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Table of Contents Summary86 1. Background88 1.1 History and development of growth monitoring programmes88 1.2 Objectives of growth monitoring89 2. Expected benefits of growth monitoring and growth promotion90 3. Objectives of this review91 4. Methodology91 5. Evidence of effectiveness of growth monitoring programmes91 5.1 Nutritional status and mortality of young children91  5.1.1 Studies before 199091  5.1.2 Studies since 199096 5.2 Utilization of primary health services103 6. Quality of implementation104 7. Caregivers' knowledge and understanding of growth charts105 8. Empowerment and community mobilization106 9. Coverage and attendance10710. Potential consequences if withdrawn10811. Feasibility and conditions under which growth monitoring and promotion can be expected to work10812. Cost‐effectiveness10913. Potential adverse consequences10914. Policy considerations and recommendations110References113 Summary The rationale for growth monitoring and promotion is persuasive but even in the 1980s the appropriateness of growth monitoring programmes was being questioned. The concerns centred largely around low participation rates, poor health worker performance and inadequacies in health system infrastructure that constrained effective growth‐promoting action. More recently there has been a call for a general review of the impact of large‐scale growth monitoring and promotion programmes to determine if the investments are justified. The launch of the new World Health Organization growth standard and charts has been a timely reminder of this debate. It is within this context that this review has been undertaken: the main purpose is to analyse the evidence that growth monitoring programmes are effective in conferring measurable benefits to the children for whom growth charts are kept. The benefits considered here are improved nutritional status, increased utilization of health services and reductions in mortality. There is evidence from small‐scale studies in Nigeria, Jamaica, India (Narangwal and Jamkhed), and from large programmes in Tanzania (Iringa), India (Tamil Nadu Integrated Nutrition Project), Madagascar and Senegal that children whose growth is monitored and whose mothers receive nutrition and health education and have access to basic child health services have a better nutritional status and/or survival than children who do not. There is tentative evidence from a large‐scale programme in Brazil (Ceara) that participation in growth monitoring confers a significant benefit on nutritional status independent of immunization and socio‐economic status. There is evidence from India (Integrated Child Development Services) and Bangladesh (Bangladesh Rural Advancement Committee and Bangladesh Integrated Nutrition Project) that growth monitoring has little or no effect on nutritional status in large‐scale programmes with weak nutrition counselling. There is evidence from Tamil Nadu in a randomized trial that when mothers are visited fortnightly at home and have unhurried counselling, no additional benefit accrues...

This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed.

Following a single blind, cross-over and non-randomized design we investigated the effect of 7-day use of chlorhexidine (CHX) mouthwash on the salivary microbiome as well as several saliva and plasma biomarkers in 36 healthy individuals. They rinsed their mouth (for 1 min) twice a day for seven days with a placebo mouthwash and then repeated this protocol with CHX mouthwash for a further seven days. Saliva and blood samples were taken at the end of each treatment to analyse the abundance and diversity of oral bacteria, and pH, lactate, glucose, nitrate and nitrite concentrations. CHX significantly increased the abundance of Firmicutes and Proteobacteria, and reduced the content of Bacteroidetes, TM7, SR1 and Fusobacteria. This shift was associated with a significant decrease in saliva pH and buffering capacity, accompanied by an increase in saliva lactate and glucose levels. Lower saliva and plasma nitrite concentrations were found after using CHX, followed by a trend of increased systolic blood pressure. Overall, this study demonstrates that mouthwash containing CHX is associated with a major shift in the salivary microbiome, leading to more acidic conditions and lower nitrite availability in healthy individuals.Chlorhexidine (CHX) has been commonly used in dental practice as antiseptic agent since 1970, due to its long-lasting antibacterial activity with a broad-spectrum of action 1 . Since then, many clinical trials have shown effective results of CHX for the clinical management of dental plaque and gingival inflammation and bleeding 2-4 . This is supported by other studies using in vitro methods and reporting positive results of CHX in reducing the proliferation of bacterial species associated with periodontal disease, such as Enterobacteria, Porphyromonas gingivalis, Fusobacterium nucleatum, as well as different species of Actinomyces and Streptococcus, including Streptococcus mutans, which is considered the main etiological agent of dental caries 4,5 . Other studies have also reported that the use of CHX was effective in the treatment of halitosis, especially in reducing the levels of halitosis-related bacteria colonising the dorsal surface of the tongue 6 .The anti-microbial activity of CHX however, has been extensively studied using in vitro culture methods, which limit the identification and cultivation of all microorganisms in the environment 4 . To the best of our knowledge, only one recent study has investigated the effect of CHX mouthwash on mixed bacterial communities (microbiome) of the tongue using new genome sequencing techniques such as 16 S rRNA 7 . The study found differences in over 10 different species colonizing the tongue, and a lower microbial diversity after using CHX for a week, but did not analyse other parameters related to oral health such as pH, lactate production or buffering capacity 7 . Additionally, we and others have recently shown that the use of CHX in healthy subjects can attenuate the nitrate-reducing activity of oral bacteria by at least 80% 8-11 . This in turn leads to lo...

SummaryTo date questionnaire surveys have been the most commonly used instruments to measure hygiene behaviours related to water and sanitation. More recently, a number of studies have used structured observations to study practices related to diarrhoea. During a trial of a hygiene education intervention to reduce diarrhoea among young children in Bandundu, Zaire, both instruments were used to measure the disposal of child faeces and various hand-washing practices. Three hundred families were observed and follow-up interviews performed with 274 (91%) mothers. At the individual level, agreement between observed and reported behaviour was little better than might be expected by chance. There was evidence of over-reporting of hand-washing before food preparation (44% vs 33%; P ϭ 0.03), hand-washing before eating (76% vs 60%; P Ͻ 0.001) and disposal of the child's faeces in a latrine (75% vs 40%; P Ͻ 0.001). On the other hand, hand-washing before feeding the child was reported less often than it was observed (7% vs 64%; P Ͻ 0.001). Our data are consistent with the hypothesis that, in general, mothers over-report 'desirable' behaviours. At the same time, our data indicate that open questions may lead to underreporting of certain behaviours. The repeatability of observations at both the individual and population levels remains to be established.

Background. There is a long tradition of communitybased rehabilitation for treatment of severe malnutrition: the question is whether it is effective and whether it should be advised for routine health systems.Objective.