This study uses the World Health Organization <mark>Child Growth Standards</mark> for the classification of stunting, wasting and underweight status. Children are classified as stunted, wasted and underweight if their height-to-age Z-score, weight-to-height Z-score and weight-to-age Z-score are below -2 respectively. Children are classified as severe stunted, severe wasted and severe underweight if their height-to-age Z-score, weight-to-height Z-score and weight-to-age Z-score are below -3 respectively (WHO Multicentre Growth Reference Study Group 2006).

Data from two parts of the survey were combined to estimate nutritional intake: the household stocks data and the personal diary data. The household stocks of food data, involved an interviewer asking the household head or representative about food currently in the house on day 1 and day 14 of the survey. The stocks were weighed by the interviewer. Nineteen food items, identified as the nineteen most common items in the previous HIES, were specified on the questionnaire. Other items were found, weighed and listed. The second source of data was derived from the participant’s recorded transactions in a personal diary for 14 days. A total number of 295,804 transactions involving food and alcohol were extracted from this diary.

The quantity of food was converted to calories using food composition information from the New Zealand FOODfiles 2012 database (2013). Energy and nutrient composition for each item was estimated by taking an average of relevant items from the FOODfiles database. The difference between stock levels on day1 and day14, plus additional purchased foods were converted to the total calories consumed by the households.

Total calories consumed by households during the two weeks were then converted to calories per capita (adult equivalent) per day. Per capita is defined by adult equivalent using children 0-14 as 0.5 adult. Guests who regularly have meals in the households were added while members of households who do not regularly eat at home were deducted. Since per adult equivalent calories were strongly right skewed, this was converted into quintiles to be included in the regression. Only per adult equivalent protein was used as an indicator for nutrition.

A logistic regression model is employed in the study. The dependent variables are children’s malnutrition status including stunting status, wasting status (low weight-for-height, indicating acute weight loss and underweight status) and underweight status (low weight compared with that expected for a well-nourished child of that age and sex) (Waterlow 1972). The control variables are household wealth quintiles, protein intake quintiles, household head education level, region, and children’s gender, age and health status.

# **3. Results**

# **3.1. Descriptive Results**

# _Overall Prevalence_

Malnutrition in PNG is prevalent and severe, and varies across the regions. The overall stunting, underweight and wasting rates are high, 46 percent, 25 percent and 15.8 percent, respectively. Not only are the overall rates high; the severe cases among the stunted, underweight and wasted children are also high at around 50 percent in each category (Figure 3).

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