Health staff understanding, application, and interpretation of growth charts in Nigeria

Area of Science:

• Pediatrics
• Public Health
• Growth Monitoring

Background:

• Accurate interpretation of infant growth patterns is crucial for timely intervention.
• Traditional Road-to-Health (RTH) charts have been used for decades to monitor child growth.
• The World Health Organization (WHO) introduced new growth charts to potentially improve growth assessment.

Purpose of the Study:

• To compare the accuracy of plotting and interpretation of infant weight gain patterns.
• To evaluate performance using both RTH and new WHO growth charts in Enugu, Nigeria.
• To assess health staff's ability to identify and respond to different weight gain trajectories.

Main Methods:

• Child health staff plotted standard weight data onto both RTH and WHO chart formats.
• Twelve charts were created, simulating fast, steady, and slow weight gain for average and small infants.
• 222 healthcare professionals (nurses, doctors, nutritionists) interpreted presented growth charts and proposed actions.

Main Results:

• Plotting accuracy was similar for both RTH and WHO charts.
• Interpretation of weight gain patterns was generally poor on both chart types.
• Recognition of slow weight gain improved significantly on WHO charts (40-65%) compared to RTH charts (19-35%).
• However, WHO charts led to over-identification of slow weight gain in normally growing small infants.
• Final attained weight influenced staff ratings more than the actual weight gain pattern.

Conclusions:

• Healthcare staff demonstrated difficulty in recognizing slow infant weight gain, relying more on current weight than growth trends.
• The new WHO growth charts offer improved recognition of slow weight gain but require careful interpretation to avoid misclassification.
• Further training is needed to enhance health staff's ability to accurately interpret growth charts and guide appropriate interventions.