van Zadelhoff Saskia J N, Haisma Hinke H
Population Research Center, Department of Demography, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
Curr Dev Nutr. 2022 Feb 17;6(4):nzac023. doi: 10.1093/cdn/nzac023. eCollection 2022 Apr.
To address malnutrition in all its forms, context should be taken into account in growth-monitoring (GM) practices.
The aim was to compare GM manuals of countries with different nutrition problems, and to assess how these manuals are adapted to the different biological, socioeconomic, and cultural contexts.
GM manuals from Tanzania, India, and the Netherlands were compared with each other, and with the materials for the WHO training course on child growth assessment. First, the aims of GM, growth measurements, interpretation of these measurements, and counseling approaches are compared. Second, contextual determinants of malnutrition are identified using the UNICEF framework for malnutrition as an analytical model.
Our results show that the GM manuals differ in their descriptions of the aim of GM, growth measurements, their interpretation, and counseling approaches. Assessing normal growth and detecting growth problems are among the aims of GM in all of the analyzed countries. In Tanzania and India, the focus is mainly on undernutrition, whereas the Dutch manuals focus on overweight and on underlying pathologies that contribute to poor linear growth. The findings of our analysis of contextual factors within the UNICEF framework show that the Tanzanian protocol is only minimally adapted to the local context. Of the manuals examined in our study, the Indian manual is most focused on the contextual determinants of malnutrition, and stresses the importance of taking customs and beliefs into account. The Dutch protocol, by contrast, emphasizes the importance of the biological environment, including parental height and ethnicity, as determinants of child growth.
The country manuals we analyzed only partly reflect the contexts in which children live. To address malnutrition in all its forms, the GM manuals should take children's biological, socioeconomic, and cultural contexts into account, as this would help health professionals to tailor counseling messages for parents.
为应对各种形式的营养不良问题，在生长监测（GM）实践中应考虑具体情况。
旨在比较存在不同营养问题国家的生长监测手册，并评估这些手册如何适应不同的生物、社会经济和文化背景。
将坦桑尼亚、印度和荷兰的生长监测手册相互比较，并与世界卫生组织儿童生长评估培训课程的材料进行比较。首先，比较生长监测的目的、生长测量、这些测量的解读以及咨询方法。其次，使用联合国儿童基金会营养不良框架作为分析模型，确定营养不良的背景决定因素。
我们的结果表明，生长监测手册在生长监测目的、生长测量、其解读以及咨询方法的描述上存在差异。在所有分析的国家中，评估正常生长和检测生长问题都是生长监测的目标。在坦桑尼亚和印度，重点主要是营养不良，而荷兰手册则侧重于超重以及导致线性生长不良的潜在病理状况。我们在联合国儿童基金会框架内对背景因素的分析结果表明，坦桑尼亚的方案仅在最小程度上适应了当地情况。在我们研究中审查的手册中，印度手册最关注营养不良的背景决定因素，并强调考虑习俗和信仰的重要性。相比之下，荷兰方案强调生物环境的重要性，包括父母身高和种族，作为儿童生长的决定因素。
我们分析的国家手册仅部分反映了儿童生活的背景。为应对各种形式的营养不良问题，生长监测手册应考虑儿童的生物、社会经济和文化背景，因为这将有助于卫生专业人员为家长量身定制咨询信息。
