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Assessment of Child Growth [message #16775] Fri, 01 March 2019 14:11 Go to next message
DataDENT is currently offline  DataDENT
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Screening for acute malnutrition is being mainstreamed into health systems and growth monitoring remains a priority intervention for many low- and middle-income countries. To assess the coverage of growth monitoring and acute malnutrition screening activities, we propose four indicators that can be calculated with the addition of a single question that asks whether a child 0-59 months of age had specific dimensions of growth (length/height, weight, and Mid-Upper Arm Circumference (MUAC)) during the last 3 months.

1. Weight measured in the last 3 months
Definition: Percentage of children 0-59 months who had their weight measured in the last 90 days

2. Weight and height measured in the last 3 months
Definition: Percentage of children 0-59 months who had their height and weight measured in the last 90 days

3. MUAC measured in the last 3 months
Definition: Percentage of children 0-59 months who had their MUAC measured in the last 90 days

4. All three measured in the last 3 months
Definition: Percentage of children 0-59 months who had their height, weight and MUAC measured in the last 90 days

Attached to this post is a completed submission form with full justification for the recommendation.

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This recommendation originated in the September 2018 Technical Consultation on Measuring Nutrition in Population-Based Household Surveys and Associated Facility Assessments a 2-day working meeting convened by the Bill & Melinda Gates Foundation and United States Agency for International Development in collaboration with the World Health Organization (WHO) and UNICEF, and coordinated by Data for Decisions to Expand Nutrition Transformation (DataDENT). The consultation included more than 60 technical experts, survey program representatives from DHS, MICS, LSMS and SMART, country data stakeholders, and donors from the nutrition measurement community.

This recommendation was authored by Rebecca Heidkamp (JHU) and reviewed by Mduduzi Mbuya (GAIN).

This recommendation is endorsed by the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). Out of the 10 sets of recommendations endorsed by TEAM, this recommendation was prioritized as Tier 2 of 3 (high priority data need).

This recommendation is also endorsed by Countdown to 2030, Alive & Thrive, the nutrition team at the Bill & Melinda Gates Foundation, and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

[Updated on: Fri, 01 March 2019 14:37]

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Re: Assessment of Child Growth [message #16928 is a reply to message #16775] Thu, 14 March 2019 05:24 Go to previous messageGo to next message
Mauro Brero is currently offline  Mauro Brero
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UNICEF Tanzania Nutrition team concurs with all the indicators.

In Tanzania, Growth Monitoring and Promotion is among the key interventions adopted both at community and at facility level within the overall stunting reduction strategy. Information will be used to support efforts to further scale-up this interventions.

UNICEF Tanzania Nutrition team

[Updated on: Thu, 14 March 2019 05:25]

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Re: Assessment of Child Growth [message #16934 is a reply to message #16775] Thu, 14 March 2019 06:12 Go to previous messageGo to next message
Geeta Verma is currently offline  Geeta Verma
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I support the four questions to find out whether growth monitoring is happening, however growth promotion activities also need to be captured.
Does the caregiver know the child's nutritional status,
Was the data plotted and discussed with them?
Did they receive any advice -
breastfeeding, food, hygiene, stimulation and play, encouraged to continue their child care
practices
Re: Assessment of Child Growth [message #17006 is a reply to message #16934] Fri, 15 March 2019 06:22 Go to previous messageGo to next message
kdearden is currently offline  kdearden
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IMA concurs: these are important indicators.
Re: Assessment of Child Growth [message #17022 is a reply to message #16775] Fri, 15 March 2019 07:04 Go to previous messageGo to next message
Paula Kawiche is currently offline  Paula Kawiche
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I indorse these questions
Re: Assessment of Child Growth [message #17026 is a reply to message #16775] Fri, 15 March 2019 07:08 Go to previous messageGo to next message
marko.kerac@lshtm.ac.uk is currently offline  marko.kerac@lshtm.ac.uk
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I agree - these would be important indicators to capture. I assume MUAC itself will also be assessed in future rounds of DHS surveys. VERY quick to do and would add invaluable new information.
Re: Assessment of Child Growth [message #17030 is a reply to message #17026] Fri, 15 March 2019 07:23 Go to previous messageGo to next message
Marie McGrath is currently offline  Marie McGrath
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I also support inclusion of MUAC in future DHS. It is widely used in programming and would greatly help in aligning projected programme caseloads and prevalence figures.
Re: Assessment of Child Growth [message #17037 is a reply to message #16775] Fri, 15 March 2019 07:53 Go to previous messageGo to next message
aperry is currently offline  aperry
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Inclusion of questions on MUAC screening is particularly key in countries where access to treatment for acute malnutrition remains a challenge and has negative implications for the health and nutrition of those affected - DFID Nutrition Policy team.
Re: Assessment of Child Growth [message #17049 is a reply to message #16775] Fri, 15 March 2019 08:45 Go to previous messageGo to next message
Haika Martin is currently offline  Haika Martin
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I endorse these
Re: Assessment of Child Growth [message #17134 is a reply to message #16775] Fri, 15 March 2019 14:43 Go to previous messageGo to next message
jruelbergeron is currently offline  jruelbergeron
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The Global Financing Facility (GFF) Secretariat supports the proposal put forth by DataDENT.

The GFF Secretariat feels strongly that data on growth monitoring and promotion coverage should be included in the new DHS 8 questionnaires. The GFF Secretariat further argues that data on the coverage not only of growth monitoring but also of growth promotion that is tied to growth monitoring activities should be collected. This could be done through the addition of questions in either one of two categories of proposed sub-questions put forth by DataDENT. The first is through an addition to this proposal on child growth assessment (labeled #6, this thread), which would ask about whether the mother received counseling on IYCF based on the child's weight and/or length measurement (if she says yes to either of the preceding questions on weight/height measurement). The second option would be to include the source of information from which counseling on IYCF was received, building on DataDENT's proposal on IYCF counseling 6-23 months questions (labeled as #5, see comment there). Both of these recommendations are tied to the need to better understand how much growth promotion is being done as part of national growth monitoring and promotion programs/activities.

Evidence has demonstrated that growth monitoring as a stand-alone intervention produces little to no effect on child nutrition outcomes (Mangasaryan et al., 2011; Bhutta et al., 2008; Garner et al., 2000). Thus, its use is not recommended without adequate nutrition counselling and referrals (Bhutta et al., 2008). Without data on the extent to which growth monitoring is accompanied by promotion as it is meant to be by design, however, policy makers and program planners are limited in the degree to which they can inform program improvement decisions. As stated in DataDENT's proposal, 61% of the 167 member states who responded to the WHO 2016-17 Global Nutrition Policy review are implementing GMP, making it the second most widely implemented nutrition intervention globally. Moreover, over half of countries report that GMP happens monthly, representing an important opportunity to seize data on its coverage and functioning to stimulate appropriate, data-informed action.

References:
Ashworth A, Shrimpton R, Jamil K. Growth monitoring and promotion: review of evidence of impact. Maternal & child nutrition. 2008 Apr;4:86-117.
Bhutta ZA, Ahmed T, Black RE, et al. Maternal and Child Undernutrition 3 What works ? Interventions for maternal and child undernutrition and survival. 2008;371.
Garner P, Panpanich R, Logan S. Is routine growth monitoring effective? A systematic review of trials. Arch Dis Child 2000;82(3):197201.
Mangasaryan N, Arabi M, Schultink W. Revisiting the concept of growth monitoring and its possible role in community-based nutrition programs. Food Nutr Bull 2011;32(1):4253.
Re: Assessment of Child Growth [message #17180 is a reply to message #16775] Fri, 15 March 2019 15:30 Go to previous messageGo to next message
1000 Days is currently offline  1000 Days
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1,000 Days is the leading non-profit organization working in the U.S. and around the world to improve nutrition and ensure women and children have the healthiest first 1,000 days. We support this recommendation.
Re: Assessment of Child Growth [message #17198 is a reply to message #17134] Fri, 15 March 2019 15:59 Go to previous messageGo to next message
AMayberry is currently offline  AMayberry
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The Council of Research & Technical Advice on Acute Malnutrition (CORTASAM) would like to submit a formal recommendation for the inclusion of MUAC and assessment of oedema to ensure that all infants, children and adults with acute malnutrition are captured in the DHS Surveys. This is critically important to support global, regional, and country level burden estimation, resource mobilisation and programming to effectively prevent and treat acute malnutrition.

- MUAC for infants <6 months of age
- MUAC for children 6-59 months of age
- MUAC for adults, both men and women
- Assessment of oedema in children 0-59 months of age


Attached is the full proposal for the request with more details on justification and indicators. The recommendation is endorsed by Council of Research & Technical Advice on Acute Malnutrition (CORTASAM) and based on the Council's previous work supporting use of MUAC in the community for detection, diagnosis and discharge (also attached).

Re: Assessment of Child Growth [message #17225 is a reply to message #17198] Fri, 15 March 2019 16:18 Go to previous messageGo to next message
gfunnell1 is currently offline  gfunnell1
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Action Against Hunger USA endorses this recommendation.
Re: Assessment of Child Growth [message #17336 is a reply to message #16775] Fri, 15 March 2019 17:49 Go to previous messageGo to next message
Erin Milner is currently offline  Erin Milner
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USAID supports this recommendation.
Re: Assessment of Child Growth [message #17365 is a reply to message #17198] Fri, 15 March 2019 19:44 Go to previous messageGo to next message
AlexandraRP is currently offline  AlexandraRP
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Endorsed by Action Against Hunger Uk
Re: Assessment of Child Growth [message #17385 is a reply to message #17198] Fri, 15 March 2019 21:31 Go to previous messageGo to next message
marko.kerac@lshtm.ac.uk is currently offline  marko.kerac@lshtm.ac.uk
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I strongly support this recommendation to measure MUAC (Mid Upper Arm Circumference) in DHS surveys. It offers great potential to enhance our understanding of infant, child (and also maternal) nutrition.

Dr Marko Kerac
Nutrition Group,
London School of Hygiene & Tropical Medicine, UK
Re: Assessment of Child Growth [message #17415 is a reply to message #16775] Fri, 15 March 2019 23:26 Go to previous messageGo to next message
Judy Canahuati is currently offline  Judy Canahuati
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La Leche League International supports this recommendation
Re: Assessment of Child Growth [message #17420 is a reply to message #16775] Fri, 15 March 2019 23:31 Go to previous message
Olutayo
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The knowledge that measuring this indicator will bring is quite key. It is incredible that so much attention goes into encouraging growth monitoring and promotion, but for the many decades of the intervention there is no data to track coverage/progress. I quite agree with the inclusion of the indicator and questions.

[Updated on: Fri, 15 March 2019 23:31]

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