The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries

Abstract

Background Undernutrition in the critical first 1000 days of life is the most common form of childhood malnutrition, and a significant problem in low‐ and middle‐income countries (LMICs). The effects of undernutrition in children aged under five years are wide‐ranging and include increased susceptibility to and severity of infections; impaired physical and cognitive development, which diminishes school and work performance later in life; and death. Growth monitoring and promotion (GMP) is a complex intervention that comprises regular measurement and charting of growth combined with promotion activities. Policymakers, particularly in international aid agencies, have differing and changeable interpretations and perceptions of the purpose of GMP. The effectiveness of GMP as an approach to preventing malnutrition remains a subject of debate, particularly regarding the added value of growth monitoring compared with promotion alone. Objectives To evaluate the effectiveness of child growth monitoring and promotion for identifying and addressing faltering growth, improving infant and child feeding practices, and promoting contact with and use of health services in children under five years of age in low‐ and middle‐income countries. Search methods We used standard, extensive Cochrane search methods. The latest search date was 3 November 2022. Selection criteria We included randomised controlled trials (RCTs), cohort studies, and controlled before‐after studies that compared GMP with standard care or nutrition education alone in non‐hospitalised children aged under five years. Data collection and analysis We used standard Cochrane methods to conduct a narrative synthesis. Our primary outcomes were anthropometric indicators, infant and child feeding practices, and health service usage. Secondary outcomes were frequency and severity of childhood illnesses, and mortality. We used GRADE to assess the certainty of evidence for each primary outcome. Main results We included six studies reported in eight publications. We grouped the findings according to intervention. Community‐based growth monitoring and promotion (without supplementary feeding) versus standard care We are unsure if GMP compared to standard care improves infant and child feeding practices, as measured at 24 months by the proportion of infants who have fluids other than breast milk introduced early (49.7% versus 70.5%; 1 study; 4296 observations; very low‐certainty evidence). We are unsure if GMP improves health service usage, as measured at 24 months by the proportion of children who receive vitamin A (72.5% versus 62.9%; 1 study; 4296 observations; very low‐certainty evidence) and the proportion of children who receive deworming (29.2% versus 14.6%; 1 study; 4296 observations; very low‐certainty evidence). No studies reported selected anthropometric ind...