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Worldwide implementation of the WHO Child Growth Standards

  • Mercedes de Onis (a1), Adelheid Onyango (a1), Elaine Borghi (a1), Amani Siyam (a1), Monika Blössner (a1) and Chessa Lutter (a2)...
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-for-age 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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Copyright
Corresponding author
*Corresponding author: Email deonism@who.int
Footnotes
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See Appendix for Members of the WHO Multicentre Growth Reference Study Group.

Footnotes
References
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1.World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series no. 854. Geneva: WHO.
2.Victora, CG, Adair, L, Fall, C et al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.
3.de Onis, M, Wijnhoven, TMA & Onyango, AW (2004) Worldwide practices in child growth monitoring. J Pediatr 144, 461465.
4.WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 450, 7685.
5.World Health Organization (2006) WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: WHO.
6.Victora, CG, de Onis, M, Hallal, PC et al. (2010) Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics 125, e473e480.
7.de Onis, M, Blössner, M & Borghi, E (2012) Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr 15, 142148.
8.de Onis, M, Onyango, AW, Borghi, E et al. (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85, 660667.
9.de Onis, M, Blössner, M & Borghi, E (2010) Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 92, 12571264.
10.Scientific Advisory Committee on Nutrition/Royal College of Paediatrics and Child Health (2011) Application of the WHO Growth Standards in the UK, 2007. Report prepared by the Joint SACN/RCPCH Expert Group on Growth Standards. http://www.sacn.gov.uk/pdfs/sacn.rcpch_who_growth_standards_report_final.pdf (accessed September 2011).
11.Centers for Disease Control and Prevention (2010) Use of World Health Organization and CDC Growth Charts for children aged 0–59 months in the United States. MMWR Recomm Rep 59, 115.
12.Dietitians of Canada, Canadian Paediatric Society, College of Family Physicians of Canada & Community Health Nurses of Canada (2010) Promoting optimal monitoring of child growth in Canada: using the new WHO growth charts. Can J Diet Pract Res 71, e1e3.
13.Centers for Disease Control and Prevention (2009) Impact of new WHO growth standards on the prevalence of acute malnutrition and operations of feeding programs – Darfur, Sudan, 2005–2007. MMWR Morb Mortal Wkly Rep 58, 591594.
14.Seal, A & Kerac, M (2007) Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: secondary data analysis. BMJ 334, 733.
15.Fernández, MA, Delchevalerie, P & Van Herp, M (2010) Accuracy of MUAC in the detection of severe wasting with the new WHO growth standards. Pediatrics 126, e195e201.
16.Binns, C & Lee, M (2006) Will the new WHO growth references do more harm than good? Lancet 368, 18681869.
17.Dale, NM, Grais, RF, Minetti, A et al. (2009) Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger. Arch Pediatr Adolesc Med 163, 126130.
18.Lapidus, N, Luquero, FJ, Gaboulaud, V et al. (2009) Prognostic accuracy of WHO growth standards to predict mortality in a large-scale nutritional program in Niger. PLoS Med 6, e1000039.
19.Vesel, L, Bahl, R, Martines, J et al. (2010) Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality. Bull World Health Organ 88, 3948.
20.Isanaka, S, Villamor, E, Shepherd, S et al. (2009) Assessing the impact of the introduction of the World Health Organization growth standards and weight-for-height z-score criterion on the response to treatment of severe acute malnutrition in children: secondary data analysis. Pediatrics 123, e54e59.
21.de Onis, M, Onyango, AW, Borghi, E et al. (2006) Comparison of the WHO Child Growth Standards and the NCHS/WHO international growth reference: implications for child health programmes. Public Health Nutr 9, 942947.
22.Saha, KK, Frongillo, EA, Alam, DS et al. (2009) Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children. Food Nutr Bull 30, 137144.
23.Bois, C, Servolin, J & Guillermot, G (2010) Usage comparé des courbes de l'Organisation mondiale de la santé et des courbes françaises dans le suivi de la croissance pondérale des jeunes nourrissons. Arch Pediatr 17, 10351041.
24.Agostoni, C, Braegger, C, Decsi, T et al. (2009) Breastfeeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 49, 112125.
25.Kerac, M, Blencowe, H, Grijalva-Eternod, C et al. (2011) Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis. Arch Dis Child 96, 10081013.
26.van Dijk, CE & Innis, SM (2009) Growth-curve standards and the assessment of early excess weight gain in infancy. Pediatrics 123, 102108.
27.Maalouf-Manasseh, Z, Metallinos-Katsaras, E & Dewey, KG (2011) Obesity in preschool children is more prevalent and identified at a younger age when WHO growth charts are used compared with CDC charts. J Nutr 141, 11541158.
28.Black, RE, Allen, LH, Bhutta, ZA et al. (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243260.
29.Nash, A, Secker, D, Corey, M et al. (2008) Field testing of the 2006 World Health Organization growth charts from birth to 2 years: assessment of hospital undernutrition and overnutrition rates and the usefulness of BMI. J Parenter Enteral Nutr 32, 145153.
30.Prost, MA, Jahn, A, Floyd, S et al. (2008) Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants. PLoS One 3, e2684.
31.Mei, Z, Ogden, CL, Flegal, KM et al. (2008) Comparison of the prevalence of shortness, underweight, and overweight among US children aged 0 to 59 months by using the CDC 2000 and the WHO 2006 growth charts. J Pediatr 153, 622628.
32.Roelants, M, Hauspie, R & Hoppenbrouwers, K (2010) Breastfeeding, growth and growth standards: performance of the WHO growth standards for monitoring growth of Belgian children. Ann Hum Biol 37, 29.
33.Marín Gabriel, MA, Pallás Alonso, CR, De La Cruz Bértolo, J et al. (2009) Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years. Acta Paediatr 98, 18151821.
34.Nuruddin, R, Lim, MK, Hadden, WC et al. (2008) Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference. Public Health Nutr 12, 716722.
35.World Health Organization (2009) WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A Joint Statement by the World Health Organization and the United Nations Children's Fund. Geneva: WHO.
36.Kerac, M, Egan, R, Mayer, S et al. (2009) New WHO growth standards: roll-out needs more resources. Lancet 374, 100102.
37.de Onis, M, Borghi, E, Siyam, A et al. (2011) Comparison of the World Health Organization growth velocity standards with existing US reference data. Pediatrics 128, e18e26.
38.van Buuren, S & van Wouwe, JP (2008) WHO Child Growth Standards in action. Arch Dis Child 93, 549551.
39.Wright, C, Lakshman, R, Emmett, P et al. (2008) Implications of adopting the WHO 2006 Child Growth Standard in the UK: two prospective cohort studies. Arch Dis Child 93, 566569.
40.Michaelsen, KF (2010) WHO Growth Standards – should they be implemented as national standards? J Pediatr Gastroenterol Nutr 51, Suppl. 3, S151S152.
41.Van de Broeck, J, Willie, D & Younger, N (2009) The World Health Organization child growth standards: expected implications for clinical and epidemiological research. Eur J Pediatr 168, 247251.
42.Duggan, MB (2010) Anthropometry as a tool for measuring malnutrition: impact of the new WHO growth standards and reference. Ann Trop Paediatr 30, 117.
43.Mei, Z & Grummer-Strawn, LM (2007) Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis. Bull World Health Organ 85, 441448.
44.Cole, TJ (2008) The WHO child growth standards and current Western growth references. Breastfeed Rev 16, 1316.
45.Rolland-Cachera, MF & Péneau, S (2009) Nouveaux standards de croissance OMS: conséquences sur l'interprétation des mesures. Arch Pediatr 16, 737738.
46.Wang, Y, Chen, C & He, W (2007) Analysis of children's nutritional status based on WHO children growth standard in China. J Hyg Res 36, 203206.
47.Hui, LL, Schooling, CM, Cowling, BJ et al. (2008) Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort. Arch Dis Child 93, 561565.
48.Prinja, S, Thakur, JS & Bhatia, SS (2009) Pilot testing of WHO Child Growth Standards in Chandigarh: implications for India's child health programmes. Bull World Health Organ 87, 116122.
49.Mamidi, RS, Shidhaye, P, Radhakrishna, KV et al. (2011) Pattern of growth faltering and recovery in under-5 children in India using WHO Growth Standards – a study on First and Third National Family Health Survey. Indian Pediatr, (Epublication ahead of print version).
50.de Onis, M & Woynarowska, B (2010) WHO Child Growth Standards for children 0–5 years and the possibility of their implementation in Poland. Med Wieku Rozwoj 14, 8794.
51.Guerra, A (2009) As curvas de crescimento da Organizacão Mundial de Saúde. Acta Pediatr Port 40, XLIXLV.
52.Júlíusson, PB, Roelants, M, Hoppenbrouwers, K et al. (2011) Growth of Belgian and Norwegian children compared to the WHO growth standards: prevalence below –2 and above +2 SD and the effect of breastfeeding. Arch Dis Child 96, 916921.
53.Wright, CM, Williams, AF, Elliman, D et al. (2010) Using the new UK-WHO growth charts. BMJ 340, c1140.
54.Wright, CM, Inskip, HM, Godfrey, K et al. (2011) Monitoring head size and growth using the new UK-WHO growth standard. Arch Dis Child 96, 386388.
55.Greer, FR (2008) Time to step up to the plate: adopting the WHO 2006 growth curves for US infants. J Pediatr 153, 592594.
56.Hoey, L & Pelletier, DL (2011) The management of conflict in nutrition policy formulation: choosing growth-monitoring indicators in the context of dual burden. Food Nutr Bull 32, 2 Suppl., S82S91.
57.Ramachandran, P (2007) Adoption of WHO growth standards (2006): issues and implications. NFI Bull 28, 16.
58.Ramachandran, P & Gopalan, HS (2011) Assessment of nutritional status in Indian preschool children using WHO 2006 Growth Standards. Indian J Med Res 134, 4753.
59.World Health Organization (2008) Training Course on Child Growth Assessment. Geneva: WHO; available at http://www.who.int/childgrowth/training/en/
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