Implementation of the WHO Multicentre Growth Reference Study in the United States

The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) North American site was Davis, California. For the longitudinal cohort (0-24 months), 208 infants were enrolled between January and December 1999 from five area hospitals at which nearly all Davis women give birth. The target sample size was lower in the United States than in the other sites, because recruitment in the United States was restricted to mothers who were willing to exclusively breastfeed for at least 4 months and continue breastfeeding for at least 12 months. For the cross-sectional component, a mixed-longitudinal design was used, which required approximately 500 subjects. The subjects were recruited by going door-to-door, with the sampling scheme based on the distribution of the subjects of the longitudinal study within the city. The cross-sectional sample was recruited between January and July 2001. Major challenges during implementation were maintaining daily communication with hospital personnel and scheduling home visits.