Comparison of Indonesian Growth Reference Chart and World Health Organization Child Growth Standard in Detecting Stunting: A Systematic Review and Meta-analysis of 15,874 Children

Abstract

Recognition of an overestimation of stunted children in Indonesia when using the World Health Organization Child Growth Standards (WHOCGS) led to the creation of the Indonesian Growth Reference Chart (IGRC) in 2005, with further improvement in 2018. This systematic review aimed to determine whether there is a difference in the diagnosis of stunting when using these two charts. This systematic review is registered in the PROSPERO database (CRD42021259934). Literature research was performed on PubMed, Science Direct, Medline, Scielo, Medrxiv, Research Square, SSRN, and Biorxiv to identify studies published from 2018 onwards that examined the comparison of IGRC and WHOCGS in detecting stunting. Three studies were included in this review. Pooled analysis showed that IGRC resulted in a lower prevalence of stunted and severely stunted children [risk ratio (RR): 0.28 (95% confidence intervals (CI): 0.15-0.51), p<0.0001, I2=97%]. Comparison between IGRC and WHOGCS for prevalence of normal height children showed that there was no difference, and this finding was not significant [RR: 1.56 (95% CI: 0.92-2.66), p=0.1, I2=100%], and the comparison for prevalence of tall children also showed that there was no difference when using IGRC or WHOGCS, and this finding was also insignificant [RR: 2.02 (95% CI: 0.78-5.20), p=0.14, I2=98%]. This meta-analysis showed that stunted and severely stunted Indonesian children are over-represented using WHOCGS. The difference between IGRC and WHOCGS has occurred because of the sample population, as IGRC includes children from all 33 provinces in Indonesia, better reflecting the growth of all children in Indonesia.