Growth monitoring--inappropriate promotion of an appropriate technology

Growth monitoring has been identified as an important component of the 'Child Survival and Development Revolution'--an initaitive advocated by UNICEF and supported by several other development agencies. In this initiative, improvements in the survival of children are attained through the widespread promotion, distribution and utilisation of selected health maintaining technologies by family members. Health workers, community institutions and welfare services help the family by providing encouragement, support and assistance. Growth monitoring has been identified as one of the key technologies--not only because it helps to promote the satisfactory nutrition of children, but also because it provides an opportunity for uniting other low-cost child health interventions. This paper re-examines the importance of widespread growth monitoring as a part of child care in developing countries. In the early sections, reasons for monitoring the growth of children are examined and the role of growth monitoring in primary health care is considered. The rationale for including growth monitoring in the child survival revolution is explored and the potential benefits of growth monitoring are reviewed. The authors then examine the results that have been achieved, to date, in a variety of programmes where child growth is being monitored. They conclude with a re-assessment of the importance of growth monitoring in child care. If the widespread promotion of growth monitoring is being considered as a means to improve the health of a community's children, three key questions must be answered. What are the risks associated with growth faltering or weight loss? To what extent can different health, educational or welfare interventions reduce these risks? How much will these interventions cost; could the resources (including mothers' time and enthusiasm) be put to better use? Such questions are not often asked in national programmes; they are rarely debated, and the decision to include growth monitoring in child care activities is usually made as a result of international pressure rather than consideration of local realities. In practice effective growth monitoring activities are not easily implemented: perhaps their widespread advocacy is not a result of a careful review of policy and programme research, more a reflection of changes in the needs and concerns of international aid agencies.