How Is Context Addressed in Growth Monitoring? A Comparison of the Tanzanian, Indian, and Dutch Manuals

Abstract

Background To address malnutrition in all its forms, context should be taken into account in growth monitoring (GM) practices. Objectives To compare GM manuals of countries with different nutrition problems, and to assess how these manuals are adapted to the different biological, socio-economic, and cultural contexts. Methods GM manuals from Tanzania, India, and the Netherlands are compared to each other, and to the materials for the WHO training course on child growth assessment. First, the aims of GM, growth measurements, interpretation of these measurements, and counseling approaches are compared. Second, contextual determinants of malnutrition are identified using the UNICEF framework for malnutrition as an analytical model. Results Our results show that the GM manuals differ in their descriptions of the aim of GM, growth measurements, their interpretation, and counseling approaches. Assessing normal growth and detecting growth problems are among the aims of GM in all of the analyzed countries. In Tanzania and India, the focus is mainly on undernutrition; whereas the Dutch manuals focus on overweight and on underlying pathologies that contribute to poor linear growth. The findings of our analysis of contextual factors within the UNICEF framework show that the Tanzanian protocol is only minimally adapted to the local context. Of the manuals examined in our study, the Indian manual is most focused on the contextual determinants of malnutrition, and stresses the importance of taking customs and beliefs into account. The Dutch protocol, by contrast, emphasizes the importance of the biological environment, including parental height and ethnicity, as determinants of child growth. Conclusion The country manuals we analyzed only partly reflect the contexts in which children live. To address malnutrition in all its forms, the GM manuals should take children's biological, socio-economic, and cultural contexts into account, as this would help health professionals to tailor counseling messages for parents.

Development and Effectiveness of the Stunting Prevention Counseling Training Module on the Knowledge and Attitudes of Health Cadres in the Kinovaro Health Center Work Area

“…The module was developed through 5 stages in the ADDIE model, namely Analysis, Design, Develop, Implementation and Evaluation. Analysis is carried out as a preliminary study related to existing potential problems 7 . Based on preliminary studies, it was found that health cadres said they did not understand stunting, let alone stunting counseling.…”