Growth monitoring and promotion: review of evidence of impact

Abstract

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...

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.…”

“…The direction of growth curve line indicates whether it is rising in parallel to the reference curve (a good sign), remaining flat (an early warning sign), or falling or descending (dangerous). 5 Four conditions are important for the growth charts to be useful. Firstly, the data on the weight and the age of the child must be reasonably accurate.…”

The Management of Conflict in Nutrition Policy Formulation: Choosing Growth-Monitoring Indicators in the Context of Dual Burden

“…In a recent WHO survey, 154 of 178 (88%) Ministries of Health across both developed and developing countries reported that they monitor child growth [15]. The logic behind the practice is that "monitoring growth by plotting a child's weight at regular intervals and comparing the pattern of growth to reference curves of healthy children… provides an early warning signal and a trigger for early action, " along with population-based data to inform national nutrition priorities [16].…”

Modeling of Food and Nutrition Surveillance in Primary Health Care

“…Food and nutrition surveillance is, thus, understood as an intervention that allows monitoring and assessing FNS-related social policies [11][12][13] . The data produced locally by PHC are useful for managers of the health sector, and through the intersectoral articulation of this with other sectors such as education, agriculture, social assistance, habitation, supply, social security, and labor, among others, to make decisions that enable achieving Food and nutrition surveillance [7][8][9][10]13 .…”

“…Timely, quality, and representative monitoring of the population's food and nutrition profile would allow identifying the scope of these policies to improve their execution, establish courses of action, and provide an account, to the society, of the huge resources invested towards social participation and accountability [6][7][8][9][10][11][12][13] .…”