• Muhammad Babar Alam Ph.D Scholar, Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore-Pakistan
  • Rubeena Zakar Head of Department and Director, Institute of Social and Cultural Studies, University of Punjab, Lahore-Pakistan
  • Muhammad Zeeshan Haroon Department of Community Medicine, Ayub Medical College Abbottabad-Pakistan



Malnourishment, Gender Analysis, BMI, CIAF, MUAC


Previous studies highlighted that CIAF is better tool for malnutrition assessment which screen more children compared to other anthropometric approaches like MUAC, BMI for age, conventional indices (Stunting, Wasting and Underweight). In literature, none of the study has mentioned CIAF performance by gender in comparison with other anthropometric approaches. The study solves this puzzle, whether CIAF has the same performance in gender analysis too or not. Data from 1152 homes gathered using purposive random sample approach. The CIAF detects more malnourished children (63%) compared to other methods. Results show that male children in the study region had a greater frequency of malnutrition than female children. The results of the chi-square showed thatage and gender of the child have a significant relationship with CIAF than other approaches.The CIAF is a superior instrument for assessing child malnutritional status since it detects more malnourishedchildren even with gender analysis too.

Author Biographies

Muhammad Babar Alam, Ph.D Scholar, Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore-Pakistan


Rubeena Zakar, Head of Department and Director, Institute of Social and Cultural Studies, University of Punjab, Lahore-Pakistan


Muhammad Zeeshan Haroon, Department of Community Medicine, Ayub Medical College Abbottabad-Pakistan



Stevens, G.A.; Finucane, M.M.; Paciorek, C.J.; Flaxman, S.R.; White, R. A.; Donner, A. J.; Ezzati, M. Nutrition Impact Model Study Group Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: A systematic analysis of population representative data. Lancet 2010, 380, 824–834.

United Nation International Children’s Emergency Fund. Levels and Trends in Child Malnutrition. 2014. Available online: on 30 November 2021).

Di Cesare, M.; Bhatti, Z.; Soofi, S.B.; Fortunato, L.; Ezzati, M.; Bhutta, Z.A. Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: An analysis of data from a nationally representative survey. Lancet Glob. Health 2015, 3, e229–e239.

Sen, J.; Mondal, N.; Dey, S.; Assessment of the nutritional status of children aged 5–12 years using upper arm composition. Ann. of Human Bio. 2011, 38, 752-759.

Nandy, S.; Svedberg, P. The Composite Index of Anthropometric Failure (CIAF): An alternative indicator for malnutrition in young children. In Handbook of anthropometry (pp. 127-137). Springer, New York, NY. 2012.

Bose, K.; Mandal, G.C. Proposed new anthropometric indices of childhood undernutrition. Malays J Nutr, 2010, 16, 131-6..

Nandy, S.; Miranda, J.J. Overlooking undernutrition? Using a composite index of anthropometric failure to assess how underweight misses and misleads the assessment of undernutrition in young children. Soc sci & med, 2008, 66, 1963-1966.

Svedberg, P. Poverty and under-nutrition: theory, measurement and policy. Oxford: Oxford University Press. 2000. Available online: https://doi. org/10.1093/0198292686.001.0001 (Accessed on 29 August 2021).

Svedberg, P. How many people are malnourished? Ann. rev. of Nutri. 2011, 31, 263-283.

McDonald, C. M.;Olofin, I.; Flaxman, S.; Fawzi, W. W.; Spiegelman, D.; Caulfield, L. E. Nutrition Impact Model Study. The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. The Am. J. of Clinic Nutri. 2013, 97, 896-901

WHO. Child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund (UNICEF). WHO Press. 2009. Available online: For BMI: (Accessed on 29 August 2021).

UNICEF. Mid-Upper Arm Circumference (MUAC) Measuring Tapes. Technical Bulletin No.13, Revision 2. 2009. Available on: on 29 August 2021).

Khan, F. J.; Javed, Y. Delivering access to safe drinking water and adequate sanitation in Pakistan. Pakistan Institute of Development Economics. 2007. PIDE Work Paper, 30, 1–47. Available on: (Accessed on 29 August 2021).

Shahid, M.; Ameer, W.; Malik, N.I.; Alam, M.B.; Ahmed, F.; Qureshi, M.G.; Zhao, H.; Yang, J.; Zia, S. Distance to Healthcare Facility and Lady Health Workers’ Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan. Int. J. Environ. Res. Public Health2022, 19, 8200. Doi:

Shahid, M.; Ahmed, F.; Ameer, W.; Guo, J.; Raza, S.; Fatima, S.; Qureshi, G. M. (2022). Prevalence of child malnutrition and household socioeconomic deprivation: A case study of marginalized district in Punjab, Pakistan. PLoS ONE 2022, 17, e0263470.

Shahid, M.; Cao, Y.; Ahmed, F.; Raza, S.; Guo, J.; Malik, N. I.; Rauf, U.; Qureshi, M. G.;Saheed, R.; Maryam, R. Does Mothers' Awareness of Health and Nutrition Matter? A Case Study of Child Malnutrition in Marginalized Rural Community of Punjab, Pakistan. Front. Public Health2022,10.

Olukemi, F.S. Assessing the prevalence of Undernutrition using the composite index of anthropometric failure (CIAF) among young children in a rural community in Oyo state, Nigeria. Nigerian J. Nutri. Sci. 2014, 35, 19-24.

Al-Sadeeq, A. H.;Bukair, A. Z.; Al-Saqladi, A. W. M. Assessment of undernutrition using Composite Index of Anthropometric Failure among children aged< 5 years in rural Yemen. East Mediter Health J, 2018, 24, 12.

Anwar, F.; Gupta, M. K.; Prabha, C.; Srivastava, R. K. Malnutrition among rural Indian children: An assessment using web of indices. Int. J. Pub Health Epidem2013,2, 78-84.

Brahmbhatt, K. R.; Hameed, S.; Naik, P. M.; Prasanna, K. S.; Jayram, S. Role of new anthropometric indices, validity of MUAC and Weech’s formula in detecting under-nutrition among under-five children in Karnataka. Int. J Biomed. and Adv. Res. 2013, 3, 896-900.

Gupta, V.; Mohapatra, D.;& Kumar, V. Nutritional assessment among children (under five years of age) using various anthropometric indices in an urban area of district Rohtak, Haryana, India. Int. J Biomed Res.2015, 6, 629-634.

Dasgupta, A.;Parthasarathi, R.; Biswas, R.;Geethanjali, A. Assessment of under nutrition with composite index of anthropometric failure (CIAF) among under-five children in a rural area of West Bengal. Ind J. of Commun. Health2014, 26, 132-138.

Stiller, C. K.;Golembiewski, S. K. E.;Golembiewski, M.; Mondal, S.;Biesalski, H. K.;Scherbaum, V. Prevalence of undernutrition and anemia among santal adivasi children, Birbhum District, West Bengal, India. Int. J of Environ Res and Pub Health2020,17, 342.

Roy, K.; Dasgupta, A.;Roychoudhury, N.; Bandyopadhyay, L.; Mandal, S.; Paul, B. Assessment of under nutrition with composite index of anthropometric failure (CIAF) among under-five children in a rural area of West Bengal, India. Int. J. of Contemp. Pediatrics 2018,5, 1651-1656.

Mandal, S.; Pal, J.;Parthasarathi, R.; Biswas, R. An assessment of nutritional status of children aged 0-14 years in a slum area of Kolkata. Int. J. of Med. Pub. Health2014, 4, 159-162.

Rastogi, S.; Maheshwari, C.; Raghav, S. K.; Lala, M. K. Assessing burden of under-nutrition among under-five children of urban slum by using composite index of anthropometric failure in Ahmedabad city, Gujarat, India. National J. of Commu. Med. 2017, 8, 496-500.

Boregowda, G.S.;Soni, G.P.; Jain, K.; Agrawal, S. Assessment of under nutrition using composite index of anthropometric failure (CIAF) amongst toddlers residing in Urban slums of Raipur City, Chhattisgarh, India. J. clinic and diagnos. Res: JCDR, 2015, 9, LC04- LC06.

Sen, J.; Dey, S.; Mondal, N. Conventional nutritional indices and Composite Index of Anthropometric Failure: which seems more appropriate for assessing under-nutrition among children? A cross-sectional study among school children of the Bengalee Muslim Population of North Bengal, India. Italian J Pub Health2011, 8, 172-185.

Titoria, R.;Ponnusamy, P.; Mehra, S. Identification of undernutrition in under five children: Z score or a composite index of anthropometric failure?.Int. J. of Com Med. and Pub. Health2019, 6, 3150.

Jawaregowda, S.K.; Angadi, M.M. Gender differences in nutritional status among under-five children in rural areas of Bijapur district, Karnataka, India. Int J Community Med Public Health. 2015, 2, 506-509.

Dhungana, G.P. Nutritional Status and the Associated Factors in Under Five Years Children of Lamjung, Gorkha and Tanahun Districts of Nepal. Nep. J. Stat.2017, 1, 15-18.

Ahmad, D.; Afzal, M.; Imtiaz, A. Effect of socioeconomic factors on malnutrition among children in Pakistan. Future Business J.2020, 6, 1-11.

Haq, I.; Hossain, M.I.; Parvin, M.M.;Saleheen, A.A.S.; Habib, M.J. Gender differences in child nutrition status of Bangladesh: a multinomial modeling approach. Int. j. humanit. soc. sci. 2021. Available online at: (Accessed on 15 January 2022)

Shahid, M.; Qureshi, M.G.; Ahmed, J.F. Socio-economic Causes of Malnutrition among Pre-School Children in Pakistan: A Gender-Disaggregated Analysis. Glob Eco Rev. 2020, 5, 47-159.

Babatunde, R.O.; Olagunja, F.I.; Fakayode, S.B.; Sola-Ojo, F.E. Prevalence and Determinants of Malnutrition among under-five children of farming household in Kwara State, Nigeria. J. Agric. Sci. 2011, 3, 173- 181.

Jayachandran, S.; Kuziemko, I. Why do mothers breastfeed girls less than boys? Evidence and implications for child health in India. Q. J. Econ. 2011, 126, 1485–1538.

Arif, G.M.; Nazir, S.; Satti, M.N.; Farooq, S. Child malnutrition in Pakistan: Trends and determinants. Pak. Inst. Dev. Econ. 2012, 2012, 1–8.

Heise, L.; Greene, M.E.; Opper, N.; Stavropoulou, M.; Harper, C.; Nascimento, M.; Zewdie, D.; Darmstadt, G.L.; Greene, M.E.; Hawkes, S. Gender inequality and restrictive gender norms: Framing the challenges to health. Lancet.2019, 393, 2440–2454.

Shahid, M.; Liu, Y.; Ameer, W.; Qureshi, M.G.; Ahmed, F.; Tang, K. Comparison of Different Nutritional Screening Approaches and the Determinants of Malnutrition in Under-Five Children in a Marginalized District of Punjab Province, Pakistan. Children 2022, 9, 1096.

Additional Files



Most read articles by the same author(s)