Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 22-25  

Comparison of World Health Organization growth standards with Indian Academy of Pediatrics growth charts of under-five children in a rural area of Puducherry


Department of Paediatrics, Pondicherry Institute of Medical Science, Puducherry, India

Date of Web Publication9-Jan-2017

Correspondence Address:
Dr. Jomol John
Department of Paediatrics, Pondicherry Institute of Medical Science, Ganapathichettikulam, Kalapet, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.197896

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  Abstract 

Aim: The aim of our study was to compare the World Health Organization (WHO) and Indian Academy of Pediatrics (IAP) growth charts by assessing the height for age and weight for age among children under 5 years of age. Materials and Methods: This was a cross-sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments were taken and plotted on both WHO and IAP growth charts. Results: The WHO and IAP charts regarding weight were comparable for both boys and girls. However, the height chart in WHO showed more stunting as compared to IAP growth charts, with the difference between the two being statistically significant (P < 0.05). Conclusion: India's own growth standards (IAP growth charts) may be more ideal for assessing growth than WHO growth standards, especially as regards height of children.

Keywords: Growth monitoring, Indian Academy of Pediatrics growth charts, World Health Organization growth standards


How to cite this article:
John J. Comparison of World Health Organization growth standards with Indian Academy of Pediatrics growth charts of under-five children in a rural area of Puducherry. Med J DY Patil Univ 2017;10:22-5

How to cite this URL:
John J. Comparison of World Health Organization growth standards with Indian Academy of Pediatrics growth charts of under-five children in a rural area of Puducherry. Med J DY Patil Univ [serial online] 2017 [cited 2024 Mar 28];10:22-5. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2017/10/1/22/197896


  Introduction Top


Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India. Almost 11 million children will die before they reach the age of 5 years and 4 million of them in the 1st month of life.[1] Growth monitoring is a screening tool to diagnose nutritional, chronic systemic, and endocrine diseases at an early stage. This ensures early management and optimal outcome. In April 2006, the World Health Organization (WHO) released new references for assessing growth and development in children from birth to 5 years. These references, known as the WHO child growth standards, replaced the National Centre for Health Statistics (NCHS)/WHO international growth reference (hereafter referred to as the NCHS standards), which had certain limitations.[2] The growth monitoring guidelines meeting of the Indian Academy of Pediatrics (IAP) recommended growth charts compiled by Agarwal et al.[3],[4] for Indian children (hereafter referred as IAP charts). In February 2007, the Ministry of Women and Child Development (nodal ministry for the Integrated Child Development Services [ICDS] program) and the Ministry of Health and Family Welfare in India changed over from the IAP growth curve to the WHO child growth curves.[5] The magnitude of different measures of nutritional status is affected by choice of reference charts used. It is, therefore, important to assess whether using the WHO growth standards will lead to changes in the estimated prevalence of underweight and stunting compared to the IAP growth charts and if so, how much of a change.

The aim of the study was to compare the WHO and IAP growth standards in under-five children.


  Materials and Methods Top


This cross-sectional study was conducted from June 2012 to July 2013. Children under 5 years of age attending various camps and those who had come to the outpatient department of our Medical College in Puducherry were included in this study by simple random sampling. The Institutional Ethical Committee had approved the study, and written informed consent from parents of all the children in the study was obtained. Any child with chronic illness, with history of any acute illness that leads to departure from normal growth pattern, with known or clinically recognizable endocrine or other system dysfunction or on chronic drug usage known to impair growth was excluded from this study.

The minimum sample calculated was 397 with the formula n = 4pq/d 2, with P taken as 46% and d taken as 0.05. Hence, 500 children were included in this study, of which 271 were boys and 229 were girls. Weight was recorded using standard weighing machine to the accuracy nearest to 25 g with the child wearing minimum clothing. Children more than 2 years of age were made to stand with bare feet on a flat floor against a stadiometer, with feet parallel and with heels, buttocks, shoulder, and occiput touching the wall. The head was held erect with eyes aligned horizontally and ears vertically without any tilt (Frankfurt plane). With the help of a wooden spatula or plastic ruler, the topmost point of the vertex was identified on the wall and height was recorded against the chart affixed. In children below 2 years of age, length was measured with the help of an infantometer. The footboard of the infantometer was moved to touch the feet to measure the length. Two readings were averaged for analysis.

After the anthropometric measurements, weight and height were plotted on the WHO and IAP growth charts separately and the values were compared. Chi-square test for categorical data was used for statistical analysis. P < 0.05 was taken as statistically significant.


  Results Top


The study group included 500 children, of which 271 were boys and 229 were girls [Table 1]. Underweight was seen in 119 children (23.80%) according to the IAP growth charts, whereas according to the WHO growth charts, 127 children (25.40%) were underweight. This difference was not statistically significant (P = 0.55). The WHO growth standards showed 68 children to be stunted (15.76%) as compared to the IAP growth charts which showed 39 children (8.45%) as stunted, the difference of which was statistically significant (P = 0.003).
Table 1: Age and sex.wise distribution of the study population

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Age-wise distribution of underweight according to the IAP and WHO growth charts has been provided in [Figure 1]. Similarly, sex-wise comparison of weight and height has been shown in [Table 2]. Age-wise distribution of stunting has been provided in [Figure 2].
Figure 1: Age-wise comparison of World Health Organization and Indian Academy of Pediatrics charts for weight

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Table 2: Sex-wise comparison of World Health Organization and Indian Academy of Pediatrics charts as regards weight and height

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Figure 2: Age-wise comparison of World Health Organization and Indian Academy of Pediatrics charts for height

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  Discussion Top


Assessment of growth not only serves as a means for evaluating the health and nutritional status of children but also provides an indirect assessment of the quality of life of an entire population.[1] The WHO growth standards were based on the Multicentre Growth Reference Study, which included 8500 children from widely different ethnic backgrounds and cultural settings, such as from Brazil, Germany, India, Norway, and Oman, who were exclusively breastfed.

This study was done to compare both the WHO growth standards and IAP growth charts. In our study, not much difference was noted between the WHO and IAP growth charts for weight in boys and girls. However, WHO growth standards showed significant difference in height charts for boys and girls compared to IAP growth charts; hence, they were not comparable. In a study done by Savitha and Kondapuram when WHO and IAP weight charts for girls were compared, there was no significant difference between the two charts. WHO charts detected more children with stunting than IAP charts, which was true for both boys and girls (P = 0.001).[6] Deshmukh et al. compared WHO charts with NCHS charts and concluded that the prevalence of underweight by the WHO standards was significantly lower (47%) compared to NCHS references (53%).[7] Ramachandran in his study reported that the prevalence of moderate and severe undernutrition is lowest by IAP growth charts and higher with the WHO standards.[8] Prinja et al. showed that comparison of overall prevalence of underweight across different age groups (using new WHO standards and IAP standards) revealed consistently higher estimates in all age groups by the IAP standards, except in the first half of infancy. The study compared WHO chart with the growth chart used in ICDS program which is based on Harvard growth standards and concluded that the prevalence of underweight was 1.4 times higher with Harvard standards, except in the first 6 months of life where it was 1.6 times higher with WHO standards.[9] When the 3rd percentile graph for both IAP and WHO were plotted together, the weight for both girls and boys overlapped, but the height graph showed the WHO graph higher than IAP graph [Figure 3],[Figure 4],[Figure 6].
Figure 3: Comparison of 3rd percentiles of weight chart for girls

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Figure 4: Comparison of 3rd percentile weight growth chart for boys

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Figure 5: Comparison of 3rd percentile of height charts for girls

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Limitation of our study was that it was conducted in a single rural area of South India, and hence, the study population may not be representative of the entire Indian population.


  Conclusion Top


The use of WHO growth standards can show increased prevalence of stunting, which can lead to overdiagnosis of stunting. This may have some impact on nutritional indicators in clinical practice and on national statistics used to measure the success of government initiatives. Although children have a similar growth pattern, the ethnic, geographic, regional, and environment factors do have a major role in the growth and development of a child. Hence, India's own growth standards (IAP growth charts) may be more ideal for assessing growth than WHO growth standards. Further multicenter studies are, however, required to generate a single appropriate chart for Indian children.

Acknowledgement

This study was done when the author was in Aarupadai Veedu Medical College, Puducherry. Thanks to Dr R Vanitha. (Assistant Professor Paediatrics).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mathad V, Metgud C, Mallapur MD. Nutritional status of under-fives in rural area of South India. Indian J Med Sci 2011;65:151-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Garza C, de Onis M. Rationale for developing a new international growth reference. Food Nutr Bull 2004;25 1 Suppl: S5-14.  Back to cited text no. 2
    
3.
Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D, Shah NK. IAP growth monitoring guidelines for children from birth to 18 years. Indian Pediatr 2007;44:187-97.  Back to cited text no. 3
    
4.
Agarwal DK, Agarwal KN. Physical growth in Indian affluent children (birth-6 years). Indian Pediatr 1994;31:377-413.  Back to cited text no. 4
    
5.
Indian Ministry of Health and Family Welfare. Recommendations. National Workshop on Adoption of New WHO Child Growth Standards, New Delhi, India; 8-9 February, 2007.  Back to cited text no. 5
    
6.
Savitha MR, Kondapuram N. Comparison of 2006 WHO and Indian academy of pediatrics recommended growth charts of under five Indian children. Indian Pediatr 2012;49:737-9.  Back to cited text no. 6
    
7.
Deshmukh PR, Dongre AR, Gupta SS, Garg BS. Newly developed WHO growth standards: Implications for demographic surveys and child health programs. Indian J Pediatr 2007;74:987-90.  Back to cited text no. 7
    
8.
Ramachandran P. Adoption of WHO growth standards (2006) – Issues and implications. NFI Bull 2007;28:1-6.  Back to cited text no. 8
    
9.
Prinja S, Thakur JS, Bhatia SS. Pilot testing of WHO child growth standards in Chandigarh: Implications for India's child health programmes. Bull World Health Organ 2009;87:116-22.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]


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