BACKGROUND METHODS WHAT IS KNOWN   Child malnutrition is a major public health problem in developing countries   New WHO Growth Standards result in more children aged 6-59 months being labelled as acutely malnourished   Malnutrition in infants aged <6 months is often neglected Recent Demographic & Health Survey datasets for 21 countries with a high burden of malnutrition were analysed. Weight-for-height z-scores were calculated using both, the NCHS and the WHO-GS. Country prevalence of malnutrition was classified by WHO criteria: (<5% =acceptable; 5-10% GAM=poor;10-15% GAM=serious; ≥15% GAM=critical) Figure 2 (right) Increases in malnutrition prevalence, WHO criteria: -17/21 countries increased the severity category on infant GAM - 2/21 countries increased the severity category on 6-59 months GAM If WHO-GS are used together with established diagnostic criteria, the numbers of infants <6 months labelled with GAM malnutrition will increase significantly compared to: - previous diagnoses based on NCHS growth references - older children aged 6-59 months who are diagnosed with WHO-GS Policy makers urgently need to consider possible risk-benefit implications for young infants aged <6 months:   RISKS of over-diagnosis are potentially serious: if concerned carers start ‘top-up’ foods or formula milks, exclusive breastfeeding will be undermined.  BENEFITS are uncertain: the evidence base for treating infant malnutrition is weak; skilled breastfeeding support is scarce; current treatment models are inpatient- based, resource intensive, and cannot easily be scaled-up. We thank the UNICEF led Inter Agency Standing Committee (IASC) Nutrition Cluster for funding the MAMI project (Management of Acute Malnutrition in Infants), from which this work arose. We also thank MEASURE DHS (Macro International Inc., Calverton, USA) & all countries surveyed for DHS datasets. WHAT THIS STUDY ADDS   Acute Malnutrition burden of disease is high in infants aged <6 months   Using WHO growth standards to diagnose malnutrition has a much greater effect on infants <6 months than on children aged 6-59 months   Potentially adverse risk-benefit implications of diagnosing more infants with malnutrition need to be addressed References: 1) Black RE, Allen LH, Bhutta ZA, et al, for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; published online Jan 17. DOI: /S (07) ) Collins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006; 27: S49–82 3) Infant and Young Child Feeding in Emergencies. Making it Matter. Proceedings of an International Strategy Meeting, 1-2 November IFE Core Group. Available at 4) Seal A, Kerac M (2007) Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: Secondary data analysis. Brit Med J 334: 733 5) Transitioning to the WHO Growth Standards: Implications for Emergency Nutrition Programmes. IASC Nutrition Cluster Informal Consultation, Geneva, June 2008 CONCLUSIONS Acute Malnutrition in infants aged <6 months: Developing country disease burden and implications of the new WHO Child Growth Standards Hannah Blencowe *, Marko Kerac †, Marie McGrath ‡, Carlos Grijalva-Eternod †, Andrew Seal † * London School of Hygiene & Tropical Medicine, ‡ Emergency Nutrition Network, † UCL Centre for International Health & Development, Institute of Child Health RESULTS Global Acute Malnutrition (GAM) is a major cause of developing country child mortality and is defined by a weight-for-height z-score (WHZ) of <-2 or nutritional oedema. If established z-score* criteria are used, new 2006 World Health Organization child growth standards (WHO-GS) label more children aged 6-59 months with malnutrition than do the widely used 1978 National Centre for Health Statistics child growth references (NCHS). Acutely malnourished infants aged <6 months are often neglected in feeding programmes. One reason is that malnutrition prevalence is assumed to be low because of breastfeeding. WHO-GS are currently being rolled out for international use – yet the impact on GAM prevalence for <6 months infants has not to date been reviewed. * Z-scores represent the number of standard deviations away from the median of a normally-distributed reference population. e.g. –1 z-score = 1 SD less than the reference population median. N =163,230 total, of which:   15,537 aged <6 months; 147,695 aged 6-59 months   Mean sample size per country: 7,771. Range: 1,710 to 45,398 Using the WHO-GS instead of NCHS: Figure 1 (below) Increases in GAM by age group % GAM in infants <6 months increased markedly: Odds ratio = 3.1 (95%CI 2.57 to 3.34) % GAM in children 6-59 months increased slightly: Odds ratio = 1.1 (95% CI 1.04 to 1.09)