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The value of intermittent growth monitoring in primary health care programmes
I H Thaver1, F Midhet, R Hussain
1Department of Community Health Sciences, Aga Khan University, Karachi.
Insights
Monthly weighing for child growth monitoring is often unfeasible. This study suggests intermittent weighing at 6 and 9 months can effectively identify children at risk of malnutrition in public health programs.
Area of Science:
- Pediatrics
- Public Health
- Nutrition
Background:
- Early detection of growth faltering is crucial to prevent severe malnutrition in children.
- Traditional monthly weighing for growth monitoring is operationally challenging in large-scale public health programs.
- Sustainable outreach programs require feasible monitoring strategies.
Purpose of the Study:
- To propose an operationally feasible intermittent growth monitoring strategy for public sector primary health care (PHC) programs.
- To determine the correlation between children's weights at different ages and subsequent weight measurements.
- To identify optimal ages for intermittent weighing to predict future malnutrition.
Main Methods:
- A historical prospective study was conducted using growth cards from 292 children in Karachi.
- Children were monitored within a primary health care (PHC) program.
- Weight data up to 24 months were analyzed for correlations and malnutrition risk.
Main Results:
- At six months, 71% of children were within the normal weight range.
- With increasing age, 10% to 39% of children progressed to Grade I Protein Energy Malnutrition (PEM).
- Weight measurements at 6 and 9 months showed significant correlation (P < 0.001) with future nutritional status, indicating their prognostic value.
Conclusions:
- Malnutrition onset is observable from 6 months of age.
- Weights at 6 months, and to a lesser extent at 9 months, are strong predictors of future malnutrition.
- Intermittent weighing at these key ages allows early identification and management of high-risk children, potentially preventing severe malnutrition.
Abstract:
The objective of growth monitoring is to detect early growth faltering before the child becomes severely malnourished. It has been found in many large projects in the private sector and in Government run Primary Health Care (PHC) programmes that monthly weighing is not feasible which makes it impossible to develop a functional outreach programme on a sustainable basis. This study is an attempt to propose an intermittent growth monitoring which is operationally feasible for large scale PHC programmes in the public sector. A historical prospective study was conducted to find out the correlation of weights of children at different ages with weights at subsequent months. Two hundred and ninety-two growth cards of children were selected from two squatter settlements of Karachi which are having a PHC programme through the Aga Khan University. At six months, about 71% of children were within the normal range, with increasing age from 10% to 39% of these children shifted to grade I Protein Energy Malnutrition (PEM). When weights of children for each month were correlated with weights at all other months up to 24 months, it was found that correlation coefficient at 6th and 9th month were significant (P value < 0.001). Probability of developing malnutrition at different weights and ages were also calculated. The results indicate that malnutrition starts appearing at 6 months and weights at 6 months and to a lesser extent at 9 months are better prognostic indices of future malnutrition. Intermittent weighing of children can help in early identification of "high risk" children who can then be managed and even be prevented from developing future malnutrition.