Health staff understanding, application, and interpretation of growth charts in Nigeria

Abstract

43We aimed to compare plotting accuracy and interpretation of weight gain patterns in average 44 and small infants on Road-to-Health (RTH) and the new WHO growth charts in Enugu, 45Nigeria. Child health staff plotted standard weights on both formats. Twelve plotted charts 46 were created, permutating 3 different weight trajectories (fast, steady, slow) ending at two 47 attained weights (average, small), with each plotted on both chart formats. Respondents 48 were shown four of these charts and asked to describe the weight gain pattern shown and 49 what action this pattern would prompt. There were 222 respondents, of whom 78% were 50 hospital-based; 54% were nurses, 32% medical doctors, and 13% nutritionists. Plotting 51 accuracy was good on both the WHO and RTH charts, but rating of weight gain was 52 generally poor. On the RTH chart, slow weight gain was correctly recognised in only 19% 53 average and 35% small infants and responses were not significantly associated with the 54 pattern shown. On the WHO charts, slow weight gain was correctly recognised in 40% 55 average and 65% small infants (p=0.002 and <0.001), but they were also more likely to rate 56 small children with normal growth as slow weight gain. In a logistic regression model, final 57 weight predicted a slow weight gain rating more strongly (OR=2.4; 1.8 to 3.2) than an actual 58 slow weight gain pattern (OR 1.8; 1.1 to 1.6). Health staff seemed unable to recognize slow 59 weight gain and were influenced more by current weight than actual weight gain pattern, 60 though the new WHO format improved recognition. 61 62

Evaluation of an mHealth tool to improve nutritional assessment among infants under 6 months in paediatric development clinics in rural Rwanda: Quasi‐experimental study

“…Our intervention was not associated with an improvement in growth monitoring accuracy. Improving growth monitoring interpretation accuracy has been found to be difficult in other studies (Mutoro & Wright, 2013) and might be explained by the quality of training or even the experience in practicing interpretation (Ezeofor et al, 2017). Our study was conducted at both hospitals and health centres, and inaccuracy in the interpretation may be due to the lack of familiarity and level of training of the staff.…”

“…Our intervention was not associated with an improvement in growth monitoring accuracy. Improving growth monitoring interpretation accuracy has been found to be difficult in other studies (Mutoro & Wright, 2013) and might be explained by the quality of training or even the experience in practicing interpretation (Ezeofor et al, 2017).…”

“…However, challenges among health care providers in using child growth charts have been reported, including misinterpretation of growth trajectories, poor plotting, inappropriate growth classifications, wrong rating of weight gain and under-consideration of slow weight gain in taking actions (Bradford et al, 2020;Ezeofor et al, 2017;Mutoro & Wright, 2013). The possibility of incorrect classification and decision is even greater among preterm born infants, for whom a corrected age must be calculated prior to using the WHO growth charts (Villar et al, 2018).…”

“…World Health Organization (WHO) growth charts are often used to assess child growth through calculation of z‐scores, including weight‐for‐length/height (WFL/H), weight‐for‐age (WFA), length/height‐for‐age (L/HFA) and head circumference‐for‐age among children under five (World Health Organization [WHO], 2006). However, challenges among health care providers in using child growth charts have been reported, including misinterpretation of growth trajectories, poor plotting, inappropriate growth classifications, wrong rating of weight gain and under‐consideration of slow weight gain in taking actions (Bradford et al, 2020; Ezeofor et al, 2017; Mutoro & Wright, 2013). The possibility of incorrect classification and decision is even greater among preterm born infants, for whom a corrected age must be calculated prior to using the WHO growth charts (Villar et al, 2018).…”

Nutritional evaluation and growth of infants in a Rwandan neonatal follow‐up clinic

“…Research among these populations of children in sub-Saharan Africa has shown high rates of stunting, wasting and underweight that are often at least double national prevalence (Kirk et al, 2017;Tann et al, 2018;Van den Boogaard et al, 2017). Although optimal weight gain in healthy, term infants has been studied and defined, there are no currently accepted international standards of how to monitor growth in premature infants, with a variety of methods used, including grams per day, grams per kilogram per day and z-scores (Fenton et al, 2017). Additionally, there is no single currently accepted standard growth chart for use in infants born prematurely.…”