OBJECTIVE: The growth of Malawian preschool children from different socioeconomic groups was examined to determine the relevance of the NCHS/WHO growth reference data for assessing child nutritional status in Malawi. DESIGN: The study involved a comparison of anthropometric data from three cross-sectional surveys of preschool children over 24 months of age. SETTING: Malawi, Central Africa. SUBJECTS: Anthropometric measurements were taken on high income Malawian children (n = 380) during a census of affluent preschools in the country's three major urban centres. Comparative data were obtained from two existing sample surveys of low income urban children (n = 225) and rural village children (n = 667). RESULTS: The distribution of weight-for-age Z-scores (HAZ) for the high income children 24-35 months of age closely resembled the NCHS/WHO child reference population (mean HAZ = -0.21; SD = 1.05). After this age HAZ decreased to a mean value of -0.58 between 60 and 71 months. Large differences in growth were observed between children from different socioeconomic groups. Regression analysis showed that at 24 months the high income children were, on average, 6.6 cm taller than the low income urban children (P < 0.001), and 9.2 cm taller than the rural children (P < 0.001). By 59 months of age these differences increased to 9.6 cm and 11.1 cm, respectively. CONCLUSIONS: Although some questions remain regarding the growth potential of Malawian children, the results suggest the NCHS/WHO reference data are relevant for Malawi and the high levels of child stunting found in the country are due to environmental not genetic factors.
OBJECTIVE: The growth of Malawian preschool children from different socioeconomic groups was examined to determine the relevance of the NCHS/WHO growth reference data for assessing child nutritional status in Malawi. DESIGN: The study involved a comparison of anthropometric data from three cross-sectional surveys of preschool children over 24 months of age. SETTING: Malawi, Central Africa. SUBJECTS: Anthropometric measurements were taken on high income Malawian children (n = 380) during a census of affluent preschools in the country's three major urban centres. Comparative data were obtained from two existing sample surveys of low income urban children (n = 225) and rural village children (n = 667). RESULTS: The distribution of weight-for-age Z-scores (HAZ) for the high income children 24-35 months of age closely resembled the NCHS/WHO child reference population (mean HAZ = -0.21; SD = 1.05). After this age HAZ decreased to a mean value of -0.58 between 60 and 71 months. Large differences in growth were observed between children from different socioeconomic groups. Regression analysis showed that at 24 months the high income children were, on average, 6.6 cm taller than the low income urban children (P < 0.001), and 9.2 cm taller than the rural children (P < 0.001). By 59 months of age these differences increased to 9.6 cm and 11.1 cm, respectively. CONCLUSIONS: Although some questions remain regarding the growth potential of Malawian children, the results suggest the NCHS/WHO reference data are relevant for Malawi and the high levels of child stunting found in the country are due to environmental not genetic factors.