Growth monitoring has become a major component of most child
health programmes in developing countries over the past two
decades. The rationale for this activity is discussed and
examined critically in the light of the evidence from
previous studies and from a detailed evaluation of three
child health care programmes in rural Zaire which included
growth monitoring. The monthly sessions to which mothers
brought their children were observed, the health workers
were interviewed, and information was obtained on programme
costs, supervision, and health records in all three
programmes. A survey of the knowledge and practices of 547
mothers of children under five years of age was carried out
in one programme's catchment population.
A total of 497 consultations were observed in the three
programmes as part of the evaluation. The consultations
lasted between 30 seconds and five minutes each, with a mean
of two minutes. Mothers and children spent three to eight
hours at the clinic in order to receive these brief
consultations, ten minutes of group health education, and if
necessary, immunizations. Whilst staff measured and
recorded weights accurately, they failed to take any
specific actions in one-third of children who had growth
faltering. Similarly, no counselling was given to one-third
of mothers whose children were ill and/or had growth
faltering, called "at-risk" children. Generally, the
quality of advice and referral for illness was more
satisfactory than the nutritional advice given mothers,
which consisted of brief, standard directives. The at-risk
children did not always receive special consultations by
better-qualified staff.
A household interview survey of 547 mothers of children
under five assessed their understanding of the growth charts
and their knowledge and reported practices with regard to
child feeding and diarrhoea. Results showed that knowledge
and practices improved with increased attendance at growth
monitoring sessions, after controlling for the mother's
educational level, tribe, socio-economic level and parity.
Since nearly two-thirds of children attending the sessions
were classified as at-risk, the value of individual
screening by weighing is questionable. Not all at-risk
children received interventions; of those who did, the
quality of the interventions was frequently inadequate.
Policy and programme recommendations for growth monitoring
in child health programmes are described, and research needs
identified