Critical assessment of the use of growth monitoring for identifying high risk children in primary health care programmes.
OBJECTIVE
To see whether change in weight was a more useful index than weight for age in assessing the risk of dying among malnourished children.


METHODS
Prospective cohort study.


METHODS
Rural community in Bangladesh being served by international health organisation.


METHODS
1011 Children aged under 5, of whom 66 died.


METHODS
Efficient screening method for identifying malnourished children at risk of dying.


RESULTS
Weight was measured every month. Weight for age and monthly change in weight averaged over one and three months were calculated. Sensitivity and specificity curves were used to compare the values of these two variables in identifying children with a high risk of dying. Weight for age was more sensitive than change in weight at all levels of specificity. Changes in weight, however, were independently related to the risk of dying even when intercurrent diseases and low weight for age were taken into account.


CONCLUSIONS
For identifying children with a high risk of dying weight for age is a more efficient screening tool than a recent change in weight. Growth monitoring as currently recommended for primary health care programmes in developing countries does not seem to be the most effective approach in identifying children in need of urgent help.
Briend
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International Centre for Diarrhoeal Disease Research, Bangladesh.
Bari
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D000367:Age Factors; D001459:Bangladesh; D001835:Body Weight; D002648:Child; D015362:Child Nutrition Disorders / Q000401:mortality* / Q000503:physiopathology; D002675:Child, Preschool; D015331:Cohort Studies; D006128:Growth; D006801:Humans; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D015430:Weight Gain; D015431:Weight Loss