Alternative methods for assessing growth in children under five years of age

Abstract

Objective: To establish alternative methods for growth assessment in children under five years of age. Design: A cross sectional study of healthy Malawian children. Setting: Postnatal wards and under-five clinics at the Queen Elizabeth Central Hospital, Ndirande and Chilomoni Health Centres in Blantyre city, Malawi. Main outcome measures: Cephalic, thoracic and pelvic measurements and their indices were examined for assessment of growth in these children. Thoracic and pelvic measurements were found to be the most appropriate alternative parameters to weight. Results: All measurements significantly correlated positively with weight but their indices did not. The degree of significance, however, was higher in pelvic and thoracic dimensions (P = 0.000) than in cephalic ones (P<0.001 for maximal cephalic length (MCL) and P <0.022 for maximal cephalic breadth (MCB), respectively. The MCL also showed a high correlation with age (R = 0.842, P = 0.002) but age only correlated moderately with the MCB (R = 0.569). The thoracic circumference (TC) and inter-nipple distance (IND) showed a very high positive correlation with age (R = 0.908, P = 0.005) and R = 0.870, P = 0.001), respectively. Similarly, a high positive correlation was shown with age by pelvic circumference (PC) and inter-spinous distance (ISD), (R = 0.891, P = 0.006 and R= 0.692, P = 0.027), respectively. Whereas the pelvic index positively correlated with age (R = 0.040), cephalic and thoracic indices significantly correlated negatively with age. Skull shapes were dolicocephalic in 43.6% of the children, mesocephalic in 31.1% and branchycephalic in 25.3%, a clear difference from Caucasian children reported earlier by other authors. Conclusion: We have established that cephalic, thoracic and pelvic dimensions significantly correlate positively with weight as age does but their indices remained relatively constant. More importantly, thoracic and pelvic measurements were the most appropriate alternative methods for growth assessment in our studied population.