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• Use of WHO New Growth Standards for Developing Countries
  Mrudula A. Phadke
  Published on: 22 March 2016

• Published on: 22 March 2016

  Use of WHO New Growth Standards for Developing Countries

  • Mrudula A. Phadke, Phadke M.A., Senior Advisor, Adjunct Professor
  • Other Contributors:
    • Nilima A. Kshirsagar, National Chair, ICMR, Director

  In response to the interesting article by P B Juliusson et. al. on Growth of Belgian & Norwegian Children compared to the WHO growth standards published in Arch. Dis. of Childhood 2011, 96:916-921 and appreciating the concerns raised by him, we raise few issues pertaining to India. It is stated in the paper that there are significant deviations, we put forth the point that developing countries must first start using WH...

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  In response to the interesting article by P B Juliusson et. al. on Growth of Belgian & Norwegian Children compared to the WHO growth standards published in Arch. Dis. of Childhood 2011, 96:916-921 and appreciating the concerns raised by him, we raise few issues pertaining to India. It is stated in the paper that there are significant deviations, we put forth the point that developing countries must first start using WHO charts, detect malnutrition which is one of the major roles of the charts and then to find out deviations which may come as an offshoot. Using WHO child growth charts, UNICEF has estimated that India has 43% prevalence of undernutrition in under 5 children next only to Timor Leste of 49% which is the highest in the world. Stunting is also seen in 48% of Indian children, similar figures of Afghanistan being 59%, the highest in the world1.

  Use of integrated management of neonatal & childhood illness (IMNCI) and WHO new growth charts has helped the country to detect Severe Acute Malnutrition. As India was one of the six countries for data collection of WHO new growth charts and that these charts give optimum growth of children, it is scientific to use them. These charts give percentiles and SAM is diagnosed when the wt. for ht. is below -3 Z score on WHO growth charts or MUAC (Mid Upper Arm Circumference) of less than 115 cms. or pedal oedema of nutritional origin in children 6 months to 59 months. The country has to resolve through its medical community on the first issue and switch to WHO charts from the ones that are in use through the Indian Academy of Pediatrics (NCHS)2. The number of children afflicted with SAM increases with the use of WHO new growth charts which will mean attention to a larger population. 8 million children in India are assumed to have SAM which will increase from 6.4% to around 15.6%. It is therefore urged that pediatricians shift to the new methodology, as one is aware that 61% of diarrhoea deaths and 53% of pneumonia deaths are due to SAM. SAM increases the child mortality 9 times3. Second point in diagnosis is community use of MUAC. Cutoff for diagnosis of SAM suggested is 115 cm which will also be appropriate for India, as anthropometric values around different populations of children upto 5 years remain unchanged for weight and height; so will it be for mid arm circumference.

  In addition to having diagnostic precision, one needs to have standardized protocols for management of SAM. Efficacy and safety of therapeutic nutrition products has been assessed world over and in India4,5. Home based foods if standardized and supplemented with micronutrients have given fair results when compared to RUTF which is found better and superior.

  If the country wishes to tackle SAM with priority, it will be important to use weight for height as the specific criterion (weight for age being a composite indicator, broad screening tool and it will detect both acute and chronic malnutrition). It will be important to use MUAC in detection and to facilitate use of standardized medicinal foods that would get absorbed better through already atrophic intestines of these children than the conventional home based rice and lentils some of which may not be absorbed properly. The country thus needs an immediate roadmap, using WHO new growth standards first, detect malnutrition and then find deviations.

  We declare no conflict of interest.

  Dr. M.A. Phadke - Senior Advisor, NRHM, Adjunct Professor, Maharashtra University of Health Sciences and Visiting Scientist, Haffkine Institute, Mumbai, India.

  Dr. N.A. Kshirsagar- National Chair, ICMR, Director, Dean, PG Institute of Medical Sciences, MGM, ESIC, Parel, Mumbai, India.

  1. Tracking progress on child & maternal nutrition, UNICEF, November 2009, 17-18.

  2. Bhatnagar S, Lodha R, Choudhary P, Sachdev HPS, Shah N, Narayan S, Wadhwa N, Makhija P, Kunnekel K and Ugra D, IAP guidelines 2006 on Hospital based management of severely malnourished children (adapted from the WHO guidelines). Ind. Ped. 2007; 44: 443-459.

  3. WHO child growth standards and the identification of severe acute malnutrition in infants & children, 2009, Pg 4.

  4. Beesabathuni K N and Natchu UCM Production and Distribution of Therapeutic Nutritional Product for Severe Acute Malnutrition in India, Opportunities and challenges, Ind. Ped 2010; Aug 47 : 702-706.

  5. Singh A S, Kang G, Ramachandran A, Sarkar R, Peter P and Bose A. Locally made ready to use therapeutic food for treatment of Malnutrition. lnd. Ped. 2010; Aug 47 : 679-685.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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