Page 34 - nhms2016 maternal and child findings

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National Health And Morbidity Survey 2016 : Maternal And Child Health (MCH) Volume II : Findings

5.2. NUTRITIONAL STATUS OF CHILDREN (AGE < 5 YEARS OLD)

5.2.1. Introduction

Nutritional status is one of the important indicators of overall health status in children and may have
a long-term health impact in their future life. Malnutrition is defined as failure of the body to obtain
appropriate amount of energy and nutrients in order to maintain healthy tissues and organ function.
While malnutrition in the form of wasting, stunting, and underweight can result from an inadequate
intake of energy and nutrient intakes, overweight and obesity problems are a result of excessive
1
energy intake (WHO, 1997).
There are four nutrition indices used to define nutritional status of children as measured through
anthropometric measurements (body weight and height), namely weight-for-age, height-for-age, body
mass index (BMI)-for-age and weight-for-height. Weight-for-age of the children reflects both acute and
chronic malnutrition of the children, whereas height-for-age of the children is a measure of linear
growth, in which reflects chronic malnutrition due to insufficient nutrition over a long-term period and
recurrent or chronic illness. As for BMI-for-age, it provides a good indicator for levels of body fat, and
it is associated with an increased risk of non-communicable chronic diseases during childhood as well
3
as later in life. Based on WHO Growth Standard (2006) for children under 5 years old, weight-for-
age <-2SD is classified as underweight, height-for-age <-2SD is classified as stunted, and BMI-for-
age <-2SD is classified as thinness while BMI-for- age >2SD is classified as overweight. In addition,
weight-for- height is an index used for assessing wasting, which reflects a recent and severe process
of weight loss due to acute starvation or severe disease. It is the best indicator that reflects level of
acute malnutrition in children and is defined by weight-for-height <-2SD according to WHO Growth
Standard (2006). 2

5.2.2. Findings

5.2.2.1. Nutritional status by weight for age

In terms of weight-for-age status, the findings showed that 84.7% (95% CI: 83.47-85.80) of children
were in the normal range weight-for-age: > -2SD to ≤ +2SD). Meanwhile, 13.7% (95% CI: 12.60-
14.85) of Malaysian children were underweight (Weight-for-age: < -2SD). Comparing the sexes, more
males (14.9%) were underweight than females (12.4%). By age groups, the highest prevalence was
found among children aged 6-11 months [17.3% (95% CI: 11.34-25.61)] and the lowest was among
children aged 36-47 months [11.5% (95% CI: 9.61-13.74)]. Based on ethnicity of the child, those from
‘Other Ethnicities’ showed the highest total prevalence of underweight [21.7% (95% CI: 15.25-29.87)],
followed by Other Bumiputeras [17.5% (95% CI: 14.62-20.84)], and Indians [15.3% (95% CI: 9.91-
22.94)].

The prevalence of overweight (Weight-for-age: >+2SD) among Malaysian children below 5 years
was 1.6% (95% CI: 1.33-2.03). Males showed a higher prevalence of overweight [1.8% (95% CI:
1.38-2.30)] compared to females [1.5% (95% CI: 1.05-2.13)]. By age groups, the highest prevalence
of overweight was among children aged 36-47 months [2.6% (95% CI: 1.90-3.53)], followed by
children aged 48-59 months [2.5% (95% CI: 1.77-3.48)]. Based on ethnicity of the child, Indians
showed the highest number of overweight children [5.5% (95% CI: 2.77-10.66)], followed by ‘Other
Ethnicities’ [1.9% (95% CI: 0.62-5.44)], and Other Bumiputeras [1.6% (95% CI: 0.85-2.94)] (Table
5.2.2.2).

2. The Dietary Reference Intake (DRI), Institute of Medicine (IOM) of the National Academies, United States, 1997
3. WHO Child Growth Standards: Methods and development: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass
index-for-age, World Health Organization, Switzerland, 2006