Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical analysis based on a systematic review

Abstract

Summaryobjective Growth Monitoring and Promotion programs (GMP) have been intensively promoted to improve children's health in developing countries. It has been hoped that regularly weighing children would result in the early detection of growth falterers, and that the growth chart would serve as an educational tool to make that state apparent to both health workers and caretakers in order to trigger improved caring practices. Our objective was to review whether GMP answers the theoretical grounds of a screening and intervention program.method A systematic literature review was performed. The WHO framework developed by Wilson and Jungner for planning and evaluating screening programs guided the analysis.results Sixty-nine studies were retrieved. Overall, evidence is weak on the performance of GMP as a screening program for malnutrition through early detection of growth falterers. The main results are:(1) malnutrition remains a public health problem, but its importance is context specific; (2) the value of a low weight velocity to predict malnutrition is unknown and likely to vary in different contexts; (3) the performance of GMP for improving nutrition status of children and in reducing mortality and morbidity is unknown; (4) the performance of the screening is affected by the unreliability of weight measurements; (5) the promotional and educational effectiveness of GMP is low, in particular the growth chart is poorly understood by mothers; (6) the acceptability seems low in regards of low attendance rates; (7) evidence is lacking regarding cost-effectiveness.conclusions We conclude that there is too little scientific evidence to indiscriminately support international promotion of GMP. However GMP could constitute a valid strategy of public nutrition in specific situations. We indicate paths for further research and how prevention programs could be developed.

Caregivers Knowledge, Attitude and Practices on Child Growth Monitoring and Promotion Activities in Lawra District, Upper West Region of Ghana

“…Contrary to findings from a study by [14], the study discovered that caregivers had poor participation in growth monitoring and promotion. Nevertheless, the findings were similar to the findings of a study conducted by [15] which found out that mothers in growth monitoring program have good preventive behaviour.…”

Child feeding knowledge and practices among women participating in growth monitoring and promotion in Accra, Ghana

“…These practices do not enable the GMP programme to effectively improve mothers' knowledge and practices for better child growth outcomes [11,12]. The poor delivery of counselling has been attributed to a lack of required knowledge and skills on the part of health workers, heavy demand relative to personnel, lack of incentives and motivation, inadequate supervision, uncooperative and mistrusting mothers [12,27,35,36]. …”

Nurses' monitoring of the Road to Health Chart at primary healthcare level in Makhado, Limpopo province

“…Similar studies suggest that a poor understanding of the growth chart and its purpose was a major reason why the monitoring programmes failed and fell into disrepute. 5,15,22 De Onis showed that more than half of the countries evaluated by UNICEF in 1978 and in 1999/2000, experienced difficulties with the use of the RTHC. 18 Many RTHCs reflected missed immunisation opportunities.…”

“…16 Twenty-nine per cent of healthcare workers in developing countries throughout the world have a poor understanding of the growth curve reference. 22 They seldom asked to see the RTHC, did not plot the weight of the child in the RTHC during consultations, and demonstrated poor identification of children with malnutrition whose weight remained below the third percentile over time. 3 This was observed at all levels of health care, namely primary, secondary and even tertiary.…”