The Multicentre Growth Reference Study

1
The Multicentre Growth Reference Study

• Oman Experience

Dr. Sahar Abdou Helmi Supt. School Health
Department Quality Control Person for follow up
team
2
Population 2331391 27 in Muscat Muscat
population is relatively affluent and educated
Has ready access to highly developed health
services 96 of births in Muscat take place in
two hospitals
3
RAPID SURVEY (1998)

• Identify socioeconomic , demographic and
  behavioral characteristics of the subpopulation
  of Muscat region.
• The mothers of 336 children aged 28 to 43 months
  were selected from the national child health
  register and interviewed
• Children weights and heights, the maternal
  measurements and families SES

4
RESULTS

• Specific socioeconomic status indicators cutoff
  of families whose children experience
  unconstrained growth in early childhood
• Monthly income 800 RO (2,083 )
• At least 4 years of maternal education
• 39 of families usually traveled out of Muscat on
  vacation

5
MGRS

• Longitudinal study
• 12 months study
• Cross sectional study
• Motor development study

6

• PLANNING PHASE
• IMPLEMENTATION PHASE

7
STUDY TIMELINE
8
Study Structure in Oman
9
TRAINIG STANDARIZATION

• Longitudinal screening and follow up teams were
  trained on anthropometric measurements
• Lactation team was trained by an International
  Board Certified Lactation Consultant.
• All teams were trained to administer the oral
  interviews and complete the questionnaire

10

• Six members of Follow up team were trained on
  motor development
• The secretaries were trained to coordinated the
  day to day activities and maintain study
  registers and participation flux charts
• Two men were trained to measure adult weight and
  height

11
STUDY MATERIALS

• MGRS Manual of Operations was adapted
• All questionnaires were translated into Arabic
• An interviewer guides were also translated into
  arabic

12
SITE SPECIFIC VARIABLES FOR OMAN

• Screening
• Reasons for not breastfeeding included No reason
  given Not enough milk,
• SES of household based on mother completed 4
  years of formal education
• Total income of the household was 800 O.R. or
  more.

13

• Follow-up
• Sources of income included social support,
  retirement, income from rented property (house,
  farm, etc), private business.
• Adaptation of the lists of supplements for the
  mother, infant formula supplements

14
IMPLEMENTATION PHASE
15
Screening

• Screening was done twice daily, Saturday ?
  Wednesday in each hospital
• Inclusion criteria are
• Health status of the infant,
• Intention to breastfeed
• Singular births,
• SES of the family
• Willingness to participate.

16
Lactation support

• The lactation counselors visited the enrolled
  mothers within 24 hours
• MGRS In Oman adopted the complementary feeding
  guidelines developed by the MOH.

17
Follow-up

• Each child was visited 20 times till 2 years of
  age.
• Main data collected
• Morbidity , Feeding pattern, supplements
• Maternal and child anthropometric measurements

18
MULTICENTRE GROWTH REFERENCE STUDY SCHEDULE OF
VISITS
19
Quality control procedures

• Daily review of questionnaires for completion
  and accuracy of coding.
• Repeat interviews phone calls for 10 of the
  mothers.
• Data entry by two persons independently.
• Frequency analysis and cross-tabulations for
  identification of conflicting responses.

20

• Bimonthly standardization sessions for
  anthropometry.
• Terminal digit preferences analysis.
• Flux charts and records of different supervisors.
• Regular meetings of different teams, and the
  steering committee.

21
CROSS SECTIOANL STUDY
22
SAMPLING STRATEGY

• Child Health Register
• Master list of 24,000 children 18 71 months
  drawn from 12 registers
• A random sample of 8,000 were selected for
  screening to get 1400 children to be measured

23
SUCCESS FACTORS

• Media coverage
• Public relation activities
• Health education materials
• Priority in Health institution
• Two receptions
• Discount cards to shops and restaurants
• All measurements are taken according to the
  procedure, and on the scheduled times.

24

• Spirit of team work
• Technical support from WHO

25
THANK YOU