Brabin L, Brabin B J, Liboon L
J Trop Med Hyg. 1984 Apr;87(2):91-7.
This study investigates decision making in an under-fives clinic by examining the referral of children for nutritional help on the basis of weight-for-age assessments ('Road to Health Card'). The weight-for-age status of each child is compared with his weight-for-height status. Children with a weight-for-height status of less than 89% and who were still failing to gain weight were considered 'at risk' and in need of referral. Of 28 such children, only four were referred. The growth curves of five wasted children who were not referred showed acute weight loss. It is suggested that community health nurses may experience problems in interpreting the trend of a child's growth curve, possibly because the information is inadequate or because they fail to interpret the given information correctly. Alternatively, community health nurses may have other reasons for nonreferral and these are also discussed. The study also considers whether incorporating a weight-for-height assessment into the clinic routine would increase the efficiency of nutritional intervention. However, there appears to be no obvious advantage if children's ages are known and the majority of children are not severely malnourished. The emphasis should be on training, not on new techniques.
本研究通过检查基于年龄别体重评估（“健康之路卡”）为儿童提供营养帮助的转诊情况，来调查一家五岁以下儿童诊所的决策过程。将每个儿童的年龄别体重状况与其身高别体重状况进行比较。身高别体重状况低于89%且仍未增重的儿童被视为“有风险”，需要转诊。在28名此类儿童中，只有4名被转诊。5名未被转诊的消瘦儿童的生长曲线显示体重急剧下降。研究表明，社区健康护士在解读儿童生长曲线趋势时可能会遇到问题，这可能是因为信息不足，或者是因为他们未能正确解读所提供的信息。或者，社区健康护士不转诊可能还有其他原因，本文也对此进行了讨论。该研究还考虑将身高别体重评估纳入诊所常规流程是否会提高营养干预的效率。然而，如果已知儿童年龄且大多数儿童没有严重营养不良，似乎没有明显优势。重点应该是培训，而不是新技术。
