Pilot testing of WHO child growth standards in Chandigarh: implications for India's child health programmes
Shankar Prinja1, Jarnail Singh Thakur, Satpal Singh Bhatia
1Postgraduate Institute of Medical Education and Research, School of Public Health, Chandigarh, India.
Insights
The new World Health Organization (WHO) growth standards reveal lower overall underweight prevalence in children compared to Indian Academy of Paediatrics (IAP) curves. These WHO standards offer better growth tracking, particularly for infants and severely malnourished children.
Area of Science:
- Pediatrics
- Public Health
- Growth Monitoring
Background:
- Accurate growth monitoring is crucial for early detection of malnutrition in children.
- Existing growth curves, such as the Indian Academy of Paediatrics (IAP) curves, may differ from global standards.
- The World Health Organization (WHO) Child Growth Standards provide a global reference for child development.
Purpose of the Study:
- To compare the prevalence of underweight in children under six years using the IAP growth curves and the new WHO Child Growth Standards.
- To evaluate the differences in nutritional status assessment between the two sets of growth references.
Main Methods:
- A random sample of 806 children under six years from Chandigarh, India, were assessed.
- Children's weight-for-age was calculated using both IAP growth curves and WHO growth references.
- Nutritional status was analyzed using WHO Anthro statistical software, with statistical significance determined by the chi2 test.
Main Results:
- Underweight prevalence in the first six months was 1.6 times higher with WHO standards compared to IAP curves.
- Overall underweight prevalence was 1.4 times higher when using IAP standards instead of WHO standards.
- Severe malnutrition was estimated to be 3.8 times higher using WHO standards than IAP standards.
Conclusions:
- The new WHO growth standards indicate a lower prevalence of overall underweight children compared to IAP standards.
- WHO standards offer superior growth tracking, especially for infants and severely malnourished children.
- Adoption of WHO standards is recommended for more accurate global growth assessment.
Objective:
To compare the prevalence of underweight as calculated from Indian Academy of Paediatrics (IAP) growth curves (based on the Harvard scale) and the new WHO Child Growth Standards.
Methods:
We randomly selected 806 children under 6 years of age from 45 primary anganwadi (childcare) centres in Chandigarh, Punjab, India, that were chosen through multistage stratified random sampling. Children were weighed, and their weight for age was calculated using IAP curves and WHO growth references. Nutritional status according to the WHO Child Growth Standards was analysed using WHO Anthro statistical software (beta version, 17 February 2006). The chi2 test was used to determine statistical significance at the 0.05 significance level.
Findings:
The prevalence of underweight (Z score less than -2) in the first 6 months of life was nearly 1.6 times higher when calculated in accordance with the new WHO standards rather than IAP growth curves. For all ages combined, the estimated prevalence of underweight was 1.4 times higher when IAP standards instead of the new WHO standards were used. Similarly, the prevalence of underweight in both sexes combined was 14.5% higher when IAP standards rather than the new WHO growth standards were applied (P < 0.001). By contrast, severe malnutrition estimated for both sexes were 3.8 times higher when the new WHO standards were used in place of IAP standards (P < 0.001).
Conclusion:
The new WHO growth standards will project a lower prevalence of overall underweight children and provide superior growth tracking than IAP standards, especially in the first 6 months of life and among severely malnourished children.
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