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Year : 2012  |  Volume : 56  |  Issue : 4  |  Page : 305-307  

Assessment of nutritional status by composite index for anthropometric failure: A study among slum children in Bankura, West Bengal

1 MBBS Student, Department of Community Medicine, B.S. Medical College, Bankura, West Bengal, India
2 Assistant Professor, Department of Community Medicine, B.S. Medical College, Bankura, West Bengal, India
3 Professor, Department of Community Medicine, B.S. Medical College, Bankura, West Bengal, India
4 Director, Institute of Health and Family Welfare, Kolkata, West Bengal, India

Date of Web Publication24-Jan-2013

Correspondence Address:
Subhadeep Shit
Bhairabpally, Kenduadihi, Bankura-722102
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-557X.106421

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A community-based cross-sectional study was conducted to find out the prevalence of composite index of anthropometric failure (CIAF) among 117 slum dwelling under-five children in Bankura town, West Bengal and its relation with some common socio-economic factors. Among study population, the prevalence of underweight was 41.6%, whereas CIAF was 80.3%. CIAF gave a near complete estimation of undernutrition unlike underweight. Children who were unimmunized, with more number of siblings, living in a nuclear family, or with illiterate mothers were more likely to be undernourished.

Keywords: Composite index of anthropometric failure, Slum, Undernutrition, Underfives

How to cite this article:
Shit S, Taraphdar P, Mukhopadhyay DK, Sinhababu A, Biswas AB. Assessment of nutritional status by composite index for anthropometric failure: A study among slum children in Bankura, West Bengal. Indian J Public Health 2012;56:305-7

How to cite this URL:
Shit S, Taraphdar P, Mukhopadhyay DK, Sinhababu A, Biswas AB. Assessment of nutritional status by composite index for anthropometric failure: A study among slum children in Bankura, West Bengal. Indian J Public Health [serial online] 2012 [cited 2020 Sep 26];56:305-7. Available from:

India has the highest proportion of undernourished children in the world. [1] According to National Family Health Survey-3 (NFHS-3) the prevalence of stunting, wasting, and underweight among under-3 children in West Bengal is 41.8%, 19.2%, and 37.6%, respectively. [2] These conventional indices reflect distinct biological process.Individually they cannot measure the overall prevalence of undernutrition, as they overlap,that is, a child may have underweight along with stunting and/or wasting. To consider all undernourished children a new aggregate indicator called CIAF has been proposed by Svedberg. [3] This model, further modified by Nandyet al., counts all children with wasting and/or stunting and/or underweight sub-grouped in six different categories (Group B-F and Y) and excludes children with no anthropometric failure (Group A). [4] Group B, F, and Y consisted of children with only wasting, stunting, and underweight, respectively, while group C, D, and E composed of children with multiple anthropometric failures. In this context, the present study was undertaken among under-five children in Patpur slums of Bankura town, to find out the prevalence of CIAF and to compare it with the conventional weight-for-age (WAZ) criteria for measuring under-nutrition, as well as to identify some of the socio-economic factors related to under-nutrition.

A cross sectional study was conducted among under-five children in four slums under the urban field practice area of BankuraSammilani Medical College, Bankura during June and July 2010. Considering the prevalence of CIAF [4] as 59.8%, 15% relative precision, 95% confidence level, and 5% nonresponse rate, the sample size became 121. From a list of all children (n= 277) living in the slum areas, 121 under-five children were selected through simple random sampling. Height and weight of under-five children whose parents were permanent residents of the study area were measured at their houses using standard procedure by the first author under the guidance of the faculty members of Community Medicine and their nutritional status was expressed in Z score for WAZ height/length-for-age [H(L)AZ], and weight-for-height/length [WH(L)Z] as per WHO international growth standards 2006. [5],[6] Age of the child was recorded in completed months and ascertained from documentary evidences like birth certificate, hospital discharge certificate, immunization cards, or by interviewing the mother with the help of a local events calendar, in the same order of preference. Immunization status was elicited on the basis of immunization cards and classified as fully immunized/partially immunized/unimmunized. Mothers or responsible caregivers of the study children were interviewed to collect information regarding type of family, literacy status of mother, economic status of the family, above poverty line (APL) or below poverty line (BPL), based on BPL card holding) and number of siblings using a predesigned semi-structured questionnaire after taking informed consent. Proportions were calculated for prevalence. The study obtained approval for Institutional Ethics Committee, B.S. Medical College, Bankura.

Mothers/responsible care givers of four children were either absent during the study or not willing to participate. Finally, 117 children were included in the present study. Among the study population 55.6% were males. [Table 1] reveals that more than 80% children had some form of anthropometric failure, whereas less than half were underweight. Nearly one-third of the children belonged to group F with both stunting and wasting and one-fourth of children were stunted and underweight (Group E). In all age group CIAF would diagnose 30% more children as undernourished compared with weight for age criteria. A total of 44 (37.6%) children in the study had single anthropometric failure (Group B, F, and Y), whereas 50 (42.7%) children had multiple anthropometric failures (Group C, D, and E).
Table1: Distribution of study population by CIAF (n = 117)

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Prevalence of anthropometric failure [Table 2] was similar in both APL and BPL families, but was higher in nuclear families compared with joint families. Children of literate mothers (68.5%) were less likely to have anthropometric failure than children of illiterate (92.3%) and just literate mothers (89.2%). A much higher proportion of anthropometric failure was found among children with three or more siblings (90%) compared with those with one (71.4%) and two (83.6%). All children who were unimmunized or partially immunized were in a state of anthropometric failure compared with 80.2% children who were fully immunized. Only, literacy was associated significantly (P < 0.05) with no anthropometric failure.
Table 2: Distribution of children by anthropometric failure and study variables (n = 117)

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The prevalence of CIAF in the study was higher compared with studies done in urban Coimbatore and rural West Bengal. [7],[8],[9] The study conducted by Mukhopadhyay et al., found a higher prevalence of undernourished children in families with lower monthly income. [8] However, the present study showed no difference of undernutrition among children of APL and BPL families. Lack of maternal education and poor child rearing practices among both APL and BPL families in the slum may have masked the effect of income in the present study. The prevalence of undernutrition, in another study also was found more in nuclear families, which corroborated the present study. [8] This may be due to the fact that better care of the child taken by larger number of members in a joint family reduces the chances of undernutrition.

Literacy status of mothers appeared to be an important factor affecting the prevalence of CIAF as in other studies. [8],[10] Association between anthropometric failure and more number of siblings was reported in an earlier study. [8] Partially immunized or unimmunized children are more prone to undernutrition was also corroborated in another study where 94.8% unimmunized or partially immunized children were undernourished compared with 53.1% in completely immunized children.

In spite of certain conceptual limitation, [11] CIAF gives a near complete picture of undernutrition as well as it helps in prioritizing undernourished children, as multiple anthropometric failures were related with greater childhood morbidity. [4] ICDS scheme uses WAZ criteria for prioritizing children for supplementary nutrition. It gives an underestimation of undernourished children and misses a considerable portion of vulnerable children having multiple anthropometric failures without being underweight. Community-based, interventional study may be undertaken to assess the feasibility of using this index by the community health and nutrition workers in India.

   References Top

1.UNICEF. The State of World's Children report, 2003. New York: UNICEF;2003.  Back to cited text no. 1
2.International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), Mumbai, India: IIPS; 2007.  Back to cited text no. 2
3.Svedberg P. Poverty and under-nutrition: Theory measurement and policy. New Delhi: Oxford India Paper backs; 2000.  Back to cited text no. 3
4.Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD. Poverty, child under-nutrition and morbidity: New evidence from India. Bull World Health Organ 2005;83:210-6.  Back to cited text no. 4
5.WHO. Physical Status: The use and interpretation of anthropometry- Report of WHO Expert Committee. WHO Technical Report Series-854. Geneva, Switzerland: World Health Organization; 1995.  Back to cited text no. 5
6.W.H.O. Multicenter Growth Reference Study Group. W.H.O. 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.  Back to cited text no. 6
7.Seetharaman N, Chaco TV, Shankar SL, Mathew AC. Measuring Malnutrition- The Role of Z-Scores and the Composite Index of anthropometric failure (CIAF). Indian J Community Med 2007;32:35-9.  Back to cited text no. 7
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8.Mukhopadhyay DK, Biswas R, Chakravorty M, Sadhukhan SK, Bonik KK. Anthropometric Failure, a new approach to measure under nutrition: An experience from a rural community of West Bengal, India. J Indian Med Assoc 2009;107:211-36.  Back to cited text no. 8
9.Mandal GC, Bose K. Assessment of overall prevalence of under nutrition using Composite Index of Anthropometric Failure (CIAF) among preschool children of West Bengal, India. Indian J Pediatr 2009;19:237-24.  Back to cited text no. 9
10.Ray SK, Biswas AB, Das Gupta S, Mukherjee D.- Rapid Assessment of Nutritional Status and Dietary pattern in Municipal area. Indian J Community Med 2000;25:14-8.  Back to cited text no. 10
  Medknow Journal  
11.Bhattacharyya AK. Composite Index of Anthropometric Failure (CIAF) classification: Is it more useful? Bull World Health Organ 2006;84:335.  Back to cited text no. 11


  [Table 1], [Table 2]

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