Percentage of children under 5 years of age, by nutritional status:
1) Stunted.
2) Wasted and overweight.
3) Underweight and overweight for age.
4) Mean z-score for height-for-age, weight-for-height, and weight-for-age.
Coverage:
Population base: Living children born 0-59 months before the survey (PR file)
Time period: Current status at time of survey
Numerators:
Stunting:
1) Severely stunted: Number of children age 0-59 months whose height-for-age z-score is below minus 3 (‑3.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc70 < ‑300)
2) Moderately or severely stunted: Number of children age 0-59 months whose height-for-age z-score is below minus 2 (‑2.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc70 < -200)
3) Mean z-score for height-for-age: Sum of the z-scores of children age 0-59 months with a non-flagged height for age score (∑ hc70/100, if hc70 < 9990)
Wasting and overweight:
4) Severely wasted: Number of children age 0-59 months whose weight-for-height z-score is below minus 3 (‑3.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc72 < ‑300)
5) Moderately or severely wasted: Number of children age 0-59 months whose weight-for-height z-score is below minus 2 (‑2.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc72 < -200)
6) Overweight: Number of children age 0-59 months whose weight-for-height z-score is above plus 2 (+2.0) standard deviations (SD) above the median on the WHO Child Growth Standards (hc72 > 200 & hc72 < 9990)
7) Mean z-score for weight for height: Sum of the z-scores of children age 0-59 months with a non-flagged weight for height score (∑ hc72/100, if hc72 < 9990)
Underweight and overweight for age:
8) Severely underweight: Number of children age 0-59 months whose weight-for-age z-score is below minus 3 (‑3.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc71 < -300)
9) Moderately underweight: Number of children age 0-59 months whose weight-for-age z-score is below minus 2 (‑2.0) standard deviations (SD) below the median on the WHO Child Growth Standards (hc71 < ‑200)
10) Overweight for age: Number of children whose weight-for-age z-score is above plus 2 (+2.0) standard deviations (SD) above the mean on the WHO Child Growth Standards (hc71 > 200 & hc71 < 9990) (legacy indicator)
11) Mean z-score for weight for age: Sum of the z-scores of children age 0-59 months with a non-flagged weight for age score (∑ hc71/100, if hc71 < 9990)
Denominators:
Number of de facto living children between ages 0 and 59 months before the survey (hv103 = 1 & hc1 in 0:59) who have:
a) Stunting: valid non-flagged height for age z-scores (hc70 < 9990)
b) Wasting and overweight: valid non-flagged weight for height z-scores (hc72 < 9990)
c) Underweight and overweight for age: valid non-flagged weight for age z-scores (hc71 < 9990)
Variables: PR file.
|
hv103 |
Slept last night |
|
hc1 |
Child's age in months |
|
hc70 |
Height/Age standard deviation (new WHO) |
|
hc71 |
Weight/Age standard deviation (new WHO) |
|
hc72 |
Weight/Height standard deviation (new WHO) |
The assignment of anthropometric z-scores based on the WHO Child Growth Standards is done through a complicated interpolation function that takes into account sex, age (measured by difference in date of birth and date of interview, both precise to day of month), height in centimeters, and weight in kilograms (precise to 100 grams). As part of the creation of a recode file, variables with the z-scores are calculated and included in that file. The z-scores are calculated using software based on the WHO Anthro program and the macros for statistical packages at http://www.who.int/childgrowth/software/en/.
If the WHO Anthro program or the WHO igrowup macros are used to recalculate z-scores, then exclude cases without a month and year of birth recorded (hc33>1). Additionally, when the data are collected the weight variable includes two decimal places for weight (e.g. 10.65). This is rounded in the recode file to one decimal (variable hc2) (e.g. 10.7) and so recalculated z-scores may differ slightly.
In the process of assigning the z-scores, checks are made on their plausibility. Z-scores for height-for-age and weight-for-age are assigned special values to children with incomplete date of birth (month or year missing or “don’t know”) as the z-scores are sensitive to changes in age. Children with height-for-age z-scores below -6 SD or above +6 SD, with weight-for-age z-scores below -6 SD or above +5 SD, or with weight for height z-scores below -5 SD or above +5 SD are flagged as having invalid data.
The percentage of children stunted, wasted, and underweight are equal to the specific numerator divided by the appropriate denominator, multiplied by 100.
The mean z-scores are equal to the numerator divided by the appropriate denominator.
Children who were not weighed and measured and children whose values for weight and height were not recorded are excluded from both the denominators and the numerators. Children whose month or year of birth are missing or unknown are flagged and excluded from both the denominators and the numerators for anthropometry indices that use age in the calculation (i.e. height-for-age and weight-for-age). Children whose day of birth is missing or unknown are randomly assigned a day of birth. In DHS-VI and earlier rounds, children were assigned day 15. Children who are flagged for out-of-range z-scores or invalid z-scores are excluded from both the denominator and the numerators.
Stunting, based on a child’s height and age, is a measure of growth faltering. Wasting, based on a child’s weight and height, is a measure of acute undernutrition. Underweight, based on weight and age, is a composite measure of wasting and stunting. Overweight, based on weight and height, is a measure of excess weight than is optimally healthy.
The World Health Organization (WHO) released an international growth standard statistical distribution in 2006, which describes the growth of children ages 0 to 59 months living in environments believed to support optimal growth of children in six countries throughout the world, including the U.S. The distribution shows how infants and young children grow under these conditions, rather than how they grow in environments that may not support optimal growth. The WHO Child Growth Standards (WHO, 2006) have replaced the NCHS/CDC/WHO international reference standard as the standard for assessing the nutritional status of children.
Due to natural variations in a well-nourished population, 2.2 percent of children will be between ‑2.0 and ‑2.99 SD below the mean, and 0.1 percent will be ‑3.0 or more SD below the mean. The extent of malnutrition in a population should be taken by the extent the proportions moderate and severe exceed these percentages that occur in a well-fed population of children.
In phases of the DHS survey before DHS-IV, only children of interviewed women and who were under 5 years old (or the cutoff for the health section of the individual questionnaire) were weighed and measured. In many surveys, only a subsample of these children were selected for anthropometry.
The later DHS surveys (DHS-V onwards) included height and weight measurements of all children born in the 5 years preceding the survey and listed in the Household Questionnaire, irrespective of the interview status of their mother.
The levels of stunting, wasting, and underweight since DHS-VI are calculated using the 2006 WHO Child Growth Standards. In earlier surveys the NCHS/CDC/WHO international reference standard was used, and results published in the earlier survey reports will differ from those using the newer standard. In order to assess trends in nutritional status, the earlier DHS nutrition indicators should be re-calculated using the 2006 WHO Child Growth Standards. The recalculated variables hc70-hc73 are available in the HW files (see Chapter 1 under Organization of Data, Recode Files) for the older surveys, and can be merged with the KR file (for the oldest surveys) or the PR file (for later surveys prior to DHS-VI).
Prior to DHS-7 if any of the three sets of z-scores (height-for-age, weight-for-height, and weight-for-age) was flagged for a child, all were considered flagged and excluded from the numerators and denominators of the indicators. In DHS-7 this was changed so that there is a separate denominator for indicators based on height-for-age, weight-for-height and weight-for-age.
Prior to DHS-7, children whose day of birth was missing or recorded as “don’t know” were assigned 15 as the day of birth. In DHS-7 and later rounds, the day of birth of the child was randomly imputed.
The overweight for age indicator (weight-for-age z-score is above +2.0 SD) is no longer included in the DHS-8 tabulation plan. All comparisons between surveys, either over time or between countries, should take into account the possible differences in the defined population base and in the reference standard used.
Assaf, S., M.T. Kothari, and T. Pullum. 2015. An Assessment of the Quality of DHS Anthropometric Data. In DHS Methodological Reports No. 16. Rockville, Maryland, USA: ICF International. https://dhsprogram.com/publications/publication-mr16-methodological-reports.cfm
Black, R.E., et al. 2013. “Maternal and child undernutrition and overweight in low-income and middle-income countries.” The Lancet 382(9890):427-451. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60937-X/fulltext
Corsi, D. J., J. M. Perkins, and S.V. Subramanian. 2017. “Child Anthropometry Data Quality from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition Surveys in the West Central Africa Region: Are We Comparing Apples and Oranges?” Glob Health Action 10(1):1328185. https://www.tandfonline.com/doi/full/10.1080/16549716.2017.1328185
Mei, Z., and L.M. Grummer-Strawn. "Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis." Bulletin of the World Health Organization 85 (2007): 441-448.
https://iris.who.int/bitstream/handle/10665/269967/PMC2636355.pdf?sequence=1&isAllowed=y
Roth, D.E., A. Krishna, M. Leung, J. Shi, D.G Bassani, A.J.D. Barros. 2017.
“Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015).” The Lancet Global Health 5, no. 12 (2017): e1249-e1257
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30418-7/fulltext
Stevens G.A., M.M. Finucane, C.J. Paciorek, S.R. Flaxman, R.A. White, A.J. Donner A.J., M. Ezzati; Nutrition Impact Model Study Group (Child Growth). 2012. “Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data.” Lancet. 380(9844): p824-34. doi: 10.1016/S0140-6736(12)60647-3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60647-3/fulltext
United Nations Department of Technical Co-operation for Development and Statistical Office. 1986. How to weigh and measure children: Assessing the nutritional status of young children in household surveys. United Nations, New York.
https://unstats.un.org/unsd/publication/unint/dp_un_int_81_041_6E.pdf
WHO. 2017. Global Nutrition Monitoring Framework: Operational Guidance for Tracking Progress in Meeting Targets for 2025. http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/
WHO. 2006. The WHO Child Growth Standards
http://www.who.int/childgrowth/en/ and
WHO/UNICEF. 2019. Recommendations for Data Collection, Analysis and Reporting on Anthropometric Indicators in Children under 5 Years Old. Geneva: WHO.
https://www.who.int/publications/i/item/9789241515559
WHO Anthro program and macros. http://www.who.int/childgrowth/software/en/
DHS-8 Tabulation plan: Table 11.1
API Indicator IDs:
CN_NUTS_C_HA3, CN_NUTS_C_HA2, CN_NUTS_C_HAM, CN_NUTS_C_WH3, CN_NUTS_C_WH2, CN_NUTS_C_WHP, CN_NUTS_C_WHM, CN_NUTS_C_WA3, CN_NUTS_C_WA2, CN_NUTS_C_WAP, CN_NUTS_C_WAM
SDG Indicator 2.2.1: Prevalence of stunting among children under 5 years of age
SDG Indicator 2.2.2: Prevalence of malnutrition among children under 5 years of age, by type (wasting and overweight)
GNMF Indicator 1: Prevalence of low height-for-age in children under five years of age
GNMF Indicator 4: Prevalence of weight-for-height >+2 SD in children under five years of age
GNMF Indicator 6: Prevalence of low weight-for-height in children under five years of age
WHO 100 Core Health Indicators: Children under 5 years who are stunted
WHO 100 Core Health Indicators: Children under 5 years who are wasted
WHO 100 Core Health Indicators: Children under 5 years who are overweight
MICS6 Indicator TC.44: Underweight prevalence
MICS6 Indicator TC.45: Stunting prevalence
MICS6 Indicator TC.46: Wasting prevalence
MICS6 Indicator TC.47: Overweight prevalence
1) Percentage of women age 20-49 with height under 145 cm.
2) Percentage of women age 15-19 who have short stature.
3) Percentage of non-pregnant, non-postpartum women age 20-49 by nutritional status based on specific body mass index (BMI) levels.
4) Percentage of non-pregnant, non-postpartum women age 15-19 by nutritional status based on specific body mass index for age (BMI-for-age) z-score levels.
5) Mean body mass index (BMI) for non-pregnant, non-postpartum women age 20-49.
6) Mean body mass index for age (BMI-for-age) z-score for non-pregnant, non-postpartum women age 15-19.
Coverage:
Population base: (IR file, PR file)
a) Women age 20-49
b) Women age 15-19
c) Non-pregnant and non-postpartum women age 20-49 years at the time of the survey
d) Non-pregnant and non-postpartum women age 15-19 years at the time of the survey
Time period: Current status at time of survey
Numerators:
1) Number of women age 20-49 with height below 145cm (v438 < 1450, if v438 in 1300:2200)
2) Number of women age 15-19 whose height-for-age z-score is below minus 2 (‑2.0) standard deviations (SD) below the median on the WHO Growth Reference (v446a < -200)
3) Number of non-pregnant, non-postpartum women age 20-49 with a body mass index (BMI) with the following values:
a) Normal: 18.5 to 24.9 (v445 in 1850:2499)
b) Total thin: less than 18.5 (v445 in 1200:1849)
c) Mildly thin: 17.0 to 18.4 (v445 in 1700:1849)
d) Moderately and severely thin: less than 17.0 (v445 in 1200:1699)
e) Total overweight or obese (>=25.0) (v445 in 2500:6000)
f) Overweight: 25.0 to 29.9 (v445 in 2500:2999)
g) Obese: 30.0 or more (v445 in 3000:6000)
4) Number of non-pregnant, non-postpartum women age 15-19 with a BMI-for-age z-score with the following values:
a) Normal: between minus 1 (-1.0) standard deviations (SD) and plus 1 (+1.0) SD above the median on the WHO Growth Reference (v446d in -100:100)
b) Total thin: less than less than minus 1 (-1.0) SD below the median on the WHO Growth Reference (v446d < -100)
c) Mildly thin: between minus 1 (-1.0) SD and minus 2 (-2.0) SD below the median on the WHO Growth Reference (v446d in -200:-101)
d) Moderately and severely thin: less than minus 2 (-2.0) SD below the median on the WHO Growth Reference (v446d < -200)
e) Total overweight or obese: greater than plus 1 (1.0) SD above the median on the median on the WHO Growth Reference (v446d > 100)
f) Overweight: between plus 1 (+1.0) SD and plus 2 (+2.0) SD above the median on the WHO Growth Reference (v446d in 101:200)
g) Obese: greater than plus 2 (2.0) SD above the median on the median on the WHO Growth Reference (v446d > 200)
5) Mean BMI: Sum of BMI for non-pregnant, non-postpartum women age 20-49 who were weighed and measured (∑ v445/100, if v445 in 1200:6000)
6) Mean z-score for BMI-for-age: Sum of the z-scores for non-pregnant, non-postpartum women age 15-19 with a non-flagged BMI for age score (∑ v446d/100, if v446d < 9990)
Denominator:
a) Number of women age 20-49 with a valid height measurement (v438 in 1300:2200)
b) Number of women age 15-19 with a valid height for age z-score (v446d < 9990)
c) Number of women age 20-49, excluding women who are pregnant or who gave birth in the 2 months preceding the date of the interview (v213 ≠ 1 and (v208 = 0 or b19_01 >= 2)), with a valid BMI (v445 in 1200:6000)
d) Number of women age 15-19, excluding women who are pregnant or who gave birth in the 2 months preceding the date of the interview (v213 ≠ 1 and (v208 = 0 or b19_01 >= 2)), with a valid BMI for age z-score (v446d < 9990)
e) Same as denominator 3
f) Same as denominator 4
Variables: IR file.
|
v012 |
Current age |
|
v208 |
Births in last five years |
|
v213 |
Currently pregnant |
|
b19_01 |
Current age of child in months (months since birth for dead children) (01 is last birth) |
|
v438 |
Respondent's height in centimeters |
|
v445 |
Body Mass Index |
|
v446a |
Height/Age standard deviation (new WHO) |
|
v446d |
BMI-for-age z-score |
|
v005 |
Women's individual sample weight |
b19_01 exists in DHS-7 and DHS-8 surveys. For older surveys use b19_01 = v008 - b3_01 to create its equivalent.
The body mass index is calculated as weight in kilograms divided by the square of height in meters.
The percentages of women, by category, are equal to the category numerators divided by the denominator and multiplied by 100.
The assignment of height-for-age and BMI-for-age z-scores based on the WHO Growth Reference is done through a complicated interpolation function that takes into account sex, age (measured by difference in date of birth and date of interview, both precise to day of month), height in centimeters, and weight in kilograms (precise to 100 grams). As part of the creation of a recode file, variables with the z-scores are calculated and included in that file. The z-scores are calculated using software based on the WHO Anthro program and the macros for statistical packages at https://www.who.int/tools/growth-reference-data-for-5to19-years/application-tools.
If the WHO Anthro program or the WHO 2007 macros are used to recalculate z-scores, then exclude cases without a month and year of birth recorded (v014 > 1). Additionally, when the data are collected the weight variable includes two decimal places for weight (e.g. 50.65). This is rounded in the recode file to one decimal (variable v437) (e.g. 50.7) and so recalculated z-scores may differ slightly.
In the process of assigning the z-scores, checks are made on their plausibility. Z-scores for height-for-age and BMI-for-age are assigned special values to women with incomplete date of birth (month or year missing or “don’t know”) as the z-scores are sensitive to changes in age. Respondents with height-for-age z-scores below -6 SD or above +6 SD, or with BMI-for-age z-scores below -5 SD or above +5 SD, are flagged as having invalid data.
The percentage of women stunted and by BMI-for-age categories are equal to the specific numerators divided by the appropriate denominators and multiplied by 100.
In ever-married women samples, the data in the IR file are augmented with data from the PR file for never-married women to provide nutritional status estimates for all women. In ever-married samples (hv020 = 1), never-married women who are de facto residents and were weighed and measured (hv115 = 0 & hv103 = 1 & either ha3 in 1300:2200 or ha40 in 1200:6000, ha70 in -600:600, or ha73 in -600:500 depending on the denominator) are added to the denominator, and to the numerators if their height (ha3) was below 145 cm, their height-for-age (ha70) was below -2.0 SD, and if their BMI or BMI-for-age were in the appropriate categories (ha40 or ha73). In ever-married samples, never-married women are assumed to not be pregnant nor to have had a recent birth.
Added variables required for ever-married samples:
|
hv020 |
Ever-married sample |
|
hv103 |
Slept last night |
|
hv115 |
Current marital status |
|
ha1 |
Woman's age in years |
|
ha3 |
Woman's height in centimeters |
|
ha40 |
Body Mass Index |
|
ha70 |
Height/Age standard deviation (new WHO) (women age 15-19) |
|
ha73 |
BMI/Age standard deviation (new WHO) (women age 15-19) |
|
hv005 |
Household sample weight |
The mean BMI or BMI-for-age z-scores are equal to the numerator divided by the denominator.
Women who were not weighed and measured and women whose values for weight and height were not recorded are excluded from both the denominator and the numerators. Women whose month or year of birth are missing or unknown are flagged and excluded from both the denominators and the numerators for anthropometry indices that use age in the calculation (i.e. height-for-age and BMI-for-age). Women whose day of birth is missing or unknown are assigned day 15. Women whose calculated BMI is below 12.0 or above 60.0 are flagged as out of range and are excluded from both the denominator and the numerators. Women who are flagged for out-of-range z-scores or invalid z-scores are excluded from both the denominator and the numerators.
BMI, also known as the Quetelet Index, is a measure of nutritional status in adults. It is based on the Fogarty Metropolitan Life tables of ideal weight for height. BMI-for-age is a measure of nutritional status in adolescents. It is sex and age specific because adolescents are still growing, and the timing of peak growth differs in boys and girls.
These indicators could be presented based on the IR file or the PR file. Using the PR file would result in a slightly larger sample size, but the IR file is chosen for consistency with other women’s indicators, and as some of the women’s characteristics used in presenting the results are only available for women with completed interviews.
In phases of the DHS survey before DHS-IV, either only interviewed women or mothers of children under 5 years (or the cutoff for the health section of the individual questionnaire) were weighed and measured. In some surveys, only a subsample of these women were selected for anthropometry. All comparisons between surveys, either over time or between countries, should take into account the possible differences in the defined population base. While pregnant women and women two months postpartum are weighed and measured, they are excluded from the BMI and BMI-for-age indicator calculations because of weight gain during pregnancy.
In DHS-8 surveys, the nutritional status of adolescents age 15-19 are calculated using BMI-for-age z-scores. To better align with adult BMI classifications, DHS-8 surveys report adolescent total thin as BMI-for-age z-scores <-1SD (Lelijveld et al. 2022). Prior survey rounds calculated adolescent nutritional status using BMI. Hence, caution should be observed when comparing the figures in DHS-8 with the results published in the final reports for previous DHS surveys.
James, W. P., T.A. Ferro-Luzzi, and J.C. Waterlow, 1988. “Definition of chronic energy deficiency in adults: Report of a working party of the International Dietary Energy Consultative Group.” European Journal of Clinical Nutrition, 42: 969–981. https://www.researchgate.net/publication/20006752_Definition_of_chronic_energy_deficiency_in_adults_Report_of_a_working_party_of_the_International_Dietary_Energy_Consultative_Group
NCD Risk Factor Collaboration. 2017. “Worldwide Trends in Body-Mass Index, Underweight, Overweight, and Obesity from 1975 to 2016: A Pooled Analysis of 2416 Population-Based Measurement Studies in 128.9 Million Children, Adolescents, and Adults. Lancet 390: 2627–42. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32129-3/fulltext
Nestel, P., and S. Rutstein 2002. “Defining nutritional status of women in developing countries.” Public Health Nutrition, 5 (1): 17–27. https://pdfs.semanticscholar.org/6e92/a38ce0272be6f6804b48a47fa7909d467de3.pdf
Metropolitan Life Insurance Company. 1942. “Ideal weights for women”. New York Statistical Bulletin, 23 (6).
WHO. 2017. Global Nutrition Monitoring Framework: Operational Guidance for Tracking Progress in Meeting Targets for 2025. http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/
WHO. 2007. WHO Growth Reference Data for 5-19 Years. WHO. https://www.who.int/growthref/en/
de Onis, M., A. W. Onyango, E. Borghi, A. Siyam, C. Nishida, and J. Siekmann. 2007. "Development of a WHO Growth Reference for School-Aged Children and Adolescents." Bull World Health Organ 85 (9): 660-7. http://www.ncbi.nlm.nih.gov/pubmed/18026621.
Lelijveld, N., R. Benedict, Wrottesley, S., Z. Bhutta, E. Borghi, T. Cole, T. Croft et al. 2022. “Towards standardized and valid anthropometric indicators of nutritional status in middle childhood and adolescence”. The Lancet Child & Adolescent Health, Volume 6, Issue 10, P738-746.
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00196-1/fulltext
DHS-8 Tabulation plan: Table 11.14.1 and Table 11.14.2
API Indicator IDs:
AN_NUTS_W_SHT, AN_NUTS_W_NRM, AN_NUTS_W_THN, AN_NUTS_W_TH1, AN_NUTS_W_TH2, AN_NUTS_W_OWT, AN_NUTS_W_OVW, AN_NUTS_W_OBS, AN_NUTS_W_BMI
GNMF Indicator 10: Proportion of overweight and obese women 18+ years of age (body mass index ≥25 kg/m2)
1) Percentage of men age 20-49 by nutritional status based on specific body mass index (BMI) levels.
2) Percentage of men age 15-19 by nutritional status based on specific body mass index for age (BMI-for-age) z-scores levels.
3) Mean body mass index (BMI) for men age 20-49.
4) Mean body mass index for age (BMI-for-age) z-score for men age 15-19.
Population base: (MR file, PR file)
a) Men age 20-49
b) Men age 15-19
Time period: Current status at time of survey
Numerators:
1) Number of men age 20-49 with a body mass index (BMI) with the following values:
a) Normal: 18.5 to 24.9 (hb40 in 1850:2499)
b) Total thin: less than 18.5 (hb40 in 1200:1849)
c) Mildly thin: 17.0 to 18.4 (hb40 in 1700:1849)
d) Moderately and severely thin: less than 17.0 (hb40 in 1200:1699)
e) Total overweight or obese (>= 25.0) (hb40 in 2500:6000)
f) Overweight: 25.0 to 29.9 (hb40 in 2500:2999)
g) Obese: 30.0 or more (hb40 in 3000:6000)
2) Number of men age 15-19 with a BMI-for-age z-score with the following values:
a) Normal: between minus 1 (-1.0) standard deviations (SD) and plus 1 (+1.0) SD above the median on the WHO Growth Reference (hb73 in -100:100)
b) Total thin: less than less than minus 1 (-1.0) SD below the median on the WHO Growth Reference (hb73 < -100)
c) Mildly thin: between minus 1 (-1.0) SD and minus 2 (-2.0) SD below the median on the WHO Growth Reference (hb73 in -200:-101)
d) Moderately and severely thin: less than minus 2 (-2.0) SD below the median on the WHO Growth Reference (hb73 < -200)
e) Total overweight or obese: greater than plus 1 (1.0) SD above the median on the median on the WHO Growth Reference (hb73 > 100)
f) Overweight: between plus 1 (+1.0) SD and plus 2 (+2.0) SD above the median on the WHO Growth Reference (hb73 in 101:200)
g) Obese: greater than plus 2 (2.0) SD above the median on the median on the WHO Growth Reference (hb73 > 200)
3) Mean BMI: Sum of BMI for men age 20-49 who were weighed and measured (∑ hb40/100, if hb40 in 1200:6000)
4) Mean z-score for BMI-for-age: Sum of the z-scores for men age 15-19 with a non-flagged BMI for age score (∑ hb73/100, if hb73 < 9990)
Denominator:
a) Number of men age 20-49 with a valid BMI (hb40 in 1200:6000)
b) Number of men age 15-19, with a valid BMI for age z-score (hb73 < 9990)
c) Same as denominator 1
d) Same as denominator 2
Variables: MR file, PR file.
|
hv103 |
Slept last night |
|
hb1 |
Man's age in years |
|
hb40 |
Body Mass Index |
|
hb73 |
BMI/Age standard deviation (new WHO) (men age 15-19) |
|
mv003 |
Respondent's line number |
|
mv005 |
Men’s sample weight |
To calculate the nutritional status for men, it is first necessary to merge the anthropometric variables from the household members recode (PR file) to the men’s recode (MR file) using the cluster, household and line numbers (see Matching and Merging Datasets in Chapter 1).
The body mass index is calculated as weight in kilograms divided by the square of height in meters.
The percentages of men, by category, are equal to the category numerators divided by the denominator and multiplied by 100.
The mean BMI is equal to the numerator divided by the denominator.
The assignment of BMI-for-age z-scores based on the WHO Growth Reference is done through a complicated interpolation function that takes into account sex, age (measured by difference in date of birth and date of interview, both precise to day of month), height in centimeters, and weight in kilograms (precise to 100 grams). As part of the creation of a recode file, variables with the z-scores are calculated and included in that file. The z-scores are calculated using software based on the WHO Anthro program and the macros for statistical packages at https://www.who.int/tools/growth-reference-data-for-5 to19-years/application-tools.
If the WHO Anthro program or the WHO 2007 macros are used to recalculate z-scores, then exclude cases without a month and year of birth recorded (mv014>1). Additionally, when the data are collected the weight variable includes two decimal places for weight (e.g. 60.65). This is rounded in the recode file to one decimal (variable hb2) (e.g. 60.7) and so recalculated z-scores may differ slightly.
In the process of assigning the z-scores, checks are made on their plausibility. Z-scores for BMI-for-age are assigned special values to men with incomplete date of birth (month or year missing or “don’t know” (m014 > 1)) as the z-scores are sensitive to changes in age. Respondents with BMI-for-age z-scores below -6 SD or above +6 SD (hb73 < -600 or bh73 > 600), are flagged as having invalid data. The percentage of men by BMI-for-age categories are equal to the specific numerators divided by the appropriate denominators and multiplied by 100.
The mean BMI-for-age z-scores are equal to the numerator divided by the denominator.
Men who were not weighed and measured and men whose values for weight and height were not recorded are excluded from both the denominator and the numerators. Men whose month or year of birth are missing or unknown are flagged and excluded from both the denominators and the numerators for anthropometry indices that use age in the calculation (i.e. BMI-for-age). Men whose day of birth is missing or unknown are assigned day 15. Men whose calculated BMI is below 12.0 or above 60.0 are flagged as out of range and are excluded from both the denominator and the numerators. Men who are flagged for out-of-range z-scores or invalid z-scores are excluded from both the denominator and the numerators.
BMI, also known as the Quetelet Index, is a measure of nutritional status in adults. It is based on the Fogarty Metropolitan Life tables of ideal weight for height. BMI-for-age is a measure of nutritional status in adolescents. It is sex and age specific because adolescents are still growing, and the timing of peak growth differs in boys and girls.
These indicators could be presented based on the MR file or the PR file. Using the PR file would result in a slightly larger sample size, but the MR file is chosen for consistency with other men’s indicators, and as some of the men’s characteristics used in presenting the results are only available for men with completed interviews.
In some surveys, only a subsample of men were selected for anthropometry. All comparisons between surveys, either over time or between countries, should take into account the possible differences in the defined population base.
In DHS-8 surveys, the nutritional status of adolescents age 15-19 are calculated using BMI-for-age z-scores. To better align with adult BMI classifications, DHS-8 surveys report adolescent total thin as BMI-for-age z-scores <-1SD (Lelijveld et al. 2022). Prior survey rounds calculated adolescent nutritional status using BMI. Hence, caution should be observed when comparing the figures in DHS-8 with the results published in the final reports for previous DHS surveys.
See References for Percentage of women by nutritional status.
DHS-8 Tabulation plan: Table 11.14.3 and 11.14.4
API Indicator IDs:
AN_NUTS_M_NRM, AN_NUTS_M_THN, AN_NUTS_M_TH1, AN_NUTS_M_TH2, AN_NUTS_M_OWT, AN_NUTS_M_OVW, AN_NUTS_M_OBS, AN_NUTS_M_BMI