NEW WHO GROWTH CHART

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A POWERPOINT PRESENTATION BY VIVEK SHARMA III/II M.B.B.S RURAL MEDICAL COLLEGE AND PRAVARA RURAL HOSPITAL INCLUDES : DEFINATION OF GROWTH CHART NCHS GROWTH CHART OLD GROWTH CHART GROWTH CHART USED IN INDIA NEW GROWTH CHART including refrence study , standards , samplesize , milestones CASE STUDY TO COMPARE NCHS & WHO USES OFF GROWTH CHART CONCLUSION ...

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Presentation Transcript

GROWTH CHART: 

By Sneha , Varsha , Sorabh , Vivek GROWTH CHART

GROWTH CHART: 

GROWTH CHART Definition: It is a visible display of a child’s physical growth and development. First designed by David Morley . Growth chart offers a simple and inexpensive way of monitoring weight & height changes in respective charts . Any deviation from “normal” detected by comparison with reference curves.

Out with the old? In with the new? : 

Implications of the new WHO 2006 Child Growth Standards Out with the old? In with the new?

NCHS 1978 Child Growth References : 

NCHS 1978 Child Growth References

NCHS 1978 Child Growth References: 

NCHS 1978 Child Growth References Adopted in 1978 by WHO as the international reference for: Weight-for-age Weight-for-length/height Length/height-for-age

NCHS 1978 Child Growth References: 

NCHS 1978 Child Growth References

old & new: 

o ld & new THE WHO GROWTH CHARTS

The OLD WHO growth chart: 

The OLD WHO growth chart It has two reference curves. Upper reference curve -the median (50 th percentile) for boys. Lower reference curve – 3 rd percentile for girls Space between two growth curves called weight channel or road to health – zone of normality for most population.

Interpretation: 

Interpretation Normal - growth line above 3 rd percentile and will run parallel to reference curves Abnormal- flattening or falling of child’s weight curves signals growth failure Earliest sign of PEM Precede clinical signs by weeks or even months such a child needs special care –objective; keep child above 3 rd percentile

Growth Chart Used In India: 

Growth Chart Used In India It has four reference curves. Purpose of reference curve – indicates degree of malnutrition. The top most curve indicates normal i.e 50 th percentile.

INTERPRETATION: 

INTERPRETATION NORMAL (M-1 SD) > 80 % of MED Grade 1 or mild malnutrition- child’s weight 71% to 80% (-1SD -2SD) . Grade 2 or moderate malnutrition –child’s weight 61% to 70% (-2SD - 3SD ) . Grade 3 or severe malnutrition - weight 51% to 60% (-3SD -4SD ) . Grade 4 or very severe malnutrition-weight below 50% (< -4SD) .

Growth Curves: 

Growth Curves Differences Between the NCHS 1978 and the WHO 2006 Weight-for-Age (WFA)

( weight for age z score ) if sara is our subject for a case study to compare both growth charts , growth monitoring & promotional programes : 

( weight for age z score ) if sara is our subject for a case study to compare both growth charts , growth monitoring & promotional programes Comparison of WAZ at the Individual Level

Case Study: Sara: 

Case Study: Sara Sara’s age Sara’s weight (kg) NCHS 1978 WAZ score WHO 2006 WAZ score 0 m 2.4 1 m 3.5 3 m 4.5 6 m 5.4 9 m 6.0 11 m 6.4

At what age does Sara cross -2 SD using the NCHS 1978 WFA growth curve?: 

At what age does Sara cross -2 SD using the NCHS 1978 WFA growth curve? NCHS -2.08 6 m median -1 SD -2 SD -3 SD

At what age does Sara cross -2 SD using the WHO 2006 WFA growth curve?: 

At what age does Sara cross -2 SD using the WHO 2006 WFA growth curve? -2.05 3 m WHO median -2 SD -1 SD -3 SD

Case Study: Sara: 

Case Study: Sara Sara’s age Sara’s weight (kg) NCHS 1978 WAZ score WHO 2006 WAZ score 0 m 2.4 -1.68 -1.99 1 m 3.5 -0.81 -1.26 3 m 4.5 -1.21 -2.05 6 m 5.4 -2.08 -2.50 9 m 6.0 -2.65 -2.65 11 m 6.4 -2.78 -2.60

PowerPoint Presentation: 

Sara’s age Sara’s weight (kg) NCHS 1978 WAZ score WHO 2006 WAZ score 0 m 2.4 -1.68 -1.99 1 m 3.5 -0.81 -1.26 3 m 4.5 -1.21 -2.05 NCHS WHO median -1 SD -2 SD -3 SD

WHO NEW GROWTH CHART: 

WHO NEW GROWTH CHART

PowerPoint Presentation: 

WHO Multicentre Growth Reference Study For developing new growth chart.

MILESTONES IN DEVELOPMENT OF THE NEW CHILD GROWTH STANDARD: 

MILESTONES IN DEVELOPMENT OF THE NEW CHILD GROWTH STANDARD Comprehensive reviews shows growth pattern of healthy breastfed infants differ from the current NCHS/WHO international reference A new growth reference is needed to improve infants health management The reference population should reflect health recommendations in view of the frequent use of references as “STANDARDS”

WHO: 

WHO MULTICENTRIC GROWTH REFERENCE STUDY {MGRS} 1997-2003 {8500 CHILDREN} 0-25 months - longitudinal 18 – 71 months - cross sectional survey Brazil , Ghana , India , Norway , Oman , & U.S.A Breast feeding and no smoking

SAMPLE SIZE GROWTH STANDARD: 

SAMPLE SIZE GROWTH STANDARD LONGITUDINAL SAMPLE ( birth – 2y ) 1743 total enrolled 882 (428 boys /454 girls ) compiled with feeding & non smoking criteria & completed 24 months follow- up Target for stable outer centiles : 400 both sexes CROSS SECTIONAL SAMPLE (2-5 y ) : 6669 ( 3450 boys/3219 girls )

WHO Multicentre Growth Reference Study: 

WHO Multicentre Growth Reference Study

GROWTH REFERENCE STUDY: 

GROWTH REFERENCE STUDY Prescriptive approach Optimal nutrition breastfed infants appropriate complementary feeding Optimal environment no microbiological contamination no smoking Optimal health care immunization & pediatric routines

ELIGIBILITY CRITERIA: 

ELIGIBILITY CRITERIA No health , environmental or economic constraints on growth : mother’s and / or father’s education > 17yrs Mother willing to follow feeding recommendations Term birth Single birth Lack of significant perinatal morbidity : defined with pediatricians Non smoking mothers before and after delivery

WHO CHILD GROWTH STANDARD: 

WHO CHILD GROWTH STANDARD Attained growth Weight - for - age Length/height- for- age Weight – for- length / height Body mass index - for – age Mid – upper arm circumference – for- age Triceps skin fold - for - age Subscapular skinfold – for – age Head circumference – for – age Growth velocity Weight , length , head circumference , arm circumference ,BMI

NEED FOR NEW STANDARDS: 

NEED FOR NEW STANDARDS Exclusive breastfeeding for six months is normative for growth and development. Earlier standards are based on infants receiving bottle and mixed feeding. We should know how children should grow but not how they are growing. Children below six years have same potential to grow and develop as long as their basic needs of nutrition, environment & health are met. the boy & girl grow differently .

NEW STANDARDS V/S OLD STANDARDS: 

NEW STANDARDS V/S OLD STANDARDS New standards are based on breast fed infants while old standards are based on mixed feeding. Old standards are from one community while new standards are from six different nations. New standards are sex specific while old are unisex . New standard are based on S.D internationally accepted classification .

Q: WHICH CRITERIA TO BE USED: 

Q: WHICH CRITERIA TO BE USED A : undoubtedly WFA Why ?? Underweight children is a still a major public health problem which affects 40% of our children. Weight for age is a good tool for assesment of under nutrition. AWWs are already weighing the children and plotting them . To detect under weight early to prevent stunting and wasting.

the no. of underweight in under five children would reduce. The no. of underweight children below six month would increase. The no, of severely under weight children would increase substantially varying from 7 to 25 in each anganwadi centre. the requiriement for funds for snp : centre and state contributition would be almost double. : 

the no. of underweight in under five children would reduce. The no. of underweight children below six month would increase. The no, of severely under weight children would increase substantially varying from 7 to 25 in each anganwadi centre. the requiriement for funds for snp : centre and state contributition would be almost double. What would happen in my state if I start using new WHO growth standards

Uses of growth chart: 

Uses of growth chart G rowth monitoring D iagnostic tool P lanning and policy making E ducational tool T ool for action E valuation T ool for teaching

Conclusion: 

Conclusion We adopted NEW WHO WFA standard due to limitations of the existing child growth standards used in the ICDS for nutritional assessment of children Clear evidences of the accuracy of the NEW WHO Child growth standards and the availability of gender disaggregated data. Guiding principal that the new standards are the “golden standards” for the child – in the best circumstances and environment – the right of the child in India . Implementing the new standards is feasible and an opportunity to revamp the ICDS system for improvement in quality and convergence with NRHM . This is a powerful entry point for accelerating reduction in under – nutrition and promoting early child develpmnt

Thank u: 

Thank u