Going for Growth (Editorial‪)‬

Monitoring growth, as it is now practised in most health systems in developing countries, is widely misunderstood and largely ineffective (1-5). So, it is no surprise that the process itself has been controversial, leading some academicians and practitioners to urge its elimination from community-based programmes (6-9). And still, monitoring growth is universally found in paediatric offices and academic centres throughout the world, seen as an integral part of good paediatric practice. As introduced by Morley in clinics that treated children aged under five years in Nigeria in the 1960s (10), monthly monitoring of growth has provided the foundation of good promotive child healthcare in large projects in India (11), Bangladesh (12), and Honduras (13), and in thousands of village of Indonesia (14). How did growth monitoring and promotion (GMP), once seen as the essential foundation of the United Nations Children's Fund (UNICEF)-promoted GOBI strategy for young children (growth monitoring, oral rehydration, breastfeeding, and immunization) fall into such disrepute, while the other GOBI components have proven highly robust? Part of the answer indeed lies in the poor understanding of its purposes and procedures by medical officers and health and nutrition workers as reported by Roberfroid et al. in this issue of the Journal (15). First, as well-documented in that paper, the primary purpose of GMP is rarely understood even by its implementers and much less by participating mothers. The emphasis is on the measuring--the 'monitoring' rather than the 'promotion' of growth. The growth card, all too often, is seen as a diagnostic tool for use by the health worker to detect existing malnutrition rather than a communication aid to encourage early action by the mother before malnutrition supervenes. The card, designed to draw a mother's attention to the pattern of growth of her own child, is instead used by workers as an anthropometric standard for measuring nutritional status. Thus, from the start, the primary purpose of GMP is diverted.