Cost-effectiveness of growth monitoring and promotion

Abstract

50 million children/year are in growth monitoring and promotion (GMP) programs in developing countries and 30 million growth charts are printed annually in India alone. GMP is a simple technology of weighing and charting, but it must be properly implemented under conditions that are conducive to program success. Critics of GMP argue that its effectiveness remains to be proved. If GMP programs lead to improved growth, health, and nutritional status, will it work when expanded to the national level and is it cost-effective? A community intervention trial in South India considered the cost-effectiveness component of these concerns, but yielded only mixed results and the recommendation that replicate studies be conducted in other countries. An observational study of 179 health workers in 100 rural health facilities in 9 developing countries found deficiencies so severe in weighing, plotting, and interpreting that GMP activities simply consumed time and resources which could have been better allocated elsewhere within the health system. GMP is unlikely to succeed in the absence of training and supervision for assessment, analysis, and action. Community involvement in and ownership of GMP are also recommended.