A new, simplified anthropometric field tool for detecting nutritional stunting, the “tallstick” has been developed in community-based pilot programmes in Nicaragua and Nigeria. The folding stick, marked to indicate height-for-age cut-off points for ages from birth to seven years below which the child is considered nutritionally stunted, is compared with arm circumference measurements as a simplified field tool. Sensitivity-specificity analyses contrasting the ability of height-for-age and arm-circumference cut-off points to detect malnutrition showed height for age to be as good as arm circumference for detecting low weight for age, weaker for low weight for height, and stronger for a composite score of any degree of malnutrition in 1,070 children 0–72 months old in urban Managua with a prevalence of wasting of 0%–4%, of stunting of 17%–38%, and of underweight of 4%–22%. The importance of detecting stunting, the likelihood of reducing stunting rates, and the feasibility of using the tallstick and its variants are discussed.
LavoipierreG.J., KellerW., DixonH., DustinJ.P., ten DamG.Measuring change in nutritional status: guidelines for assessing the nutritional impact of supplementary feeding programmes for vulnerable groups.Geneva: World Health Organization, 1983.
2.
GrantJ.P.The state of the world's children, 1990.Oxford, UK: Oxford University Press/UNICEF. 1990: 7879.
3.
HabichtJ.P.Some characteristics of indicators of nutritional status for use in screening and surveillance. Am J Clin Nutr1980; 33: 531–35.
4.
HabichtJ.P., MeyersL.D., BrownieC.Indicators for identifying and counting the improperly nourished. Am J Clin Nutr1982; 35: 1241–54.
5.
WaterlowJ.C.Observations on the natural history of stunting. In: WaterlowI.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14.New York: Raven Press, 1988: 1–16.
6.
SeiregM.Food and nutrition surveys.Managua, Nicaragua: UNICEF/PQAN, 1989.
TrowbridgeF.L., StaehlingN.Sensitivity and specificity of arm circumference indicators in identifying malnourished children. Am J Clin Nutr1980; 33: 687–96.
9.
ShakirA.Arm circumference in the surveillance of protein-calorie malnutrition in Baghdad. Am J Clin Nutr1975; 28: 661–65.
10.
ZeitlinM.F., InchiongM.B., LacunaR., OpenaM.The advantages of using a thigh circumference tape analogous to the Shakir strip for detection of malnutrition in preschool children. J Trop Pediatr1981; 27: 267–70.
11.
SPSS-X user's guide.3rd ed.Chicago, III, USA: SPSS Inc., 1988.
12.
ZeitlinM.F., PyleD.F., AustinJ.E., SemporeG., GoubaE.Circumference growth charts for community level workers with little or no formal schooling. J Trop Pediatr1982; 28: 62–68.
13.
VelzeboerM.I., SelwynB.J., SargentI.I.F., PollittE., DelgadoH.Evaluation of arm circumference as a public health index of protein energy malnutrition in early childhood. J Trop Pediatr1983; 29: 135–43.
14.
ZeitlinM.F.Comparison of malnourished children selected by weight-for-age, mid-upper-arm circumference, and maximum thigh circumference. J. Trop Pediatr1986; 32: 190–95.
15.
GayleH.D., BinkinN.J., StaehlingN.W., TrowbridgeF.L.Arm circumference v. weight-for-height in nutritional assessment: are the findings comparable? J Trop Pediatr1988; 34: 213–17.
16.
ChenL.C., Alauddin ChoudryA.K.M., HuffmanS.L.Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children. Am J Clin Nutr1980; 33: 1836–45.
17.
The Kasongo Project Team.Anthropometric assessment of young children's nutritional status as an indicator of subsequent risk of dying. J Trop Pediatr1989; 29: 77–83.
18.
RohdeJ.E. ed. Symposium: growth monitoring and promotion: an international experience. Ind J Pediatr1988; 55(1): SI–S123.
19.
ChorltonR.Improving child survival and nutrition: the joint WHO/UNICEF nutrition support programme in Iringa, Tanzania.Dar es Salaam, Tanzania: UNICEF, 1989.
20.
JelliffeD.B.The assessment of the nutritional status of the community. WHO Monograph Series, no 53.Geneva: WHO, 1966.
21.
SeoneN., LathamM.C.Nutritional anthropology in the identification of malnutrition in childhood. Environ Child Health1971; 17: 98.
22.
GeyerV.The management of nutritional emergencies in large populations: assessment and surveillance of nutritional status.Geneva: WHO, 1970: 21–35.
23.
KellerW.The epidemiology of stunting. In: WaterlowJ.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14.New York: Raven Press, 1988: 17–39.
24.
KellerW., FillmoreC.M.Prevalence of protein-energy malnutrition. World Health Stat Q1983; 36: 129–67.
25.
SecklerD.Small but healthy: a basic hypothesis in theory, measurement, and policy of malnutrition. In: SukhatmeP.V., ed. Newer concepts in nutrition and their implications for policy.Pune, India: Maharashtra Association for the Cultivation of Science. 1982: 127–37.
26.
HabichtJ.P., MartorellR., YarbroughC.Malina RM, Klein RE. Height and weight standards for pre-school children: how relevant are ethnic differences in growth potential? Lancet1974; 1(858): 611–14.
27.
MartorellR.Genetics. environment, and growth: issues in the assessment of nutritional status. In: VelazquesA., BourgesH., eds. Genetic factors in nutrition.New York: Academic Press, 1984: 373–92.
28.
MartorellR., MendozaF., CastilloR.Poverty and stature in children. In: WaterlowJ.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14.New York: Raven Press, 1988: 5774.
29.
GopalanC.“Small is healthy” for the poor, not the rich!Bull Nutr Found India1983: 1–5.
30.
MartorellR.Body size, adaptation and function. Human Organization1989; 48(1): 16–20.
31.
Van LerbergheW.Linear growth retardation and mortality. In: WaterlowJ.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14.New York: Raven Press, 1988: 245–64.
32.
MataL.Environmental factors affecting nutrition and growth. In: GraceyM., FalknerF., eds. Nutritional needs and assessment of normal growth. Nestle Nutrition Workshop Series, vol. 7.New York: Raven Press, 1985: 165–82.
33.
TomkinsA.The risk of morbidity in a stunted child. In: WaterlowJ.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14.New York: Raven Press, 1988: 185–99.
34.
RichardsonS.A.The influence of social, environmental, and nutritional factors on mental ability. In: ScrimshawN.S., GordonJ.G., eds. Malnutrition, learning, and behavior.Cambridge, Mass, USA: MIT Press, 1968.
35.
MonckebergF., TislerS., ToroS., GattasU., VegaL.Malnutrition and mental development. Am J Clin Nutr1972; 25: 766–72.
36.
SigmanM., NeumannC., BakshM., BwiboN., McDonaldM.A.Relationship between nutrition and development in Kenyan toddlers. J Pediatr1989; 115: 357–64.
37.
KemmerI.A.Research results from phase I: Child Development for the Computer Age Project. Nigerian component of the Tufts-UNICEF-JNSP Three Country Positive Deviance in Nutrition Research Project. New York, 1989.
38.
GoldenM.H.N.The role of individual nutrient deficiencies in growth retardation of children as exemplified by zinc and protein. In: WaterlowJ.C., ed. Linear growth retardation in less developed countries. Nestle Nutrition Workshop Series, vol. 14. New York: Raven Press, 1988: 143–63.
39.
ZeitlinM., GhassemiH., MansourM.Positive deviance in child nutrition-with emphasis on psychosocial and behavioural aspects and implications for development.Tokyo: The United Nations University, 1989.
40.
van StaverenW.A., DhuyvetterJ.H.M., BonsA., ZeelanM., HautvastJ.G.A.Food consumption and height/weight status of Dutch preschool children on alternative diets. J Am Dietet Assoc1985; 85(12): 1579–84.
41.
DwyerJ.T., DietzW.H., AndrewsE.M., SuskindR.M.Nutritional status of vegetarian children. Am J Clin Nutr1982; 35: 204–16.
42.
MalcolmL.A.Growth retardation in a New Guinea boarding school and its response to supplementary feeding. Br J Nutr1970; 24: 297–305.
43.
AllenL.H., StanekE., PeltoG.H., ChavezA.Correlates of growth and size of Mexican preschoolers with diet, morbidity, and nutritional status. (Abstract) FASEB J1988; 2: A1204.
44.
PeltoG.H., AllenL.H., ChavezA., MartinezE., FieldT.Cognitive performance, growth and diet of preschool children in highland Mexico. (Abstract) FASEB J1988; 2: A1204.
45.
BonifiaJ.The Nicaraguan Positive Deviance Project phase I report. Workshop report. Proceedings of the 14th International Congress of Nutrition, Seoul, Korea, Aug 1989.
46.
Joint FAO/WHO/UNU Expert Consultation.Energy and protein requirements. WHO Technical Report Series, no 724.Geneva: WHO, 1985.
47.
ZerfasA.J.The insertation tape: a new circumference tape for use in nutritional assessment. Am J Clin Nutr1975; 28: 782–87.
48.
NabarroD., McNabS.A simple new technique for identifying thin children. J Trop Med Hyg1980; 83: 21–33.
49.
Government of Tanzania, WHO, and UNICEF.The Joint WHO/UNICEF Nutrition Support Programme in Iringa, Tanzania, 1983–1988: evaluation report.Dar es Salaam: Government of Tanzania, 1988.
