Health Organization Multicentre Growth Reference Research Articles

Anthropometric measurements of term babies delivered in a mission hospital in Southwest Nigeria.

Babies birth anthropometric measurements are useful for retrospective assessment of foetal in utero health status, anticipatory care and growth monitoring. At community level, measurements other than birth weight (BW) may help predict low BW (LBW). The aim of the study was to determine the mean anthropometric measurements of term babies, its comparability with standard values, acceptable cutoff and surrogate for LBW. A cross-sectional study involving 257 term babies delivered by booked mothers at the Sacred Heart Hospital Abeokuta and selected by systematic random sampling. BW, occipitofrontal circumference (OFC), chest circumference (CC), mid-upper arm circumference (MUAC) and crown-heel length (CHL) were measured, and data were analysed using SPSS version 21 with significant P < 0.05 and confident interval of 95%. Mean BW, CC, OFC, CHL and MUAC were 3.25 ± 0.47 kg, 33.32 ± 1.98 cm, 34.7 ± 1.93 cm, 48.16 ± 2.87 cm and 11.57 ± 1.41 cm, respectively, with no significant mean difference between male and female babies. The mean OFC was higher than the national standard, World Health Organization Multicentre Growth Reference Study (WHO-MGRS) and INTERGROWTH-21. The mean cutoff for LBW was OFC - 31.89 cm, CC - 29.56 cm, CHL- 43.33 cm and MUAC - 9.35 cm (P = 0.000) with OFC being the best surrogate of LBW at Sensitivity, Specificity and Degree of Accuracy/area under the curve of 66.7%, 97.6% and 82.1% respectively. LBW babies had lower mean anthropometric cutoff values at variance from the WHO-MGRS and INTERGROWTH-21. Mean OFC was higher than both standards reflecting the need for cautious interpretation to prevent misdiagnosis of macrocephaly. We recommend OFC as an alternative for predicting LBW when access to weighing scale is a challenge.

Association of Practices Regarding Infant and Young Child Feeding with Anthropometry Measurements Among an Urban Population in Karnataka, India.

BackgroundMothers' knowledge of infant and young child feeding (IYCF) play a crucial role in the overall growth and development of a child, determined by their anthropometry. Malnutrition has been linked to the short- and long-term effects on child health and, ultimately, national development. This community-based cross-sectional study focuses on the nutritional parameters of infants and young children in an urban slum population. The primary objective was to study IYCF from birth up to two years of age. The secondary objective involved studying the association between feeding practices and anthropometric measurements among children of 12-23 months of age.MethodsThe mothers of 96 children who were between 12 and 23 months of age, living in the urban slum of B.K Nagar, Bangalore, India, were administered the United Nations Children's Fund (UNICEF) IYCF questionnaire. Breastfeeding and complementary feeding information from these children from birth to 24 months were obtained. Anthropometric measurements were measured with appropriate calibrations.ResultsThe population consisted of 57.3% females and 42.7% males. All children had mean anthropometric measurements below the World Health Organization Multicentre Growth Reference Study (WHO-MGRS) standard (weight for age in males, P=0.009, and females P=0.005). A delay in the initiation of breastfeeding was observed in female children (54.5%), showing a significant reduction in their weight (P=0.020) as compared to those initiated early. There was also a declining trend of continuation of breastfeeding from age 12 months to 23 months. The study revealed a high consumption of gripe water (68.8%) and bottle feeding (40.4%). A significant difference was found in children who consumed nutritious food, especially meat, with height (P=0.018) and weight (P=0.011), along with other foods.ConclusionIYCF and anthropometry have a direct association, evidence of which is reflected by the mother’s knowledge of feeding practices along with other socioeconomic parameters.

Fetal growth standards: the NICHD fetal growth study approach in context with INTERGROWTH-21st and the World Health Organization Multicentre Growth Reference Study.

Three recently completed longitudinal cohort studies have developed intrauterine fetal growth charts, one in the United States and two international. This expert review compares and contrasts the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies, INTERGROWTH-21st and World Health Organization Multicentre Growth Reference Study conclusions in light of differences in aims, sampling frames, and analytical approaches. An area of controversy is whether a single growth reference is representative of growth, regardless of ethnic or country origin. The INTERGROWTH and World Health Organization Fetal studies used a similar approach as the World Health Organization Multicentre Growth Reference Study for infants and children, the aim of which was to create a single international reference for the best physiological growth for children aged 0-5 years. INTERGROWTH made the same assumption (ie, that there would be no differences internationally among countries or racial/ethnic groups in fetal growth when conditions were optimal). INTERGROWTH found differences in crown-rump length and head circumference among countries but interpreted the differences as not meaningful and presented a pooled standard. The World Health Organization Multicentre Growth Reference Study was designed to create a pooled reference, although they evaluated for and presented country differences, along with discussion of the implications. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Study was designed to assess whether racial/ethnic-specific fetal growth standards were needed, in recognition of the fact that fetal size is commonly estimated from dimensions (head circumference, abdominal circumference, and femur length) in which there are known differences in children and adults of differing racial/ethnic groups. A pooled standard would be derived if no racial/ethnic differences were found. Highly statistically significant racial/ethnic differences in fetal growth were found resulting in the publication of racial/ethnic-specific derived standards. Despite all 3 studies including low-risk status women, the percentiles for fetal dimensions and estimated fetal weight varied among the studies. Specifically, at 39 weeks, the 50th percentile for estimated fetal weight was 3502 g for whites, 3330 g for Hispanics, 3263 g for Asians, and 3256 for blacks in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study, compared with 3186 g for INTERGROWTH and 3403 g for World Health Organization Multicentre Growth Reference Study. When applying these standards to a clinical population, it is important to be aware that different percentages of small- and large-for-gestational-age fetuses will be identified. Also, it may be necessary to use more restrictive cut points, such as the 2.5th or 97.5th, for small-for-gestational-age or large-for-gestational-age fetuses, respectively. Ideally, a comparison of diagnostic accuracy, or misclassification rates, of small-for-gestational-age and large-for-gestational-age fetuses in relation to morbidity and mortality using different criteria is necessary to make recommendations and remains an important data gap. Identification of the appropriate percentile cutoffs in relation to neonatal morbidity and mortality is needed in local populations, depending on which fetal growth chart is used. On a final point, assessment of fetal growth with a one-time measurement remains standard clinical practice, despite recognition that a single measurement can indicate only size. Ultimately, it is knowledge about fetal growth in addition to other factors and clinical judgment that should trigger intervention.

Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years.

BackgroundLead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows.MethodsWhole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20–40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses.ResultsMedian (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6–6.3) μg/dl and 4.2 (1.7–7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20–40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02–1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94–1.00).ConclusionsThere is a significant association between stunting and concurrent lead exposure at age 20–40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20–40 months is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0190-4) contains supplementary material, which is available to authorized users.

Web-Based Versus Conventional Training for Medical Students on Infant Gross Motor Screening.

Early detection of developmental abnormalities is important for early intervention. A simple screening method is needed for use by general practitioners, as is an effective and efficient training method. This study aims to evaluate the effectiveness, acceptability, and usability of Web-based training for medical students on a simple gross motor screening method in infants. Fifth-year medical students at University of Indonesia in Jakarta were randomized into two groups. A Web-based training group received online video modules, discussions, and assessments (at www.schoology.com ). A conventional training group received a 1-day live training using the same module. Both groups completed identical pre- and posttests and the User Satisfaction Questionnaire (USQ). The Web-based group also completed the System Usability Scale (SUS). The module was based on a gross motor screening method used in the World Health Organization Multicentre Growth Reference Study. There were 39 and 32 subjects in the Web-based and conventional groups, respectively. Mean pretest versus posttest scores (correct answers out of 20) were 9.05 versus 16.95 (p=0.0001) in the Web-based group and 9.31 versus 16.88 (p=0.0001) in the conventional group. Mean difference between pre- and posttest scores did not differ significantly between the Web-based and conventional groups (mean [standard deviation], 7.56 [3.252] versus 7.90 [5.170]; p=0.741]. Both training methods were acceptable based on USQ scores. Based on SUS scores, the Web-based training had good usability. Web-based training is an effective, efficient, and acceptable training method for medical students on simple infant gross motor screening and is as effective as conventional training.

Crescimento humano: parâmetros e reflexões acerca de referenciais

The research “Growth parameter of Sri Lankan children during infancy: a comparison with world health organization multicentre growth reference study “, by P.J. Perera et al.1, published in this issue of the journal is basically whether the WHO reference 20062 is appropriate for the Sri Lanka, due to the results presented, it necessarily causes some reflections on the growth of children, the determinants and implications, both for the primary care of children and adolescents in general, as for the use of growth as an indicator of welfare of the population groups. First of all we need to consider that such research, in its methodological aspects, was performed in a proper and careful manner, which confers robustness to their results, sine qua non characteristics to perform any considerations. The first consideration is related to the extreme care that must be taken when evaluating growth based on results obtained from the use of a reference (curve) of growth. Whatever the reference used, the results must be carefully analyzed3, even when resorting to a reference done with the best methodological cares, as proposed by the WHO reference in 2006. We must always remember that this is only a reference; therefore it is more a descriptor of the growth trend than a standard that must be achieved by all in an absolute manner. The authors reflection about possible negative repercussions for breastfeeding in their country is a good example1, even assuming that the exchange of reference cannot be considered the only solution to such difficulties. A critically use, and not a purely mechanical analysis, when comparing the values obtained with the reference would probably be a better solution, including the educational aspects that would then arise. In this sense, the results of the study, interpreted from another angle of view, the collective, produce an estimation that 85% or more of the children from Sri Lanka in the first year of life are lower than the median of the reference or, what is even worse, that 50% of the total is below the 15th percentile of the reference length of WHO 2006, which indicates a very high prevalence of stunting. This induces a second thought: however it is known that the growth is a result of the interaction between genetics and environment4,5, it is not possible to consider that such growth deficit is due mainly to ethnic characteristics, therefore genetic, of the population of Sri Lanka, even accepting what the authors say about the sample, i.e. a population relatively well situated within the socio-economic scenario of the country. It is not always possible to achieve an optimal growth pattern (if it exists). It is often important to try to understand whether a particular child (or a group of children) is having a growth that is compatible with the expression of their potential in the environment they live in, because if they are under, not in the referential, but the best possible under the circumstances, it will require for us to comprehend the reasons in order to produce some consistent way of intervention to optimize the growth in that particular environment. As a result, a third reflection becomes necessary considering the demographic, epidemiological and, especially, the nutritional6 transitions. Popkin believes that the nutrition transition is composed of several stages, among which there is one in which coexist a population with absence of severe protein-energy malnutrition, the presence of stunting (possible sequel of chronic malnutrition in the first years of life) and a gradually increase of the prevalence of overweight and obesity that progressively ends up also extending towards the layers of lower socioeconomic status. In addition, Journal of Human Growth and Development 2014; 24(1): 7-10 EDITORIAL

Growth parameters of Sri Lankan children during infancy: A comparison with world health organization multicentre growth reference study

Objectives: growth monitoring (GM) is an important intervention ensuring wellbeing of children. If GM to be meaningful it is essential to have reference standards appropriate for that population. In Sri Lanka growth charts based on WHO multi centre growth reference study (MGRS) are used for GM. This study was carried out to ascertain the appropriateness of MGRS charts for GM in Sri Lankan children. Methods: out of a birth cohort of 2215 children, 250 from each sex were invited fora followed up. Children were examined at 2, 4, 6, 9 and 12 months, to measure weight and length. Statistical characteristics of weight and length for each sex were calculated and compared with MGR data. Results: out of babies invited to participate in the study 244 boys and 241 girls responded initially. Out of this 85% of boys and 86% of girls completed the follow up. Weight and length of both sexes deviated significantly at all ages from MGRS data. Conclusion: MGRS data seems to be inappropriate for monitoring growth of Sri Lankan children

Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study.

Linear growth from birth to 2 years of children enrolled in the World Health Organization Multicentre Growth Reference Study was similar despite substantial parental height differences among the six study sites. Within-site variability in child length attributable to parental height was estimated by repeated measures analysis of variance using generalized linear models. This approach was also used to examine relationships among selected traits (e.g. breastfeeding duration and child morbidity) and linear growth between 6 and 24 months of age. Differences in intergenerational adult heights were evaluated within sites by comparing mid-parental heights (average of the mother's and father's heights) to the children's predicted adult height. Mid-parental height consistently accounted for greater proportions of observed variability in attained child length than did either paternal or maternal height alone. The proportion of variability explained by mid-parental height ranged from 11% in Ghana to 21% in India. The average proportion of between-child variability accounted for by mid-parental height was 16% and the analogous within-child estimate was 6%. In the Norwegian and US samples, no significant differences were observed between mid-parental and children's predicted adult heights. For the other sites, predicted adult heights exceeded mid-parental heights by 6.2-7.8 cm. To the extent that adult height is predicted by height at age 2 years, these results support the expectation that significant community-wide advances in stature are attainable within one generation when care and nutrition approximate international recommendations, notwithstanding adverse conditions likely experienced by the previous generation.

Growth monitoring: a survey of current practices of primary care paediatricians in Europe.

ObjectiveWe aimed to study current practices in growth monitoring by European primary care paediatricians and to explore their perceived needs in this field.MethodsWe developed a cross-sectional, anonymous on-line survey and contacted primary care paediatricians listed in national directories in the 18 European countries with a confederation of primary care paediatricians. Paediatricians participated in the survey between April and September 2011.ResultsOf the 1,198 paediatricians from 11 European countries (response rate 13%) who participated, 29% used the 2006 World Health Organization Multicentre Growth Reference Study growth charts, 69% used national growth charts; 61% used software to draw growth charts and 79% did not use a formal algorithm to detect abnormal growth on growth charts. Among the 21% of paediatricians who used algorithms, many used non-algorithmic simple thresholds for height and weight and none used the algorithms published in the international literature. In all, 69% of paediatricians declared that a validated algorithm to monitor growth would be useful in daily practice. We found important between-country variations.ConclusionThe varied growth-monitoring practices declared by primary care paediatricians reveals the need for standardization and evidence-based algorithms to define abnormal growth and the development of software that would use such algorithms.

Socioeconomic predictors of unconstrained child growth in Muscat, Oman

We conducted a study to identify socioeconomic factors associated with unconstrained growth among preschoolers in Muscat, Oman. A sample of children born in 1995 and aged 28-43 months was drawn from the Child Health Registers of 2 health care centres. Sociodemographic data were collected by oral interview and maternal and child anthropometry measured. Regression analysis was used to identify socioeconomic indicators and cut-offs associated with unconstrained growth. Children from households with a monthly income > or = 800 Omani rials and mother's education > or = 4 years attained height-for-age levels comparable to the current international growth reference. By screening using this criterion, we could obtain a suitable sample for the World Health Organization Multicentre Growth Reference Study in Muscat.