A new classification of acute protein-energy malnutrition
Gernaat, H.B.; Voorhoeve, H.W.
Journal of Tropical Pediatrics 46(2): 97-106
2000
ISSN/ISBN: 0142-6338 PMID: 10822936 DOI: 10.1093/tropej/46.2.97Document Number: 263165
Current schemes to classify protein-energy malnutrition (PEM) in hospitalized children below 5 years of age in developing countries are of limited usefulness, because age is often not known and wasted children are insufficiently discriminated. In this study, a newly proposed scheme, based on the presence of wasting (weight-for-height <= - 2 z scores) and oedema, was compared with clinical and the original Wellcome criteria to classify PEM in 538 under-fives hospitalized for PEM in a rural hospital in Nchelenge, Zambia. Wasting in the absence of oedema was clinically false-positively diagnosed in 34.0%, whereas the Wellcome classification gave rise to 28.6% false-positive and 39.9% false-negative diagnosis. In the presence of oedema, clinical diagnosis of wasting was 44.7% false-positive and 41.4% false-negative, while the Wellcome scheme had a false-negative rate of 54.3%. We conclude that the Wellcome classification did not add to the clinical diagnostic accuracy of PEM as opposed to the proposed scheme, which merits further study. In an Appendix the use and calculation of z scores of weight-for-height is further explained.