Worldwide implementation of the WHO Child Growth Standards
Objective: To describe the worldwide implementation of the WHO Child Growth Standards ('WHO standards').
Design: A questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption.
Subjects: Two hundred and nineteen countries and territories.
Results: By April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-forage was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards' roll-out.
Conclusions: Five years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potential.
de Onis, M., Onyango, A., Borghi, E., Siyam, A., Bloessner, M., Lutter, C., & WHO Multictr Growth Reference Stud (2012). Worldwide implementation of the WHO Child Growth Standards. Public Health Nutrition, 15(9), 1603-1610. DOI: 10.1017/S136898001200105X