Child Growth Monitoring Research Articles

The Effectiveness of Training and Mentoring Activities to Improve Cadre Performance in Child Growth Monitoring (CGM)

Routine growth monitoring of children in Indonesia is done through Posyandu. Posyandu cadres who have sufficient knowledge about Child Growth Monitoring (CGM) are needed to improve early detection of child malnutrition to prevent stunting. The ability to use WHO-Anthro software followed by mentoring programs is expected to help increase cadre capacity in CGM performance. This study aims to determine the effectiveness of training and mentoring activities in using WHO-Anthro software to improve cadres’ performance in monitoring children's growth. This research was a collaborative research with the Ministry of Health. This experimental research used one group pretest-posttest design. This research was conducted on 30 female cadres from 30 Posyandu in Semarang City, Indonesia. Intervention activities and data collection were carried out for three months. Data were analyzed by comparison tests. The results showed that after the intervention there was an increase in knowledge scores, practice scores and performance scores of cadres in CGM. It was concluded that training and guidance on the implementation of WHO-Anthro software improved cadre performance in CGM.

Strengthening growth monitoring among under-5-year children to fight childhood undernutrition in India.

Introduction:Growth monitoring of children in India is usually done by Anganwadi workers using weight-for-age growth charts. We wanted to assess the magnitude of various types of undernutrition among under-5 children using multiple growth charts and risk factors of undernutrition. We also wanted to assess if prevalence of undernutrition improves following sensitization of various stakeholders.Methodology:This is a single-arm prospective study conducted at a selected urban primary health center area in Puducherry. All the eligible 366 under-5 children and their mothers were included. Data were collected using pretested structured questionnaire. Assessment of nutritional status was done using three types of growth charts. Three home visits were made, at an interval of around 6 months, for monitoring the nutrition status of children.Results:The prevalence of undernutrition at baseline was 15.8% (95% CI 12–19.6). The prevalence of underweight, wasting, and stunting were 9.6%, 7.6%, and 7.3%, respectively. Weight-for-age growth chart could identify only 67% with stunting and 50% of children with wasting. The decrease in prevalence of wasting, underweight, and stunting were 63.6%, 44.8%, and 31.5%, respectively, over 1-year follow-up. Nutrition status could improve by prevention of low birth weight, ensuring gaps between births and promotion of breastfeeding and hand hygiene.Conclusion:It is important to use multiple growth charts for assessing nutritional status of children, instead of relying only on weight-for-age growth chart. Overreliance on use of weight-for-age growth chart will fail to identify more children with wasting. Under-5 undernutrition status can be decreased following intensive growth monitoring and planning appropriate actions involving various stakeholders.

Case Report: Medical Aspect, Growth, and Quality of Life in Children with 46,XX Testicular Disorder of Sex Development (DSD)

46,XX testicular disorder of sexual development (DSD) is characterized by male phenotype with 46,XX karyotype. The incidence rate is 1:25,000 in male newborn. Infants with ambiguous external genitals will be confronted with issue of gender assigment and may result in a stressful condition in the parents. Since gender assignment is inevitable, several factors should be considered in DSD management. The management approach for children born with DSD is individualized and multidisciplinary. Gender assignment aims to facilitate the patient to obtain the best quality of life. Adaptation of children with 46,XX testicular DSD as a determinant of quality of life is also influenced by psychological and family conditions. The purpose of this report was to observe medical growth and development aspects of the child with 46,XX terticular DSD as indicated by the aspects of growth and development, and health related quality of life, as well as the influential aspects. PA, 18 months, was diagnosed with 46,XX testicular DSD. The patient routinely visited to endocrinology clinic, urologic surgery, and child psychiatry clinic from the age of 6 months. The parents decided to raise patient as male. The patient had undergone surgery for hypospadias correction, hormone injections, child growth monitoring, and psychological monitoring (medical records of Dr. Soetomo Hospital, Surabaya in 2015). Management should consider individual and multidiciplinary accompaniment of the patient and parents, the importance of group support, and follow-up to adulthood, as well as possible longterm outcomes that will occur in the future so that the patients and the parents need to be prepared.

Understanding women's, caregivers', and providers' experiences with home-based records: A systematic review of qualitative studies.

Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants’ reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records’ potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems.

Lessons Learned from Introducing a Village Health Registry in Malawi.

The Village Health Registry (VHR) was a community health data collection tool introduced in 1998. It was first introduced in Mwanza district of Malawi with the objectives of collecting community-based data, analysing and taking action in a local setting. The tool was collecting and updating data such as demography, immunization status for children under one year, growth monitoring for children under five, monitoring of all pregnant women, incidence of malaria, acute respiratory infections, diarrhoea cases, water and sanitation and deaths, by visiting households in every village every month.The tool was able to collect all targeted information as required. The data collected by the tool appeared to be more reliable than that obtained through a national information system used by the Ministry of Health (MoH) for the same district and the same year. It was easy for health centres to accurately order supplies based on actual requirements, to follow-up cases during disease outbreaks and to identify deficiencies in immunisation coverage rates.Despite promising results, the VHR registry fell into disuse following the establishment of a national register. The MoH’s Health Information System (HIS) data used projections which normally did not represent the actual situation on the ground while the VHR registry gave real physical data which was representative and verifiable. The potential of the VHR outweighed that of the HIS. Although the HIS had been rolled out nationally, there were shortfalls which MoH could consider rectifying to reach its full potential. In conclusion, the VHR was worth adopting as it would give MoH realistic statistics to be effectively used at all levels.

Assessment of knowledge of AWWs regarding growth monitoring and impact of training on their knowledge in Amritsar district of Punjab, India

Background: Present study was planned to assess the existing knowledge and awareness among AWWs about growth monitoring and nutritional status of children and also to evaluate the impact of training on their knowledge.Methods: The study was carried out in the department of community medicine, SGRDIMSAR, Amritsar. A sample of 405 AWWs was selected by using simple random sampling technique. The data was collected by administering a predesigned and pretested Performa to the AWWs before and after each training session. Pre-test and post-test assessment was done to assess the existing knowledge of AWWs and also to evaluate impact of training on their knowledge regarding growth monitoring and nutritional status of children. The data collected was analyzed using SPSS 20.0 version.Results: The study revealed that majority (72.1%) of the workers fell into the category of poor knowledge and only 4.2% had good knowledge regarding growth monitoring and nutritional status of children before the training session. Age, educational status and work experience of AWWs were found to be significantly associated with their pre-test knowledge. There was statistically significant improvement in the knowledge of AWWs after training. Also, association between education level and post-test knowledge of AWWs was found to be significant.Conclusions: Regular in-service training or refresher training programmes should be organized for AWWs to enhance their knowledge regarding different aspects of ICDS especially growth monitoring and nutritional status.

Early detection of childhood obesity through extended routine growth monitoring of children below two years of age in the Asia Pacific region.

Introduction Increased body fat deposition during early life predisposes to higher obesity and metabolic disorder risks in later life. This is particularly relevant in the Asia Pacific region where historically prevalent under-nutrition is now been paralleled or even overruled by over-nutrition over the last few decades. This overview aims to evaluate the potential of early detection of obesity (risk) among experts through addition of specific growth monitoring assessments in children during the first two years of life. Methods A discussion among experts from Malaysia, Singapore, Sri Lanka and Australia on infant growth and a qualitative evaluation of current practice highlighted the need to measure body composition to assess the quality of growth. Current tools are mainly directed towards simple anthropometric measures such as body weight, length and head circumference which do not adequately reflect concurrent changes in body composition to detect early life adiposity development. Recent findings have shown benefits of measurement such as the sum of four skinfold thickness (S4SFT) during the first two years of life for risk assessment of later overweight/obesity. We recommend this assessment for routine practice as a proxy for fat deposition in young children. Further studies to understand implementation hurdles and cost-effectiveness of S4SFT and health outcomes in young children in the Asia Pacific region are necessary. Conclusion Inclusion of four skinfold thickness measurements as part of routine growth monitoring assessment, in addition to weight and height, could be recommended to assess adiposity development in early life allowing identification of infants at risk for obesity.

Hubungan Kebiasaan Konsumsi Ikan dan Asupan Protein Hewani dengan Kejadian Stunting Batita di Pulau Pasaran Kotamadya Bandar Lampung

As the age and nutritional intake are lower than the need, and the high burden of infectious diseases in early life, most infants in Indonesia continue to experience a decline in nutritional status with peak decline at approximately 18-24 months of age. The prevalence of stunting in children year 2013 is 37.2%. Lampung Province is included into 15 provinces with a serious category or has a prevalence of =40 percent (Riskesdas, 2013). The purpose of this study is to identify the relation between fish consumption habits and animal protein intake with stunting in a toddler. This was a cross-sectional study with 49 toddlers as a sample who live in Pulau Pasaran Bandar Lampung. There was no significant relationship between the frequency of fish consumption (p = 1,000) and there was a significant relationship between the consumption of animal protein with the stunting(p = 0.002). It is necessary to establish a program of growth monitoring of children in the form of regular height measurement at least every 3 months in the second and third year and every 6 months in the fourth and fifth year at posyandu level with the assistance of nutritionist of puskesmas. It is also suggested that diversify the daily menu for toddlers is needed by adding some of the animal protein in snacks and main meals to increase consumption of animal protein.

Using data from multiple studies to develop a child growth correlation matrix.

In many countries, the monitoring of child growth does not occur in a regular manner, and instead, we may have to rely on sporadic observations that are subject to substantial measurement error. In these countries, it can be difficult to identify patterns of poor growth, and faltering children may miss out on essential health interventions. The contribution of this paper is to provide a framework for pooling together multiple datasets, thus allowing us to overcome the issue of sparse data and provide improved estimates of growth. We use data from multiple longitudinal growth studies to construct a common correlation matrix that can be used in estimation and prediction of child growth. We propose a novel 2‐stage approach: In stage 1, we construct a raw matrix via a set of univariate meta‐analyses, and in stage 2, we smooth this raw matrix to obtain a more realistic correlation matrix. The methodology is illustrated using data from 16 child growth studies from the Bill and Melinda Gates Foundation's Healthy Birth Growth and Development knowledge integration project and identifies strong correlation for both height and weight between the ages of 4 and 12 years. We use a case study to provide an example of how this matrix can be used to help compute growth measures.

A Capability Approach to Child Growth

For decades, child growth monitoring has been performed by measuring anthropometric indicators and comparing them against universal standards. Since the 1970s various efforts have been made to expand the focus from anthropometric indicators and include broader contextual and structural factors that influence children’s growth. However, those efforts have so far not led to changes in the dimensions that are taken into account in child growth monitoring. In this paper we introduce the Capability Approach asan evaluative framework for growth monitoring of children under five years old. Applying the CA helps focusing on what children are able to achieve by analyzing their available resources (endowments), as well as the mechanisms that could enhance or restrict their access to those resources (conversion factors). In addition, children’s growth could be assessed alongside the caregivers’ capabilities that children rely on to achieve their full growth potential. We present a child growth evaluation framework as well as a matrix, which has different categories of dimensions that interact with each other and ultimately shape children’s growth. The framework is a flexible tool, and is thus broad enough to accommodate contextual differences.

Growth patterns of Palestinian children from birth to 24 months.

Growth faltering in early life can adversely affect health in later childhood and adulthood. Growth monitoring of children can provide evidence to help formulate effective strategies to address growth problems but such information on Palestinian children is lacking. This study aimed to determine the growth patterns of children under 2 years in Gaza, Palestine. This retrospective cohort study was conducted in 2014 in 10 randomly selected primary health care clinics in 5 governorates of Gaza. Weight and length data were obtained from the health cards of children born in 2012, and z-scores were calculated and compared with the WHO Growth Standard (2006). A total of 2 632 children's cards were included at the beginning of the study. Weight-for-age and weight-forlength decreased from birth to 6 months to about -0.40 SD but increased afterwards to -0.11 SD and 0.34 SD at 24 months respectively. Length-for-age declined after 6 months, reaching -0.85 SD at 24 months. At 6 months, the prevalence of underweight and stunting were 5% and 9% but at 24 months, the prevalence was 4% and 20% respectively. Wasting was highest at 6 months (10%) but decreased to 3% at 24 months. Significantly more girls were stunted at 9, 12 and 18 months (P < 0.001), underweight at 24 months (P < 0.05) and wasted at 12 months (P < 0.05). Early life faltering in length was more pronounced than weight, with stunting occurring in one fifth of boys and girls by 2 years of age. Preventive strategies are urgently needed to address early life causes of undernutrition, particularly stunting, in Palestinian children in Gaza.

Cost savings through implementation of an integrated home-based record: a case study in Vietnam

ObjectivesIn Vietnam, there are three major home-based records (HBRs) for maternal and child health (MCH) that have been already nationally scaled up, i.e., Maternal and Child Health Handbook (MCH Handbook), Child Vaccination Handbook, and Child Growth Monitoring Chart. The MCH Handbook covers all the essential recording items that are included in the other two. This overlapping of recording items between the HBRs is likely to result in inefficient use of both financial and human resources. This study is aimed at estimating the magnitude of cost savings that are expected to be realized through implementing exclusively the MCH Handbook by terminating the other two. Study designSecondary data collection and analyses on HBR production and distribution costs and health workers' opportunity costs. MethodsThrough multiplying the unit costs by their respective quantity multipliers, recurrent costs of operations of three HBRs were estimated. Moreover, magnitude of cost savings likely to be realized was estimated, by calculating recurrent costs overlapping between the three HBRs. ResultsIt was estimated that implementing exclusively the MCH Handbook would lead to cost savings of United States dollar 3.01 million per annum. The amount estimated is minimum cost savings because only recurrent cost elements (HBR production and distribution costs and health workers' opportunity costs) were incorporated into the estimation. Further indirect cost savings could be expected through reductions in health expenditures, as the use of the MCH Handbook would contribute to prevention of maternal and child illnesses by increasing antenatal care visits and breastfeeding practices. ConclusionTo avoid wasting financial and human resources, the MCH Handbook should be exclusively implemented by abolishing the other two HBRs. This study is globally an initial attempt to estimate cost savings to be realized through avoiding overlapping operations between multiple HBRs for MCH.

Cost and Consequences of Integrated Public Health Campaign in Baglung District, Nepal

Correction: On 17th May 2020 the third author's name was changed from 'Chiranjibi' to 'Chiranjivi'&#x0D; Budget allocated, especially for new pilot program should yield better health effects than the regular ones. The government of Nepal launched Integrated Public Health Campaign (IPHC), a new type of intervention to make rural and vulnerable communities more aware about basic level health care services and increase their utilization. This paper examines the cost of the campaign and its outcomes in terms of providing awareness, utilization of maternal health services and improving health indicators. The study followed a comparative quasi experimental design, study unit being the household and the campaign. Case and Control village development committees (VDCs) were selected from the same territory and matched based on the criteria of IPHC and other socio-demographic &amp; health services characteristics. Cost calculation was based on direct method whereas the effectiveness was measured by analyzing the output of campaign between case and control VDC. The total cost of the campaign was NRs. 18, 00,000 with per household cost NRs. 585.93 and per capita cost NRs. 123.11. The awareness level of Free Health Services (FHS), Primary Health Care-Out Reach Centre and Safe Delivery Incentive Program (SDIP) was found to be 3.3, 2.65 and 1.95 times more in people of Case VDC than those of Control VDC. Moreover, there was no significant association between implementation of campaign with different practices of maternal health viz. Antenatal Care visit, delivery, SDIP and post natal care visit. The campaign was found effective in improving the status of OPD visit, measles, TT2+, growth monitoring of children and vitamin A supplementation to postpartum mothers. The campaign was effective in limited aspects. In case of its continuation, revision is necessary with the introduction of newer and better approaches.&#x0D; Economic Journal of Development Issues Vol. 23&amp;24 No. 1-2, (2017) Combined Issue, Page : 113-122

Designing instrument for early stimulation, detection, and intervention for growth and development of children based on android system

One of the factors that is thought to be the cause of the lack of success in child growth and development monitoring programs is the use of instruments that are less practical. This study aims to make a more practical instrument that is Android-based child development detection software, considering that Android-based gadgets are a popular communication tool for health workers. The design stages included: 1) provision of hardware, software, brainware, and material books; 2) frame making, material compilation, material integration into the frame; 3) evaluation of the quality of instruments through FGDs with users, and 4) giving recommendations. Evaluation of the quality of the instrument through the 3 stages of the FGD showed that content, accuracy, format, ease of use, timeliness, and spped of operation are good. Furthermore, it was recommended for the government to use this instrument as a medium for implementing the ESDIGDC program, as well as for researchers to use and refine this design as an instrument for research on children's growth and development.

Factors Associated with Underweight among Under-Five Children in Eastern Nepal: Community-Based Cross-sectional Study.

Undernutrition is a leading cause of morbidity and mortality in children in developing countries including Nepal. This study aimed to identify sociodemographic, environmental, and maternal and child health (MCH) factors associated with objectively assessed underweight among children aged under 5 years in Ilam district of eastern Nepal. A community-based cross-sectional study of 300 mothers of children under 5 years was conducted using interviewer-administered questionnaires from July to August 2012. The sample was derived by randomly selecting three village development committees (VDCs), then three wards from each of these three VDCs were selected making a total sample of nine wards. Finally, individuals were selected from the nine wards using systematic random sampling. Chi-square tests were used to identify factors associated with childhood underweight. Logistic regression analyses were conducted to determine odds ratios for the factors associated with underweight. The prevalence of underweight was 37% [95% confidence interval (CI): 33-43%]. Children who were more than 24 months of age were more likely to be underweight (adjusted odds ratio (aOR) = 2.72; 95% CI: 1.57, 4.70) than children aged less than 24 months. Children of families who consumed water without treatment had higher odds of being underweight (aOR = 2.48; 95% CI: 1.28, 4.78) than those who used water after boiling. Children whose mother perceived their size at birth as normal were more likely to be normal weight (aOR = 0.40; 95% CI: 0.16, 0.99) compared to a smaller size at birth. Children whose growth was monitored had a low chance of being underweight (aOR = 0.35, 95% CI: 0.15, 0.97). Nearly two-fifth of under-five children were found to be underweight. The age of children, drinking water purification practices, growth monitoring, and mother's perception of size at birth were significantly associated with childhood underweight. These findings suggest that interventions focusing on access to child growth monitoring, and water and sanitation practices may reduce the childhood underweight.

ICHRCloud: Web & Mobile based Child Health Imprints for Smart Healthcare.

Reducing child mortality with quality care is the prime-most concern of all nations. Thus in current IT era, our healthcare industry needs to focus on adapting information technology in healthcare services. Barring few preliminary attempts to digitalize basic hospital administrative and clinical functions, even today in India, child health and vaccination records are still maintained as paper-based records. Also, error in manually plotting the parameters in growth charts results in missed opportunities for early detection of growth disorders in children. To address these concerns, we present India's first hospital linked, affordable automated vaccination and real-time child's growth monitoring cloud based application- Integrated Child Health Record cloud (iCHRcloud). This application is based on HL7 protocol enabling integration with hospital's HIS/EMR system. It provides Java (Enterprise Service Bus and Hibernate) based web portal for doctors and mobile application for parents, enhancing doctor-parent engagement. It leverages highchart to automate chart preparation and provides access of data via Push Notification (GCM and APNS) to parents on iOS and Android mobile platforms. iCHRcloud has also been recognized as one of the best innovative solution in three nationwide challenges, 2016 in India. iCHRcloud offers a seamless, secure (256 bit HTTPS) and sustainable solution to reduce child mortality. Detail analysis on preliminary data of 16,490 child health records highlight the diversified need of various demographic regions. Thus, primary lesson would be to implement better validation strategies to fulfill the customize requisites of entire population. This paper presents first glimpse of data and power of the analytics in policy framework.

Assessment of growth monitoring in child care visits at the Family Health Strategy in two municipalities of Paraíba State, Brazil.

to assess the process and structural aspects of child care visits at the Family Health Strategy, in relation to growth monitoring. evaluative study of implementation analysis, carried out in two municipalities of Paraíba State, Brazil; structural characteristics of the services were assessed and child care visits were observed for analysis of the working process. 119 visits (53 in one municipality and 66 in the other) were observed; they were conducted by 18 nurses who were in charge of child care visits (nine from each municipality); five of the nurses had no training to work in primary health care and four units did not have a scale; weight (84.9%), height (84.0%) and cephalic perimeter (82.7%) measurements were held more frequently than recommendations for mothers (11.8% and 29.4% of the visits about height and weight, respectively). child growth monitoring is an action not yet consolidated, with significant deficiencies in the process.

Awareness and utilization of community clinic services among women in rural areas in Bangladesh: A cross-sectional study.

BackgroundIn recent years, Bangladesh government has accomplished the ambitious project of establishing hospitals 18,000 Community Health Clinics in sub-districts across the country. Operating under the affiliation of the government hospitals, these community health clinics aim to provide free healthcare services and to increase health-awareness among the extreme poor communities in the rural areas. However, a great proportion of the people are still not well aware of the services offered by the community health clinics. Thus, it is imperative to identify the factors of awareness regarding the community clinics. Research-based evidence is necessary to improve the efficacy and service coverage of community clinics among key population.MethodsCross-sectional data of size 11,673 women aged 15 to 49 years living in rural settings across seven divisions were extracted from the latest Bangladesh Demographic and Health Survey 2014. The main outcome measures of our study were awareness and utilization of Community Clinic Services (CCs). Descriptive statistics were used to present the baseline socio-demographic and economic characteristics; Chi-square test and logistic regression were performed to identify the factors associated with awareness of community clinics.ResultsAbout one-third (36.7%) of the women were aware of community clinics. Geographical location, level of education, household wealth status and frequency of reading newspaper were found to be significantly associated with awareness about community clinic services. Services reported to be obtained in the community clinics include family planning, immunization, tetanus, antenatal care, vitamin A, and health care for children and child growth monitoring. In the multivariate logistic regression, the odds of awareness among participants with primary education [p<0.001, AOR = 1.255, 95%CI = 1.107–1.357], secondary qualification [p<0.001, AOR = 1.370, 95%CI = 1.242–1.510] and tertiary [p<0.001, AOR = 1.526, 95%CI = 1.286–1.809] had approximately 23%, 37% and 53% respectively higher odds of awareness when compared to those with no formal education. Compared to the women living in richest households, odds of awareness were approximately 12.5%, 12.8%, 4.5% and 22.4% respectively higher among women reported in poorer, middle, richer and richest household wealth status when compared to poorest wealth status.ConclusionOur findings suggested that policies enhancing improved education could benefit health awareness. Poverty elimination and income generation programs among women are also likely to improve awareness about community health clinics in the target population. Special policy attention is required to address the regional variation of awareness about Community clinics.

Towards a capability approach to child growth: A theoretical framework

Child malnutrition is an important cause of under‐5 mortality and morbidity around the globe. Despite the partial success of (inter)national efforts to reduce child mortality, under‐5 mortality rates continue to be high. The multidimensional approaches of the Sustainable Development Goals may suggest new directions for rethinking strategies for reducing child mortality and malnutrition. We propose a theoretical framework for developing a “capability” approach to child growth. The current child growth monitoring practices are based on 2 assumptions: (a) that anthropometric and motor development measures are the appropriate indicators; and (b) that child growth can be assessed using a single universal standard that is applicable around the world. These practices may be further advanced by applying a capability approach to child growth, whereby growth is redefined as the achievement of certain capabilities (of society, parents, and children). This framework is similar to the multidimensional approach to societal development presented in the seminal work of Amartya Sen. To identify the dimensions of healthy child growth, we draw upon theories from the social sciences and evolutionary biology. Conceptually, we consider growth as a plural space and propose assessing growth by means of a child growth matrix in which the context is embedded in the assessment. This approach will better address the diversities and the inequalities in child growth. Such a multidimensional measure will have implications for interventions and policy, including prevention and counselling, and could have an impact on child malnutrition and mortality.

Women\u2019s education level amplifies the effects of a livelihoods-based intervention on household wealth, child diet, and child growth in rural Nepal

BackgroundMany organizations seek to alleviate poverty in the developing world, often focusing their interventions on women. The role, status, and education of women are fundamentally important facets of development. Thus, understanding the interaction of women’s educational level and the response to interventions is important. Therefore, we examined the impact of educational level of household adults on responses to a livestock-based community intervention.MethodsSix pair-matched communities in 3 districts of Nepal (Chitwan/Nawalparasi/Nuwakot), were randomly assigned to receive community development activities via women’s self-help groups at baseline or 1 year later. At 6 intervals over 48 months, a 125- item questionnaire addressing family demographics and child health/nutrition was completed in each household, plus child growth monitoring. Results were analyzed in relation to the highest education attained by any woman in the household, the child’s mother, men, or any other adult in the household.ResultsOutcomes (wealth, water/toilet availability, child diet diversity and growth) all significantly related to adult education. However, notable differences were found comparing the impact of men’s and women’s education. Percent change in wealth score was significant only in households where women had primary or secondary education (respectively, p = .0009 and p < .0001). Increased soap use related only to women’s education (p < .0001). When adjusted for group assignment, baseline income, wealth, and animal scores, higher women’s education was significantly associated with increased household wealth (p < .0001), better child height-for-age z scores (HAZ, p = .005), and improved child diet diversity (p = .01). Higher mother’s education predicted better child HAZ (primary, p = .01, secondary, p = .03) and diet diversity (primary, p = .05, secondary, p < .0001). Higher men’s education was significantly associated with household wealth (p = .02) and child diet diversity (p = .04), but not HAZ; higher education of any household member was associated only with household wealth (p < .0001). Moreover, households where the mother’s education was better than the best-educated man also were significantly more likely to have children with better HAZ and dietary diversity (p = .03, p < .0001). Thus, the educational level of women and mothers had the broadest impact on child outcome variables.ConclusionsHousehold characteristics vary among participants in most community development projects. Of these, adult education likely mediates response to the inputs provided by the intervention. Particularly in interventions directed towards women, better education may enhance the ability of households to put interventions into practice, thus improving wealth, hygiene, and child diet and growth indices.