Counting the stunted children in a population: a criticism of old and new approaches and a conciliatory proposal.

Two methods for estimating the prevalence of growth retardation in a population are evaluated: the classical method, which is based on the proportion of children whose height is more than 2 standard deviations below the expected mean of a reference population; and a new method recently proposed by Mora, which is based on the whole height distribution of observed and reference populations. Application of the classical method to several simulated populations leads to the conclusion that in most situations in developing countries the prevalence of growth retardation is grossly underestimated, and reflects only the presence of severe growth deficits. A second constraint with this method is a marked reduction of the relative differentials between more and less exposed strata. Application of Mora's method to the same simulated populations reduced but did not eliminate these constraints. A novel method for estimating the prevalence of growth retardation, which is based also on the whole height distribution of observed and reference populations, is also described and evaluated. This method produces better estimates of the true prevalence of growth retardation with no reduction in relative differentials.