Construction of a Community Height Surveillance Programme: The Hackney Growth Initiative

Abstract

Objectives -To determine why, in the London Borough of Hackney before 1990, fewer children than expected were identified with remedial causes of short stature. To construct a practical model for height surveillance of 5 and 11 year old school entrants to improve the quality of child growth surveillance. Setting -City and Hackney Borough, London, United Kingdom. Methods -School nurses were trained by a clinical auxologist to measure children's height at school entry accurately and reproducibly. New procedures for measurement technique, plotting of data, referral, and audit were established. A reference manual was provided and a continuing training programme was started. Results -During the first year the percentage of the target group measured was low. Changes in work practice led to improvements from 77% measured in the first year to 91% in the second year and 87% in the third year for 5 year olds. Improvements for 11 year olds were from 36% to 86% to 87% over the three years. Only 1·2% of 5 year olds and 2·6% of 11 year olds measured had height less than the third centile (compared with Tanner's height standards). Conclusions -School nurses measured height reliably. New audit procedures led to rapid changes in working practice and improvements in the percentage of children measured. The low numbers of short children previously identified with UDrecognised abnormality may indicate an upward trend in height in this inner city population.

Effectiveness and cost-effectiveness of height-screening programmes during the primary school years: a systematic review

“…Five other studies described screening programmes involving children of primary-school age (but not restricted to school entry) 18 29 31 33 35. Two studies included a group of older children as well as those at primary school 36 37. The study conducted in Germany38 differed from the others in that it involved a national network of paediatric practices and a computerised monitoring system into which routine height measurements for all children aged 0 to 18 were input on an ongoing basis.…”

A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions

“…Twelve studies provided data on growth-related conditions detected by growth monitoring programmes. 56,59,71,76,79,[81][82][83]86,87,91,93 Eight studies were conducted in the UK, 56,59,71,76,82,86,91,93 one in Sweden, 79 one in Spain, 81 one in Germany 83 and one in the USA. 87 All studies were of a 'diagnostic yield' design.…”

“…78,89,90 Three of the included growth monitoring programme studies reported cost data. 56,59,79 Four of the included growth monitoring programme studies reported on human resource-related data as part of the process of evaluating the monitoring programme 56,82,87,96 and eight of the included growth monitoring programmes used methods to ascertain or verify the height of children identified as meeting the predefined referral criteria. 56,59,76,79,81,82,91,93 Attitudes towards routine growth monitoring programmes…”

“…Twelve of the included growth monitoring programme studies provided data on the diagnostic yield of growth related conditions from routine growth monitoring. 56,59,71,76,79,[81][82][83]86,87,91,93 Only two studies 79,83 focused on conditions relating to tall stature and short stature; the remainder aimed to identify conditions of short stature only. A brief overview of the programmes is given in Table 6.…”

“…Some studies measured children of the same age group 59,71,76,86,93 whereas others studied a cross-section of ages using single or serial measurement but providing results only for the entire cohort rather than by age group. 56,79,[81][82][83]87,91 Full details of ages measured are given in Table 6. Table 7 gives details of personnel involved in measuring and the measuring equipment used.…”