Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

international reference population because of the prescriptive, rather than descriptive, nature of the
WHO Child Growth Standards versus the NCHS/CDC/WHO international reference population. The
WHO Child Growth Standards identify the breastfed child as the normative model for growth and
development, and they document how children should grow under optimum conditions and infant
feeding and child health practices.
The use of the WHO Child Growth Standards is based on the finding that well-nourished
children of all population groups for which data exist follow very similar growth patterns before
puberty. The internationally based standard population serves as a point of comparison, facilitating the
examination of differences in the anthropometric status of subgroups in a population and of changes
in nutritional status over time.
For the purposes of comparison with previous surveys, indices are expressed in standard
deviation units (SD) from the median of the NCHS/CDC/WHO international reference population,
which was in use prior to the new WHO Child Growth Standards.
Each of the three nutritional status indicators is expressed in standard deviation units
(z-scores) from the median of the reference population. In any large population, there is variation in
height and weight; this variation approximates a normal distribution. The three indices—height-forage,
weight-for-height, and weight-for-age—provide different information about growth and body
composition, which can be used to assess nutritional status. The height-for-age index indicates linear
growth retardation and cumulative growth deficits. Children whose height-for-age z-score is below
minus two standard deviations (-2 SD) from the median of the reference population are considered
short for their age (stunted) and chronically malnourished. Children who are below minus three
standard deviations (-3 SD) from the median of the reference population are considered severely
stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and is
worsened by recurrent and chronic illness. Height-for-age, therefore, represents the long-term effects
of malnutrition in a population and does not vary according to recent dietary intake.
The weight-for-height index measures body mass in relation to body length and describes
current nutritional status. Children whose z-scores are below minus two standard deviations (-2 SD)
from the median of the reference population are considered to be thin for their height (wasted) and
acutely malnourished. Wasting represents failure to receive adequate nutrition in the period
immediately preceding the survey and may be the result of inadequate food intake during a recent
episode of illness, causing loss of weight and the onset of malnutrition. Children whose weight-forheight
is below minus three standard deviations (-3 SD) from the median of the reference population
are considered severely wasted. Children whose weight-for-height is above two standard deviations
(+2 SD) from the median reference population are considered to be overweight.
Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into
account both acute and chronic malnutrition. Children whose weight-for-age is below minus two
standard deviations (-2 SD) from the median of the reference population are classified as underweight.
Children whose weight-for-age is below minus three standard deviations (-3 SD) from the median of
the reference population are considered severely underweight.
Height and weight data were collected from the sampled household population in Timor-
Leste. A total of 9,989 children under age 5 were identified in the households. Information on height
or weight was missing for 3 percent of children who were not present and for 8 percent who refused to
be measured. The final analysis of nutritional status is based on the remaining 8,171 1 children (88
percent). The results are shown in Table 12.1.
1 These are unweighted numbers.
148 | Nutrition of Children and Women