Emerging needs for growth monitoring and promotion

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Emerging needs for growth monitoring and
promotion
Presentation at India Habitat Center, New Delhi
8th February 2007

• Presentation by
• Dr. Prakash V. Kotecha
• Professor and Head
• Preventive Social Medicine
• Government Medical College Vadodara

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Indian Scenario Are we comfortable?

• Malnutrition is more common in India than in
  Sub-Saharan Africa
• One in every three malnourished children in the
  world lives in India
• Close to 50 per cent of U5 deaths occur in first
  month
• Majority of them die at home...but have history
  of contact health personnel once at least..

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India

• 20 of births of the world in India
• 30 of neonatal deaths in India
• 40 of LBW babies birth in India

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Trend in childrens Nutritional status NFHS
reveals.
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Why Growth Charts?

• Malnutrition is not the result of poverty alone
• It is a problem of feeding rather than food
• Poorer countries have shown better nutritional
  status
• If the problem identified early and then
  appropriate action taken on time, growth
  monitoring can help
• Challenge remains..
• Our approach needs to be consistent and simple
  and easyat least at AW and Health worker level..
• Till now, it is NOT..

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Example to see the difficulties

• The study was conducted among children registered
  and attending Vadodara Urban Slum Aanaganwadi
• From 30 Aanganwadi, children were studied from
  0-59 months by visiting home of the registered
  children..
• Data then were compiled for comparing IAP and
  NCHS standards and now extended to WHO growth
  standards to get a comparative idea
• Let us examine them..

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What do AWW see in these data

• 2.2 are in grade 3 4
• Rest 97.8 are largely NOT Malnourished.
• More girls are malnourished than boys..
• When grade 2 is counted as malnourished, 22 are
  needing extra attention, 78 are NORMAL..

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Comparing Charts Gender Difference WA on 1914
children (Vadodara ICDS)
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Comparing Charts Gender Difference WA on 1914
children (Vadodara ICDS)
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Comparing Charts Underweight on 1914 children
(Vadodara ICDS) By Age
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Comparing Charts Underweighton 1914 children
(Vadodara ICDS)
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Comparing Charts Underweight on 1914 children
(Vadodara ICDS)
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Comparing Charts HA on 1914 children (Vadodara
ICDS)
Stunting will always be higher with WHO Standards
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Comparing Charts HA on 1914 children (Vadodara
ICDS)
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Comparing Charts HA on 1914 children (Vadodara
ICDS)
Stunting will always be higher with WHO Standards
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Comparing Charts HA on 1914 children (Vadodara
ICDS)
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To Conclude

• The goals of growth monitoring charts used by
  AWW/Health worker are different than used by
  scientists and give very different pictures
• Charts used to classify rather than action on
  individual child
• Longitudinal data of monitoring not very clear to
  AWW/HW
• Recommendations for malnourished child (giving
  double ration is not practical..
• Did we set ourselves up for failure in the first
  place?

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To Conclude

• The targets have been not achieved in reducing
  malnutrition in many areas
• Failure to use growth monitoring meaningfully is
  one of the reason..
• Our commitments (political, social and cultural)
  need to be more firm and our actions focused to
  our ultimate aims
• That is why we are here..

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Thank you