Growth parameters of under 2-year-old Indian children: A comparison to WHO MGRS 2006 charts

Abstract

Context: Growth is an important biological process by which an individual reaches a point of complete physical development. Growth monitoring of a child is a very important utility to detect the deviation from normal growth. In India, for children below 2 years of age WHO multicentre growth reference study (MGRS) 2006 charts are being used for growth monitoring, which were prepared by measuring children from six different countries who were raised in optimum conditions of health and nutrition. Aim: This study was carried out to verify the appropriateness of the WHO MRGS 2006 charts to monitor the growth of Indian children who are below 2 years of age. Settings and Design: The study was carried out in a tertiary care hospital in Pune, Maharashtra. Materials and Methods: A total of 1947 children [1089 boys (55.9%)] were measured for weight, length and head circumference. Z score for each observed value was calculated according the similar but gender-specific WHO MGRS 2006 growth charts. Statistical Analysis Used: The age- and sex-specific Z-scores or standard deviation scores along with prevalence were obtained for each study parameter using WHO standards. Results: A total of 24.08%, 21.31%, and 20.54% of the children were classified as underweight, stunted and microcephalic respectively when compared to the WHO MGRS 2006 growth charts. Conclusion: The WHO MGRS 2006 charts may not be appropriate for growth monitoring of Indian children below 2 years of age and there is a need formulate growth charts which can reflect the growth of Indian children.

World variation in head circumference for children from birth to 5 years and a comparison with the WHO standards

“…However, there are indications that infants in some Asian countries may have relatively smaller heads in the first month of life, though not later, while Indians, particularly boys, may have smaller heads at all ages before 5 years. A more recent study among 0–2 year-old Indian infants from middle to upper income groups similarly reported WHO standards classified 26% boys and 14% girls as microcephalic (<−2SD) 38. These observations in Asian children differ from those among European and particularly UK children who had larger heads than the WHO standards from birth.…”

“…Given the observed ethnic differences in head size, there has already been advocacy for using population-specific references in clinical settings, instead of the WHO standards, in Ethiopia,8 Norway and Belgium4 or calling for caution when using WHO standards in India38 and in the UK 5. In particular, in the UK, where the greatest exaggeration of macrocephaly from birth to 3 years and rapid head growth in the first 6–9 months was observed, recommendations have been to use other indicative signs together with the WHO cut-offs (which were adopted for use in the UK in 2009) for deciding whether referral is required 5…”