Worldwide practices in child growth monitoring

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Abstract

Objective

To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference.

Study design

A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access.

Results

Responses were received from 178 (88%) countries, 154 of which included growth charts (n = 806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment).

Conclusions

The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.

Section snippets

Methods

A questionnaire on child growth charts was sent to the Ministries of Health in 202 countries and territories through WHO regional and country offices. The questionnaire was developed centrally and pretested for comprehensibility with nutritional advisers based in the six WHO regions. The questions were kept as short as possible for clarity and to improve responsiveness, and all but two had precoded answers. The original English version was translated into French and Spanish, and the translated

Results

Of the 202 countries and territories contacted, 178 (88%) responded to the questionnaire and 154 (76%) sent hard copies of growth charts (806 charts). Table I presents the coverage and response rate of the survey by geographic region.

The growth charts received differed in layout and age range covered. The majority (55%) were used for infants and young children (0 to 5 years) and 29% covered birth to adolescence (0 to 18 years), whereas the rest applied to variable age spans (eg, 0 to 6 years,

Discussion

A worldwide survey of national practices in the use and interpretation of growth charts has been conducted. The high response rate demonstrated that growth monitoring is an intrinsic part of pediatric care around the world. This underscores the importance of taking advantage of the opportunity provided by the development of the new international growth reference to review existing practices and strengthen local programs to overcome current problems. In this process, the particular circumstances

Acknowledgements

We are grateful to Ms Monika Blössner for her assistance in the development of the survey questionnaire.

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