Primary health care issues : growth monitoring

This state-of-the-art review of GM shows planners how to maximize the benefits of GM through the use of anthropometric indicators, nutritional status classification systems, record-keeping systems, measurement tools, program organization, family education and the training of primary health care workers. An analysis of commonly used anthropometric indicators for GM reveals that weight-for-age most inclusively identifies children with mortality risk, while weight-for-height provides the most accurate picture of intervention effectiveness. Systems designed to classify children as adequately or inadequately nourished should be compatible with the clinic"s available resources and promote client and staff morale. Planners are shown how to select recording systems (cards and growth charts) which are intelligible to workers and clients while facilitating community and regional profiles. Eight measuring instruments (arm circumference tape; locally produced, single beam "clinic", free hanging, dial spring, and tubular spring scales; length/ height boards; weight/height charts) are evaluated and rated for standardization, ease of use and repair, taring, durability, readability, nonthreatening appearance, cost, and portability. Guidelines for establishing periodicity, selecting participants, setting up monitoring sessions, targeting recipients of food programs, and supporting community and family initiatives are specified for the community, family, and program managers. Planners are encouraged to teach improved nutrition through strategies which ensure mothers" active involvement in all GM activities. A section on training workers describes responsibilities and the accompanying skills needed to effectively establish GM activities, educate mothers, stimulate community participation, and record information that will help evaluate the program. Finally, the value of using GM programs to identify nutrition problems geographically and monitor program impact on the target population and, in general, as a way of helping communities to identify, solve, and prevent nutrition problems is presented. A 138-item bibliography (1946-81) and two appendices on GM tools are included.