Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical analysis based on a systematic review

Trop Med Int Health. 2005 Nov;10(11):1121-33.
Roberfroid D, Kolsteren P, Hoeree T, Maire B.Department of Public Health, Nutrition Unit, Institute of Tropical Medicine,Antwerp, Belgium.
OBJECTIVE: Growth Monitoring and Promotion programs (GMP) have been intensivelypromoted to improve children's health in developing countries. It has been hopedthat regularly weighing children would result in the early detection of growthfalterers, and that the growth chart would serve as an educational tool to makethat state apparent to both health workers and caretakers in order to triggerimproved caring practices. Our objective was to review whether GMP answers thetheoretical grounds of a screening and intervention program.
METHOD: Asystematic literature review was performed. The WHO framework developed byWilson and Jungner for planning and evaluating screening programs guided theanalysis.
RESULTS: Sixty-nine studies were retrieved. Overall, evidence is weakon the performance of GMP as a screening program for malnutrition through earlydetection of growth falterers. The main results are: (1) malnutrition remains apublic health problem, but its importance is context specific; (2) the value ofa low weight velocity to predict malnutrition is unknown and likely to vary indifferent contexts; (3) the performance of GMP for improving nutrition status ofchildren and in reducing mortality and morbidity is unknown; (4) the performanceof the screening is affected by the unreliability of weight measurements; (5)the promotional and educational effectiveness of GMP is low, in particular thegrowth chart is poorly understood by mothers; (6) the acceptability seems low inregards of low attendance rates; (7) evidence is lacking regardingcost-effectiveness.
CONCLUSIONS: We conclude that there is too little scientificevidence to indiscriminately support international promotion of GMP. However GMPcould constitute a valid strategy of public nutrition in specific situations. Weindicate paths for further research and how prevention programs could bedeveloped.