RESUMO
In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children <5-y-old attending well-child clinics in 2 affluent populations (Argentina and Italy) and 2 less-affluent ones (Maldives and Pakistan). Length/height and weight were measured by doctors and epidemiologists who also recorded a clinical assessment of each child's length/height in relation to age and weight relative to length/height. Anthropometric indicators of nutritional status were generated based on the WHO standards. As expected, Pakistan and the Maldives had higher rates of stunting, wasting, and underweight than Italy and Argentina, and the reverse was true for overweight and obesity. Where stunting was prevalent, the children classified as short were a mean <-2 SD for height-for-age. In all sites, the children classified as thin were indeed wasted (<-2 SD for weight-for-height) and a positive association in trend was evident between weight-for-height and the line-up of groups from thin to obese. The overall concordance between clinical assessments and the WHO standards-based indicators attested to the clinical soundness of the standards.
Assuntos
Peso Corporal , Desenvolvimento Infantil , Organização Mundial da Saúde , Argentina , Pré-Escolar , Humanos , Ilhas do Oceano Índico , Lactente , Itália , Desnutrição/epidemiologia , PaquistãoRESUMO
The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development.
Assuntos
Desenvolvimento Infantil , Proteção da Criança , Bem-Estar do Lactente , Estudos Multicêntricos como Assunto , Antropometria , Brasil , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos Transversais , Seguimentos , Gana , Crescimento e Desenvolvimento , Humanos , Índia , Lactente , Recém-Nascido , Estudos Longitudinais , Noruega , Omã , Desempenho Psicomotor , Padrões de Referência , Projetos de Pesquisa , Estados Unidos , Organização Mundial da SaúdeRESUMO
The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved.
Assuntos
Desenvolvimento Infantil , Desempenho Psicomotor , Brasil , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos Transversais , Seguimentos , Gana , Humanos , Índia , Lactente , Recém-Nascido , Estudos Longitudinais , Noruega , Omã , Desempenho Psicomotor/fisiologia , Controle de Qualidade , Padrões de Referência , Estados Unidos , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference. STUDY DESIGN: A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access. RESULTS: Responses were received from 178 (88%) countries, 154 of which included growth charts (n=806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment). CONCLUSIONS: The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.