Growth charts in primary child-health care: time for reassessment.

Selected data from the Tamil Nadu Integrated Nutrition Project (TINP) indicated that growth monitoring with the entire package of services (rather than just regular weighing) in TINP was associated with improved child nutritional status. It was maintained that the benefits of growth monitoring existed over and above those of supplementary feeding. Over 85% of the children in poor communities, in the regions where growth monitoring is now being recommended, suffer from undernutrition and growth retardation of varying degrees. An assessment report of the Integrated Child Development Services (ICDS) program in India states that growth charts were maintained only in 51% of anganwadis: although all anganwadi workers had been training in growth monitoring, only 46.3% were found competent with respect to weighing, 30.2% with respect to age assessment, 36.9% with respect to plotting weights, and 32.2% with respect to interpretation. Examination of data covering 3704 children under 6 years old in the ICDS program found that almost half the children had never been monitored and that another 25% were monitored inadequately. The only 3 major interventions that can be undertaken by child health workers serving poor communities are: 1) advice and education regarding appropriate diets and health practices, 2) immunization, prompt diagnosis, and treatment of infections, 3) ORT in diarrhea, and 4) supplementary feeding in selected situations with available resources. Discarding growth monitoring of individual children in the course of domiciliary visits would give the worker sufficient time to provide appropriate advice. Total abandonment of growth monitoring in child-health care programs is not proposed, however, growth monitoring operations should not become so elaborate, expensive, and time-consuming that they become counterproductive.