Newly developed WHO growth standards: Implications for demographic surveys and child health programs

Objective To compare estimates of undernutrition based on the World Health Organization (WHO) Child Growth Standards (‘WHO standards’) and the National Center for Health Statistics NCHS/WHO international growth reference (‘NCHS reference’), and discuss implications for child health programs and reporting of prevalence of underweight in demographic surveys. Methods A cross-sectional study was carried out in 20 Anganwadi centers under Primary Health Centre, Anji. Total of 1491 under-six year children attending the Anganwadi centers were studied for nutritional status. Nutritional status was analyzed by NCHS standards by using EPI_INFO 6.04 software package and also by newly introduced WHO Child Growth Standards by Anthro 2005 software package. Chi-square test was used to compare the results. Results According to WHO standards, the prevalence of underweight and severe underweight for children 0–6 year was 47.4% and 16.9% respectively. By NCHS reference, the overall prevalence of underweight and severe underweight for children 0–6 years was 53% and 15% respectively. The prevalence of underweight as assessed by WHO standards was significantly lower when compared with the assessment based on NCHS reference (p<0.01). But, WHO standards gave higher prevalence of severe underweight than NCHS reference though the difference was not statistically significant (p>0.05). Conclusion In the light of newly developed WHO Child growth standards, all the nutrition-related indicators in demographic surveys like NFHS should now be derived using the WHO standards. There is need to reanalyze NFHS-I and NFHS-II data using WHO standards and findings should be made available so that it becomes comparable and trends over the years can be studied.     

World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings

As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country‐specific analyses of the indicators' associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross‐country patterns of associations of each of these indicators with child stunting, wasting, height‐for‐age z‐score (HAZ) and weight‐for‐height z‐score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub‐Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05). These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed. The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.     

World Health Organization growth charts for monitoring the growth of Australian children: time to begin the debate

The recently released World Health Organization growth charts are methodologically robust, as well as clinically useful tools for monitoring the growth of children. They have been endorsed by premier organisations such as the Royal College of Paediatrics and Child Health (UK), Canadian Pediatric Society, Australian Breastfeeding Association, United Nations Standing Committee on Nutrition, International Union of Nutrition Sciences, International Pediatric Association and the European Childhood Obesity Group. The Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics have also recently endorsed these charts for the 0- to 24-month age group in USA. These growth charts have been adopted by many countries including Canada, UK and New Zealand. Nearly 140 countries are at various stages of implementing them. They offer significant advantages over the currently used CDC 2000 growth charts. They have the potential to contribute in reducing the worldwide incidence of obesity as well as under nutrition in children. Except Northern Territory, Australia continues to use the CDC 2000 growth charts. Paediatricians need to initiate and lead robust debate involving key stakeholders about the implementation of World Health Organization growth charts for monitoring the growth of Australian infants and children.     

World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries

Eight World Health Organization (WHO) feeding indicators (FIs) and Demographic and Health Survey data for children <24 months were used to assess the relationship of child feeding with stunting and underweight in 14 poor countries. Also assessed were the correlations of FI with country gross national income (GNI). Prevalence of underweight and stunting increased with age and ≥ 50% of 12-23-month children were stunted. About 66% of babies received solids by sixth to eighth months; 91% were still breastfeeding through months 12-15. Approximately half of the children were fed with complementary foods at the recommended daily frequency, but <25% met food diversity recommendations. GNI was negatively correlated with a breastfeeding index (P < 0.01) but not with other age-appropriate FI. Regression modelling indicated a significant association between early initiation of breastfeeding and a reduction in risk of underweight (P < 0.05), but a higher risk of underweight for continued breastfeeding at 12-15 months (P < 0.001). For infants 6-8 months, consumption of solid foods was associated with significantly lower risk of both stunting and underweight (P < 0.001), as was meeting WHO guidance for minimum acceptable diet, iron-rich foods (IRF) and dietary diversity (P < 0.001); desired feeding frequency was only associated with lower risk of underweight (P < 0.05). Timely solid food introduction, dietary diversity and IRF were associated with reduced probability of underweight and stunting that was further associated with maternal education (P < 0.001). These results identify FI associated with growth and reinforce maternal education as a variable to reduce risk of underweight and stunting in poor countries.     

Complementary feeding practices and child growth outcomes in Haiti: an analysis of data from Demographic and Health Surveys

The Haitian National Nutrition Policy identifies the promotion of optimal complementary feeding (CF) practices as a priority action to prevent childhood malnutrition. We analysed data from the nationally representative 2005–2006 Haiti Demographic Health Survey using the World Health Organization 2008 infant and young child feeding indicators to describe feeding practices among children aged 6–23 months and thus inform policy and programme planning. Multivariate regression analyses were used to identify the determinants of CF practices and to examine their association with child growth outcomes. Overall, 87.3% of 6–8‐month‐olds received soft, solid or semi‐solid foods in the previous 24 h. Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) were achieved in 29.2%, 45.3% and 17.1% of children aged 6–23 months, respectively. Non‐breastfed children were more likely to achieve MDD than breastfed children of the same age (37.3% vs. 25.8%; P < 0.001). The proportion of children achieving MMF varied significantly by age (P < 0.001). Children with overweight mothers were more likely to achieve MDD, MMF and MAD [odds ratio (OR) 2.08, P = 0.012; OR 1.81, P = 0.02; and OR 2.4, P = 0.01, respectively] than children of normal weight mothers. Odds of achieving MDD and MMF increased with household wealth. Among mothers with secondary or more education, achieving MDD or MAD was significantly associated with lower mean weight‐for‐age z‐score and height‐for‐age z‐score (P‐value <0.05 for infants and young child feeding indicator × maternal education interaction). CF practices were mostly inadequate and contributed to growth faltering among Haitian children 6–23 months old.     

Breastfeeding practices and child growth outcomes in Haiti: an analysis of data from Demographic and Health Surveys

Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10‐year period using data from three Haitian Demographic and Health Surveys (1994–1995, 2000 and 2005–2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005–2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994–1995: 36.6%, 95% confidence interval (CI) 29.9–43.9; 2000: 49.4%, 95% CI 44.1–54.8; 2005–2006: 43.8%, 95% CI 40.5–47.1]. EBF among 0–5‐month‐olds increased sharply (1994–18995: 1.1%, 95% CI 0.4–3.2; 2000: 22.4%, 95% CI 16.5–29.5; 2005–2006: 41.2%, 95% CI 35.4–47.2). The proportion of breastfeeding children 0–5 months who received soft, solid or semi‐solid foods decreased (1994–1995: 68.5%, 95% CI 57.3–77.9; 2000: 46.3%, 95% CI 39.3–53.4; 2005–2006: 30.9%, 95% CI 25.9–36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0–23 months. Age group and department were significant predictors of EBF among children 0–5 months. ErIBF was associated with higher weight‐for‐age z‐scores [effect size (ES) 0.22; P = 0.033] and height‐for‐age z‐scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10‐year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.     

Postpartum sex taboos and child growth in Tanzania: Implications for child care

The social context and cultural meaning systems shape caregivers' perceptions about child growth and inform their attention to episodes of poor growth. Thus, understanding community members' beliefs about the aetiology of poor child growth is important for effective responses to child malnutrition. We present an analysis of caregivers' narratives on the risks surrounding child growth during postpartum period and highlight how the meanings attached to these risks shape child care practices. We collected data using 19 focus group discussions, 30 in‐depth interviews and five key informant interviews with caregivers of under‐five children in south‐eastern Tanzania. Parental non‐adherence to postpartum sexual abstinence norms was a dominant cultural explanation for poor growth and development in a child, including different forms of malnutrition. In case sexual abstinence is not maintained or when a mother conceives while still lactating, caregivers would wean their infants abruptly and completely to prevent poor growth. Mothers whose babies were growing poorly were often stigmatized for breaking sex taboos by the community and by health care workers. The stigma that mothers face reduced their self‐esteem and deterred them from taking their children to the child health clinics. Traditional rather than biomedical care was often sought to remedy growth problems in children, particularly when violation of sexual abstinence was suspected. When designing culturally sensitive interventions aimed at promoting healthy child growth and effective breastfeeding in the community, it is important to recognize and address people's existing misconceptions about early resumption of sexual intercourse and a new pregnancy during lactation period.     

The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants

AIM: To evaluate the performance of the 2000 Centers for Disease Control and Prevention (CDC) growth charts in comparison with the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference as a tool for assessing growth in healthy breastfed infants. METHODS: Weight and length measurements were obtained from a pooled longitudinal sample of 226 healthy breastfed infants. Weight-for-age (WA), length-for-age (LA) and weight-for-length (WL) z-scores based on the CDC and NCHS/WHO references were computed for each child. Age-specific mean z-scores and proportions below and above specific cut-off points were calculated. RESULTS: Breastfed infants grow more rapidly in the first 2 mo of life and less rapidly from 3 to 12 mo in relation to the CDC WA curves. Similarly, breastfed infants experience greater linear growth than the CDC median until age 4 mo. Thereafter, the mean LA z-score declines until month 9. Apart from a 1-mo difference in the time when linear growth begins to falter, the pattern of growth is remarkably similar when compared with the two references. The growth trajectories indicate that infants in the CDC reference are heavier and shorter than the NCHS/WHO reference population. Combining the two measurements as WL reveals that higher weight overrides lower length in the CDC versus the NCHS population, thus the estimated prevalence of wasting is higher by the CDC reference. CONCLUSION: As was the case when compared with the NCHS/WHO reference, there are notable differences in the growth trajectory of breastfed infants examined against the CDC reference. A reference based on healthy breastfed infants is required if the growth patterns of infants following international feeding recommendations are to be correctly assessed.     

髋臼环状骨突生长速度的研究

目的研究髋臼各组成部分环状骨突生长板的生长速度。方法选用年龄3～4周的新西兰大白兔20只，采用伸膝位长腿石膏管型固定的方法，将幼兔的左下肢固定8周，分别于固定后4、6、8周拍摄X线片直至出现髋臼发育不良兔动物模型7只。将分离出的发育不良髋臼制作病理组织学切片，运用图像分析技术量化髋臼发育不良动物模型中髋臼各组成部分（髂骨、坐骨、耻骨）的环状骨突生长板的生长速度。结果实验组发育不良的髋臼各骨中，坐骨环状骨突生长板生长速度最大，其次为髂骨，耻骨环状骨突生长板生长速度最低；对照组发育正常的髋臼各骨中，髂骨环状骨突生长板生长速度最大，其次为坐骨，耻骨环状骨突生长板生长速度最低。结论不同方向的力学刺激对髋臼各骨的生长发育具有重要影响。     

Climate change: The implications for child health in Australasia

Children are particularly vulnerable to the health effects of climate change, the biggest global health threat of the 21st century. However, the worst effects on child health can be avoided, and well‐designed climate policies can have important benefits for child health and equity. We call on child health professionals to seize opportunities to prevent climate change, improve child health and reduce inequalities, and suggest useful actions that can be taken.     

肠道炎症阻滞儿童体格生长的免疫和内分泌机制

肠道炎症常伴发儿童的生长落后。生长激素(GH)和胰岛素生长因子-1(IGF-1)是调控出生后骨骼纵向生长的重要物质,抑制GH/IGF轴可阻滞儿童体格生长。肠道发生炎症时,异常升高的促炎症因子IL-1β、IL-6和TNF-α通过干扰GH/IGF轴,系统性以及在生长板局部水平影响骨骼生长,进而导致儿童生长阻滞。     

Parental age and child growth and development: Child health check‐up data

Background: The aim of the present study was to determine whether parental age has any influence on child health. Methods: Well‐baby check‐up data at 1 month and at 12 months of age were used. The trends of parental age in association with growth measurements, incidence of physical and developmental abnormalities, occurrence of low birthweight, and maternal history of spontaneous abortion were analyzed. Results: Associations between increasing paternal age and incidence of psychomotor developmental delay at 12 months, increasing paternal and maternal age and increasing birthweight, and increasing parental age and higher incidence of history of spontaneous abortion were found. The incidence of low‐birthweight infants was significantly decreased with increasing paternal age. Conclusions: Not only increasing maternal age but also increasing paternal age have influences on child development and growth in the general population.     

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.
Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2–6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight ≥2500 g. We compared 475 infants breastfed exclusively for ≥6 months (group A), 870 infants breastfed fully/exclusively ≥4 months, but not exclusively ≥6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).
Results: In multivariate analysis ≥6 months of exclusive breastfeeding reduced significantly the risk for ≥1 episode of gastrointestinal infection(s) during months 1–9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44–0.82). The application of the World Health Organization (WHO) – child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.
Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for ≥6 months of exclusive breastfeeding.     

The associations between women's empowerment measures,child growth and dietary diversity: Findings from an analysis of demographic and health surveys of seven countries in Eastern Africa

Evidence on the efficacy of women''s empowerment to improve child growth and minimum dietary diversity (MDD) in the Eastern Africa (EA) region is limited. This cross‐sectional study used recent Demographic and Health Survey data of mother–child dyads from seven countries in EA to examine the associations between women''s empowerment measures, child growth and MDD. Length‐for‐age z‐scores, weight‐for‐length z‐scores and weight‐for‐age z‐scores were used to categorize growth indicators of 6–23 months old children. Multivariable logistic regression was used to identify significant associations. Among all countries, 32%–59% of children experienced growth failure. Children meeting MDD were 18%–45%. Women having self‐esteem were associated with lower odds of stunting (adjusted odds ratio [AOR] = 0.62 in Rwanda), wasting (AOR = 0.38 in Uganda), underweight (AORs = 0.60 and 0.57 in Tanzania and Uganda, respectively) and growth failure (AOR = 0.64 in Rwanda). Having health decision control in Burundi was associated with lower odds of stunting (AOR = 0.49) and child growth failure (AOR = 0.52) and higher odds of meeting MDD (AOR = 2.50). Having Legal empowerment among women increased the odds of stunting (AOR = 1.79 in Burundi), underweight (AOR = 1.77 in Uganda) and growth failure (AOR = 1.87 in Burundi). Economic empowerment showed mixed associations with child growth and MDD among some countries. Women''s self‐esteem and health decision control were associated with better child growth and MDD for some countries in EA. Nutrition‐sensitive interventions aimed at improving child growth and MDD should consider local contexts when addressing women''s empowerment.