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Editor- Voss states that height screening beyond school entry fails
to detect new growth problems in British school children1. However, it is
not known if this is true for children living in remote Aboriginal
communities in the Northern Territory of Australia where nutritional and
infectious diseases are prevalent and rates of stunting, wasting and
anaemia are high2.
For over 20 years annual weight and height measurements have been
part of school screening in remote Aboriginal communities in the Northern
Territory of Australia. Last year we analysed3 growth data collected from
routine school screening from 11 remote Aboriginal communities in 1993. We
found that 43/664 (6.5%) children aged 4-18 years were short (<1st
centile height for age) and 32/424 (7.6%) of 4-10 year olds were thin or
wasted (< -2.5 SD below the median weight for weight). We then
retrospectively reviewed the case notes of the short and thin children to
determine the age at which growth faltering commenced and what growth
interventions had occurred. Growth faltering was defined as failure to
gain weight for 2 months or more4.
Weight faltering had occurred in all children by 18 months. The
average age of onset of weight faltering was 6.6 months (range 3.5-12
months) for short children and 8.9 months (range 7.5-18 months) for thin
children. Height faltering commenced in all children by 3 years. All
children identified as being short or thin were already known to have poor
growth prior to school entry and many had previously been assessed by the
local doctor or visiting paediatrician and were being monitored.
Our findings suggest that growth monitoring beyond 5 years of age is
unlikely to detect new growth problems in Aboriginal children living in
remote areas and that growth monitoring in infancy had not resulted in
effective interventions to improve growth. In response to this and other
reviews, a new Growth Assessment and Action program has been established
for children in the Northern Territory. This program includes regular
measurements of weight and height and focuses on early intervention for
growth faltering. After school entry at 4-5 years, a final height and
weight measurement is performed at 10 years of age. This will be evaluated
in two years. We agree that repeatedly weighing and measuring school-age
children does little to improve health outcomes. In the Northern Territory
of Australia the priority is to further develop interventions to improve
the nutritional status of all children.
Dr Barbara A Paterson
Senior Policy Officer, Maternal and Child Health
Territory Health Services
Building 4, Royal Darwin Hospital
PO Box 40596
Casuarina, NT 0811
Australia
Ms Tina McKinnon
Co-ordinator, Remote Area Community Child Health
Dr Karen Edmond
Community Paediatrician
References
1 Voss L. Changing practice in growth monitoring (editorial). BMJ,
1999;318:344-5.
2 Paterson B, Ruben A, Nossar V. School-screening in remote
Aboriginal communities- results of an evaluation. Aust N Z J Public
Health. 1998; 22(6):685-689.
3 Dean AG, Dean AJ, Coulombier D, Brendel KA, Dickier RC, Sullivan K,
Fagan RF, Arner, TG. Epi-Info, Version 6. A word-processing, database and
statistical program for public health on IBM-compatible microcomputers.
Centres for Disease Control and Prevention, Atlanta, Georgia, USA, 1995.
A review of growth monitoring in Aboriginal school children in Australia
Editor- Voss states that height screening beyond school entry fails
to detect new growth problems in British school children1. However, it is
not known if this is true for children living in remote Aboriginal
communities in the Northern Territory of Australia where nutritional and
infectious diseases are prevalent and rates of stunting, wasting and
anaemia are high2.
For over 20 years annual weight and height measurements have been
part of school screening in remote Aboriginal communities in the Northern
Territory of Australia. Last year we analysed3 growth data collected from
routine school screening from 11 remote Aboriginal communities in 1993. We
found that 43/664 (6.5%) children aged 4-18 years were short (<1st
centile height for age) and 32/424 (7.6%) of 4-10 year olds were thin or
wasted (< -2.5 SD below the median weight for weight). We then
retrospectively reviewed the case notes of the short and thin children to
determine the age at which growth faltering commenced and what growth
interventions had occurred. Growth faltering was defined as failure to
gain weight for 2 months or more4.
Weight faltering had occurred in all children by 18 months. The
average age of onset of weight faltering was 6.6 months (range 3.5-12
months) for short children and 8.9 months (range 7.5-18 months) for thin
children. Height faltering commenced in all children by 3 years. All
children identified as being short or thin were already known to have poor
growth prior to school entry and many had previously been assessed by the
local doctor or visiting paediatrician and were being monitored.
Our findings suggest that growth monitoring beyond 5 years of age is
unlikely to detect new growth problems in Aboriginal children living in
remote areas and that growth monitoring in infancy had not resulted in
effective interventions to improve growth. In response to this and other
reviews, a new Growth Assessment and Action program has been established
for children in the Northern Territory. This program includes regular
measurements of weight and height and focuses on early intervention for
growth faltering. After school entry at 4-5 years, a final height and
weight measurement is performed at 10 years of age. This will be evaluated
in two years. We agree that repeatedly weighing and measuring school-age
children does little to improve health outcomes. In the Northern Territory
of Australia the priority is to further develop interventions to improve
the nutritional status of all children.
Dr Barbara A Paterson
Senior Policy Officer, Maternal and Child Health
Territory Health Services
Building 4, Royal Darwin Hospital
PO Box 40596
Casuarina, NT 0811
Australia
Ms Tina McKinnon
Co-ordinator, Remote Area Community Child Health
Dr Karen Edmond
Community Paediatrician
References
1 Voss L. Changing practice in growth monitoring (editorial). BMJ,
1999;318:344-5.
2 Paterson B, Ruben A, Nossar V. School-screening in remote
Aboriginal communities- results of an evaluation. Aust N Z J Public
Health. 1998; 22(6):685-689.
3 Dean AG, Dean AJ, Coulombier D, Brendel KA, Dickier RC, Sullivan K,
Fagan RF, Arner, TG. Epi-Info, Version 6. A word-processing, database and
statistical program for public health on IBM-compatible microcomputers.
Centres for Disease Control and Prevention, Atlanta, Georgia, USA, 1995.
4 WHO. The Growth Chart, WHO, Geneva, 1986.
Competing interests: No competing interests