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Journal ArticleDOI

Worldwide implementation of the WHO Child Growth Standards.

01 Sep 2012-Public Health Nutrition (Cambridge University Press)-Vol. 15, Iss: 9, pp 1603-1610
TL;DR: Five years after their release, the WHO standards have been widely scrutinized and implemented and countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potential.
Abstract: Objective: To describe the worldwide implementation of the WHO Child Growth Standards (‘WHO standards’). Design: A questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption. Setting: Worldwide. Subjects: Two hundred and nineteen countries and territories. Results: By April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-forage was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards’ roll-out. Conclusions: Five years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children’s right to achieve their full genetic growth potential.

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Book
01 Jun 2009
TL;DR: The United Nations Children's Fund (UNICEF) as mentioned in this paper was originally created to provide relief for children in countries devastated by the destruction of World War II, and in 1965, it was awarded the Nobel Prize for Peace for its humanitarian efforts.
Abstract: The United Nations Children's Fund, or UNICEF, was originally created to provide relief for children in countries devastated by the destruction of World War II. After 1950, UNICEF turned to focus on general programs for the improvement of children's welfare worldwide, and in 1965, it was awarded the Nobel Prize for Peace for its humanitarian efforts. The organization concentrates on areas in which relatively small expenditures can have a significant impact on the lives of the most disadvantaged children in developing countries, such as the prevention and treatment of disease, child healthcare, malnutrition, illiteracy, and other welfare services.

1,156 citations

Journal ArticleDOI
TL;DR: It is shown that stunting is the best overall indicator of children's well‐being and an accurate reflection of social inequalities and the challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.
Abstract: Childhood stunting is the best overall indicator of children's well-being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below -2 SD from the length-for-age/height-for-age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length-for-age/height-for-age z-score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post-natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.

762 citations


Cites background or methods from "Worldwide implementation of the WHO..."

  • ...Today, over 140 countries are using the robust methodology of the WHO standards, which accurately describe physiological growth and harmonize child growth assessment the world over (de Onis et al. 2012)....

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  • ...The use of cut-off points is required to determine the limits of ‘normality’, and this practice is not unique to anthropometry but widely applied in clinical and laboratory tests....

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Journal ArticleDOI
TL;DR: In this paper, a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short and long-term consequences is presented.
Abstract: An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

458 citations

Book ChapterDOI
TL;DR: Growth assessment is a key screening tool for assessing child health and nutritional wellbeing and adequate equipment and the use of standardized techniques are essential for reducing measurement error and minimizing bias.
Abstract: • Growth assessment is a key screening tool for assessing child health and nutritional wellbeing • Anthropometry is the most universally applicable, noninvasive method of assessing the growth status of children • Interpretation of the growth trajectory is highly dependent on the growth charts used • The WHO Child Growth Standards, based on the physiological growth of healthy breastfed infants, are the growth charts recommended by the WHO for universal application • Anthropometric measurements need to be accurate; adequate equipment and the use of standardized techniques are essential for reducing measurement error and minimizing bias

380 citations

References
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Journal ArticleDOI
TL;DR: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years.
Abstract: Objective To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Methods Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. Findings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). Conclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. Bulletin of the World Health Organization 2007;85:660–667.

6,037 citations

Journal ArticleDOI
TL;DR: The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.

5,634 citations

Journal ArticleDOI
TL;DR: It is concluded that damage suffered in early life leads to permanent impairment, and might also affect future generations, as undernutrition is associated with lower human capital and its prevention will probably bring about important health, educational, and economic benefits.

3,341 citations


"Worldwide implementation of the WHO..." refers background in this paper

  • ...performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, increased risk of nutrition-related chronic diseases((2))....

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  • ...That figure is likely to continue to increase given the importance of monitoring WFA during the first year of life, and thereafter monitoring height in addition to weight, because faltering patterns are clearly different for LHFA and WFA((6)) and short stature (or stunting) is associated with negative long-term outcomes((2,7))....

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