP. World population prospects: the 2008 revision. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat; 2008.Google Scholar
  23. Vaessen M. In: Khlat M, editor. Demographic evaluation of health programmes – proceedings of a seminar in Paris. Paris: CICRED, UNFPA; 1996.Google Scholar
  24. Wagstaff A, Watanabe N. Socio-economic inequalities in child malnutrition in the developing world. World Bank Policy Research Working Papers. Washington DC; 2000.Google Scholar
  25. WHO/CDR. Household survey manual: diarrhoea and acute respiratory infections. Geneva: WHO; 1994.Google Scholar
  26. World Health Organization. Expert Committee on Nutrition and Physical Status: uses and interpretation of anthropometry. Geneva: World Health Organization; 1995.Google Scholar
  27. World Health Organization Multicentre Growth Reference Study Group. 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.Google Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.School for Policy StudiesUniversity of BristolBristolUK

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