Purpose and Outcome

The primary aim of growth monitoring is to improve child health by regular anthropometry (which literally means measurement of man and refers to body measures such as weight, height, and mid-upper arm circumference). However, the measurements are useful only if they are properly recorded and interpreted and a suitable intervention is introduced when the child's growth is suboptimal.

It is important to target the purpose, measurement, and intervention to the environment in which they are used. In practice, this makes growth monitoring a very different proposition in the developing and industrialized worlds due to differences in the burden of disease, resources, and training.

The disease burden is much greater in the developing world, with diarrhea, malaria, respiratory infection, tuberculosis, and HIV all common. Here, effective growth monitoring can in principle save lives. In contrast, in the industrialized world such conditions are less common and milder, so the focus is more on growth disorders such as growth hormone deficiency or Turner's syndrome, where mortality is not the issue.

This different focus also affects the target age range when children are monitored. Mortality risk in the developing world is greatest during infancy, and it is increased by low birth weight. So poor early growth is a potent risk factor for infant mortality, and infancy is the period when growth monitoring is likely to be of greatest value. In contrast, the main concerns in the industrialized world are growth disorders that usually show themselves after infancy, although infant failure to thrive is also a concern. So in the developing world growth monitoring targets the preschool years, whereas in the industrialized world it covers all childhood up to and including puberty.

Throughout the world mothers are encouraged to take their infants to the clinic for regular anthropometry and immunizations. But in the developing world, where infants are much more likely to grow poorly, it makes economic sense to educate mothers, who have the greatest influence over their infant's environment, about the principles of growth monitoring. This education component is not stressed in the same way in the industrialized world.

Maternal education is thus a secondary aim of growth monitoring in the developing world. If growth monitoring makes mothers more aware of their child's state of health, then it should also have an impact on the child's health.

In addition to detecting disease and raising parental awareness at the individual level, growth monitoring in the sense of information gathering has potential benefits at the population level. It provides information about average child growth that is useful for comparison, policy, and planning. For example, a knowledge of mean height for age and weight for age in children from different regions is useful for identifying areas where the prevalence of malnutrition is highest, which in turn allows resources of emergency aid and support staff to be effectively targeted.

Growth monitoring also supports scientific research on the prevention and treatment of disorders affecting growth. Evidence-based child health relies on well-designed studies to test the impact of interventions on child health outcomes. Growth is a proxy for child health and is a common choice of outcome. So growth monitoring fits naturally into the framework of a randomized clinical trial, in which it is used to measure the impact of the intervention. This is different from the situation considered by the Cochrane Review, in which growth monitoring was the intervention. Strictly, the use of repeated anthropometry as an outcome should not be called growth monitoring because it omits the important final stage in which some intervention depends on it.

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