Adjustments for weighing clothed babies at high altitude or in cold climates

Abstract

Public health nutritionists rely on anthropometry for nutritional assessment, program planning, and evaluation. Children are usually heavily clothed at high altitudes and in cold climates. Failing to adjust for clothing weight could underestimate malnutrition prevalence. The objective of this paper is to validate an adjustment process for estimating clothing weight and quantify potential misclassification error. In March and September 2009, 293 and 272 children under 2 years of age, respectively, were measured for weight and length in 14 highlands communities in Ecuador. Weight-for-age z-scores (WAZ) and weight-for-height z-scores (WHZ) were compared using clothing-unadjusted weights and two types of clothing-adjusted weights: individual clothing-weights and population-mean clothing-weights. Modelling showed up to 24% of children’s nutritional status and degree of malnutrition were misclassified for WAZ, and 13% for WHZ, when clothing was not taken into account in this cold climate. Compared with the more time-intensive individual clothing-weight adjustment, the population-mean clothing-weight adjustments had high specificity and sensitivity for WAZ. In cold climates, adjusting for population mean clothing weight provides a better estimate of the prevalence of malnutrition to inform appropriate program decisions for addressing underweight. An individual clothing weight adjustment may also be essential to classify a specific child’s nutritional status when acute malnutrition is a concern.

Keywords:

• malnutrition
• anthropometry
• children
• clothing
• climate

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The International Development Research Center (IDRC) of Canada provided funding for the research through a doctoral research award. The lead author also received a doctoral research award from the Canadian Institutes for Health Research (CIHR).