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  • Title: Utility of growth monitoring: its relevance in the promotion of child health.
    Author: Kapil U, Joshi A, Nayar D.
    Journal: Indian Pediatr; 1994 Feb; 31(2):239-44. PubMed ID: 7875860.
    Abstract:
    Growth monitoring (GM) in India is a strategy to detect early growth retardation, promote optimum growth, create awareness about growth among mothers, enhance delivery of primary health care, and identify those at risk of malnutrition. Anthropometric measures include weight, height, mid-upper arm circumference, chest circumferences, and the ratio of chest to head circumference. Weight-for-age is the recommended measure of growth, because of the measure's sensitivity to change. In developing countries preventive growth charts are used. In developed countries curative growth charts are used and require decimals of age and the ability to use graphs. The weight measure is sensitive to changes due to malnutrition. Maternal maintenance of a growth card provides a visual reminder about the nutrition and health of her child, an immunization record, feeding patterns, and child spacing. Growth monitoring programs involved weighing, maintaining growth charts, promoting health advice among mothers, following-up by health workers, arranging mothers' meetings, maintaining home visits by health workers, and supplying other health care services such as immunization, birth spacing promotion, and oral rehydration information and supplies. Growth monitoring and growth surveillance are different but complementary. Growth monitoring is not just periodic nutritional assessment. Growth monitoring involves improving interactions between mothers and the community, educating about nutrition, and improving child health. 33% of India's administrative blocks (2600 blocks) are involved in the Integrated Child Development Services (ICDS), which promote child health and nutritional status. The "anganwadi" worker serves as the main functionary for an area of about 1000 total population. Slowness of growth has been reported as disregarded in favor of attention to severe malnourishment. Success of growth monitoring was determined to be contingent on early identification of growth faltering, being part of the primary care system, having adequate supplies of weighing equipment, providing nutrition and health education, having community support, and providing referral services. Deficits in selected ICDS programs were lack of skills to use growth charts. Quality of programs varied widely. Recommendations were made for future improvements.
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