全球儿童成长监测评估：国家政策和做法的横断面调查

Global assessment of childhood growthmonitoring: cross-sectional survey ofnational policies and practices Annariina Koivu1*, Ulla Ashorn1*,Elaine Borghi2, Andreas Hasman3,Purnima Menon4, Aman Pulungan5,6,Julie Ruel-Bergeron7, Linda Shaker-Berbari3, Madhumita Singh5, NaveenThacker5, Wilson Milton Were8,Kaisa Ylikruuvi1, Per Ashorn1,8;International Growth Monitoring SurveyConsortium BackgroundMonitoring children’s growth is crucial in pae-diatric care for early identification of health issues, with theWorld Health Organization (WHO) advocating for its practicethroughout childhood. However, the focus and implementa-tion of growth monitoring vary globally, reflecting differenthealth priorities and practices. MethodsWe conducted a global, cross-sectional, question-naire-based survey, targeted at representatives of the minis-try responsible for growth monitoring and promotion, and atrepresentatives of national paediatric societies. 1CentreforChild,AdolescentandMaternalHealthResearch,TampereUniversity,Tampere,Finland 2DepartmentofNutritionandFoodSafety,WorldHealthOrganization,Geneva,Switzerland3ChildNutritionandDevelopment,UnitedNationsChildren’sFund,NewYork,NewYork,USA4Poverty,HealthandNutritionDivision,InternationalFoodPolicyResearchInstitute,SouthAsiaOffice,NewDelhi,India5InternationalPaediatricAssociation,Marengo,Illinois,USA6DepartmentofChildHealth,FacultyofMedicine,UniversityofIndonesia,Jakarta,Indonesia7HumanDevelopmentNetwork’sHealth,Nutrition,andPopulation,WorldBank,WashingtonD.C.,USA8DepartmentofMaternal,Newborn,ChildandAdolescentHealthandAgeing,WorldHealthOrganization,Geneva,Switzerland*Jointfirstauthorship. ResultsWe obtained responses from 122 countries. Of these,88% had national growth monitoring guidance, most oftenissued by the ministry of health. Weight was the most con-sistently measured early childhood growth monitoring indi-cator, recorded routinely in 98% of countries during growthmonitoring visits for children aged <1 year. The WHO ChildGrowth Standards were used in 86% of countries. The mostcommon follow-up action for growth faltering was provisionof nutritional or health advice, cited by 91% of respondentsfor children aged <1 year, with advice frequency decreasingas child age increased. ConclusionsChildhood growth monitoring is widely adopt-ed, but implemented with considerable variation acrosscountries. Strengthening its impact will require standard-ising indicators, integrating evidence-based guidelines intoprimary care, and ensuring equitable, actionable use acrossage groups. Correspondence to: AnnariinaKoivuTampereCentreforChild,Adolescent,andMaternalHealthResearch,FacultyofMedicineandHealthTechnology,TampereUniversityKalevantie4,TampereFinlandannariina.koivu@tuni.fiUllaAshornTampereCentreforChild,Adolescent,andMaternalHealthResearch,FacultyofMedicineandHealthTechnology,TampereUniversityKalevantie4,TampereFinlandulla.ashorn@tuni.fi Monitoring children’s growth is a standard practice inpaediatric care globally. It is based on the well-estab-lished understanding that excessively slow or rapid ratesof weight or height gain, which are linked to multipleadverse outcomes, can serve as sensitive indicators of achild’s health. By systematically tracking anthropomet-ric measurements such as weight, height, and body massindex (BMI) over time, health service providers can iden- tify deviations from expected growth patterns and intervene early to prevent or manage poten-tial health concerns. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recom-mend growth monitoring throughout childhood and adolescence as a component of broader well-child visits, with the WHO Child Growth Standards used as a reference throughout the process[1,2]. While its importance is widely recognised, the purpose and implementation of growth mon-itoring vary across countries and remain a subject of debate [3−5]. Some programmes utilise itprimarily as an early warning system to identify children at risk of growth faltering (e.g.Ethiopia)[6], while others shift the focus to overweight children (e.g.Qatar) [7]. The different approaches tothe end goals of growth monitoring are reflected in what is measured and which anthropometricindices are calculated. For example, while health workers in Ghana focus on growth trends bytracking weight-for-age over time, those in Nepal tend to rely on a single measurement point toassess underweight, emphasising a child’s current status over their growth trajectory [8]. The components of growth monitoring, such as the use of length measurement, are also beingreconsidered in the literature [9−11]. A further ongoing debate relates to the use of a global stand-ard for growth assessment, as opposed to local references [12,13]. Finally, variations in oper-ational factors, including utilisation levels, the accurac