Composite index of anthropometric failure (CIAF) classification: is it more useful?

Letters Composite index of anthropometric failure (CIAF) classification: is it more useful? Editor – The paper published by Nandy et al. in the Bulletin on the composite index of anthropometric failure (CIAF) is welcome in view of the paucity of recent attempts to classify undernouri i ished children satisfactorily. 1 However, the usefulness of the CIAF classification has to be considered visiàivis Waterlow's widely used stunting–wasting classifii i cation. 2 In addition to height for age (HA) and weight for height (WH), the CIAF classification uses weight for age (WA) — a measure that does not differentii i ate acute, chronic, and past (recent or remote) undernutrition. The CIAF clasi i sification introduces two new groups of children (group B and group C). Group B (2.6%) has normal HA and WA but low WH, an improbable anthropoi i metric combination; group C (6.1%), with higher HA but low WH and WA, is of little immediate concern and can be considered " healthy " , presumably growing up to become thin tall adults. 3 Other groups, A, D, E, F and Y in the CIAF classification are covered by the Waterlow classification. 4 The CIAF classification does not address the limitations of the Waterlow classification. 2 Firstly, it does not satisfy the longifelt need for a combined clinical and anthropometric classificai i tion that would be useful for clinical as well as community health work. The classification proposed by the Wellcome Trust Working Party in 1970 5 and the one used in a WHO monograph in 1999 6 are inadequate because their coverage of syndromes is incomplete and predetermined, and inappropriate anthropometric criteria are assigned to the syndromes. Personally, I prefer to use a composite classification in which a syndrome is first diagnosed clinically and the anthropometric status (criteria not predetermined) of stunting–wasting is then applied to it. Secondly, although children with Ziscores of less than –3 are considered to be severely undernourished, the lower limit of severity remains undefined. I have observed children aged 3–5 years suffering from prolonged or repeated nutritional assaults with extremely low Ziscores (HA: –6 to –7;WA: –5 to –6; and WH –3 to –4) and identified a very severe type, the nutritionally battered child. Possibly such cases are flagged as improbable in National Family Health Surveys (NFHS) and hence excluded. 1 The severe cases of stunting–wasting in the absence of kwashiorkor or marasi i mus …