WASH’ Nutrition

Chronic undernutrition or stunting is indicated by a low height-for-age (HFA). As opposed to acute undernutrition which
reflects recent nutritional status, chronic undernutrition is a process occurring over longer term in the period between
conception and 24 months of age. It is a consequence of prolonged or repeated episodes of nutritional deficiencies (energy
or micronutrients) and can also reflect exposure to repeated infection or other illnesses throughout the early years of life,
compromising the growth of a child. 5
Underweight is a composite form of undernutrition defined by a low weight-for-age (WFA) when compared to the WHO
growth standards. Underweight is easier to measure than weight-for-height or height for age because it doesn’t require a
height measurement, but it is generally considered inferior to the measures above as it doesn’t indicate if a child is wasted or
stunted.
Micronutrient deficiencies, also known as “hidden-hunger”, occur when the body does not have sufficient amounts of vitamin
or mineral due to insufficient dietary intake and/or insufficient absorption and/or suboptimal utilization of the vitamin or
mineral. WHO ranks deficiencies of zinc, iron and vitamin A in the top 10 causes of the disease burden in developing countries.
Micronutrient deficiencies affect the survival, health, development and well-being of those affected. 6
All forms of undernutrition can and should be prevented.
Table 1: Cut-off values and anthropometric indicators of undernutrition
Anthropometric indicators used to measure child growth and nutritional status
Prevalence cut-off
values of public health
significance
ACUTE
UNDERNUTRITION
SAM
MAM
WFH indicator < -3 Z-scores of the WHO Growth standards
and/or MUAC below 115 mm and/or presence of edema
WFH Z-score < -2 but > -3
115 mm ≤ MUAC < 125 mm without edema
Refers to GAM 7 :
< 5%: Acceptable
5-9%: Medium
10-14%: High
≥ 15%: Very high
*SHPERE standard for
emergencies: SAM >2%
STUNTING
Severe
Moderate
HFA indicator < - 3 Z-scores of the WHO Growth standards
HFA indicator < - 2 Z-scores of the WHO Growth standards
< 20%: Low
20-29%: Medium
30-39%: High
≥ 40%: Very high
< 10%: Low
UNDERWEIGHT
WFA indicator < -2 Z-scores of the WHO standards
10-19%: Medium
20-29%: High
≥ 30%: Very high
Micronutrient
deficiencies
Usually measure through biomarkers, which requires taking a
blood and/or urine sample
Depends on a deficient
mineral/vitamin
Adapted from: WHO (2010) “Nutrition Landscape Information System”
5 - Ibid
6 - Ibid
7 - Global Acute Malnutrition (GAM) is the sum of the prevalence of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) at a population level
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WASH’Nutrition
A practical guidebook