Pilot Testing of WHO Child Growth Standards: India Perspectives
More than 80% of undernourished children are located in 20 countries of the world, with India being home to more than half of the world’s underweight children. Nutritional programs and growth monitoring are justified on various arguments emerging from economics, social welfare and human rights approach. India’s Integrated Child Development Services (ICDS) program is a holistic program directed at overall child development including nutritional status by monitoring growth of children through active involvement of mothers. ICDS program uses an Indian Association of Pediatrics (IAP) classification based on Harvard standards to monitor growth of children under 5 years age.
Recently, in 2006, World Health Organization introduced new growth standards based on the Multicentre Growth Reference Study (MGRS). Government of India endorsed the new WHO growth standards for a phased introduction in India’s health and nutritional programs for monitoring child growth. We piloted the use of WHO growth standards in ICDS program in Chandigarh, India. The present chapter discusses the drawbacks of the old growth standards and provides justification for introduction of new WHO growth standards. We present the results of a study where we compared underweight prevalence among children under 5 years using the WHO growth standards and the IAP classification (using Harvard growth charts).
Our study shows that 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). In contrast, severe malnutrition estimated for both sexes was 3.8 times higher when the new WHO standards were used in place of IAP standards (P < 0.001).
The new WHO growth standards will project a lower prevalence of overall underweight children and provide superior growth tracking than do IAP standards, especially in the first 6 months of life and among severely malnourished children. This chapter concludes by highlighting that the use of growth monitoring can be successful only with concurrent active participation of the mothers of children. Programmatic efforts should focus on building the capacity of mothers in monitoring growth of children for improvement in health and nutritional status.
KeywordsWorld Health Organization Growth Standard Urban Slum Growth Monitoring National Family Health Survey
Body mass index
District Level Household Survey
Indian Association of Pediatrics
Indian Association of Preventive and Social Medicine
Integrated Child Development Services
International Institute of Population Sciences
Indian Public Health Association
Multicentre Growth Reference Study
National Center for Health Statistics
World Health Organization
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