Hrev_master [page 8] [Healthcare in Low-resource Settings 2014; 2:1785] Growth chart: passport to child health care in low-resource settings Saurabh R. Shrivastava, Prateek S. Shrivastava, Jegadeesh Ramasamy Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India Dear Editor, Under the United Nations Millennium Declaration, 189 countries had adopted the tar- get to achieve Millennium Development Goals (MDG) by the year 2015.1 The prevalence of underweight children under-five years of age is an indicator to measure progress towards MDG-1, which aims to halve the proportion of people who suffer from hunger between 1990 and 2015.1 Globally, underweight prevalence has declined from 25% in 1990 to 16% today. The greatest reductions have been achieved in Central and Eastern Europe, however the situ- ation still remains grim in developing nations and in low-resource settings.2 In 2011, an esti- mated 101 million under-five children were underweight worldwide with the highest con- tributions from South Asia (59 million) and sub-Saharan Africa (30 million).2 The physical growth of infants and under- five children has been recognized as an impor- tant parameter to assess health and wellbe- ing.2,3 Multiple interventions – specific (such as use of growth charts, prevention and treat- ment of acute malnutrition/micronutrient defi- ciencies, safeguarding the maternal nutrition- al status, compliance with the infant and young child feeding practices - exclusive breastfeeding for six months followed by com- plementary feeding, etc.) as well as general (such as promotion of good sanitation prac- tices and access to clean drinking water, pro- motion of utilization of healthcare services by community involvement, etc.) have been implemented to counter the problem of under- nutrition.4,5 In low-resource settings, supervision and monitoring of growth of under-five children is of immense significance, as it can aid in early detection of acute malnutrition. The growth chart or road-to-health chart is a visual display of the child’s physical growth. It is designed primarily for the longitudinal follow-up of a child, so that changes over time can be inter- preted.5 Growth chart has a unique role in rural and tribal areas where people do not have access to specialists/tertiary care centers/labo- ratory services readily.3,4 Growth charts help in detecting whether a child is receiving ade- quate nutrition required for the basic physio- logical need of growth and development.3,6 Different types of growth charts have been developed and utilized in varied settings for accurate monitoring of growth of children.3,6,7 Apart from growth monitoring, the chart has many potential uses such as a diagnostic tool for identifying high risk children; for planning and designing of policies at the local and cen- tral level based on extent of malnutrition prevalent in an area; as an educational aid to illiterate mothers by encouraging her to partic- ipate actively in growth of her child; for assist- ing health worker to decide the type of inter- vention needed for specific children; and for evaluating the effectiveness of corrective measures / special interventions employed.3,5,6 To conclude, growth chart is a scientifical- ly sound, robust tool for monitoring health, well-being and nutritional status of infants and young children in different settings. It is an irreplaceable tool in low-resource set- tings where if used diligently, can significantly minimize the prevalence of malnutrition and associated complications. References 1. WHO. Millennium development goals. Geneva: World Health Organization ed.; 2013. Available from: http://www.who. int/mediacentre/factsheets/fs290/en/ 2. Cole TJ. The secular trend in human phys- ical growth: a biological view. Econ Hum Biol 2003;1:161-8. 3. Grummer-Strawn LM, Reinold C, Krebs NF. Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Morb Mortal Wkly Rep 2010;59:1-13. 4. UNICEF. Improving child nutrition: the achievable imperative for global progress. New York, NY: UNICEF ed.; 2013. Available from: http://www.unicef.org/ publications/ index_68661.html 5. Park K. Preventive medicine in obstetrics, pediatrics and geriatrics. In: Park K, eds. Text book of preventive and social medi- cine. 21st ed. Jabalpur: Banarsidas Bhanot; 2011. pp 502-5. 6. WHO. WHO child growth standards. Geneva: World Health Organization ed.; 2006. Available from: http://www.who.int/ childgrowth/standards/Technical_report.p df 7. Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: a new growth chart. Pediatrics 2012;130:1136-40. Healthcare in Low-resource Settings 2014; volume 2:1785 Correspondence: Saurabh RamBihariLal Shriva - stava, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur-Guduvancherry main road, 603108 Kancheepuram, India. Tel./Fax: +91.988.422.7224. E-mail: drshrishri2008@gmail.com Key words: growth chart, underweight, low- resource settings, millennium development goals. Contributions: SS: conception and design, draft- ing of the article, review of literature, guarantor; PS: drafting the article, review of literature, revis- ing it critically for important intellectual content; JR: general supervision of the research, overall guidance in writing the manuscript. Conflicts of interests: the authors declare no potential conflict of interests. Received for publication: 29 June 2013. Accepted for publication: 14 July 2013. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0). ©Copyright S.R. Shrivastava et al., 2014 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2014; 2:1785 doi:10.4081/hls.2014.1785 No n- co mm er cia l u se on ly