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Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical
D Roberfroid1, P Kolsteren, T Hoerée
1Department of Public Health, Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium. drobertfroid@itg.be
Insights
Evidence is weak that Growth Monitoring and Promotion (GMP) programs effectively screen for malnutrition or improve child health. More research is needed to determine GMP
Area of Science:
- Child Health
- Public Health Nutrition
- Screening Programs
Background:
- Growth Monitoring and Promotion (GMP) programs are widely promoted in developing countries to improve child health.
- GMP aims to detect growth faltering early and use growth charts for education to improve child care practices.
Purpose of the Study:
- To systematically review the evidence on Growth Monitoring and Promotion (GMP) programs.
- To evaluate if GMP aligns with the theoretical framework of a screening and intervention program.
Main Methods:
- A systematic literature review was conducted.
- The WHO framework for screening programs guided the analysis of retrieved studies.
Main Results:
- Evidence is weak regarding GMP's effectiveness in screening for malnutrition and improving child nutrition status.
- Low effectiveness was observed in the promotional and educational aspects of GMP, with poor understanding of growth charts by mothers.
- Low attendance rates suggest limited acceptability, and evidence on cost-effectiveness is lacking.
Conclusions:
- Insufficient scientific evidence exists to support the universal promotion of Growth Monitoring and Promotion (GMP) programs.
- GMP may be a valid public nutrition strategy in specific contexts.
- Further research is recommended to refine prevention programs and identify optimal implementation strategies.
Objective:
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.
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