全球儿童成长监测评估：国家政策和做法的横断面调查

Global assessment of childhood growthmonitoring: cross-sectional survey of Annariina Koivu1*, Ulla Ashorn1*,Elaine Borghi2, Andreas Hasman3,Purnima Menon4, Aman Pulungan5,6,Julie Ruel-Bergeron7, Linda Shaker-Berbari3, Madhumita Singh5, NaveenThacker5, Wilson Milton Were8,Kaisa Ylikruuvi1, Per Ashorn1,8; BackgroundMonitoring children’s growth is crucial in pae-diatric care for early identification of health issues, with theWorld Health Organization (WHO) advocating for its practicethroughout childhood. However, the focus and implementa- MethodsWe conducted a global, cross-sectional, question-naire-based survey, targeted at representatives of the minis- 1CentreforChild,AdolescentandMaternalHealthResearch,TampereUniversity,Tampere,Finland ResultsWe obtained responses from 122 countries. Of these,88% had national growth monitoring guidance, most oftenissued by the ministry of health. Weight was the most con-sistently measured early childhood growth monitoring indi-cator, recorded routinely in 98% of countries during growthmonitoring visits for children aged <1 year. The WHO Child 2DepartmentofNutritionandFoodSafety,WorldHealthOrganization,Geneva,Switzerland 3ChildNutritionandDevelopment,UnitedNationsChildren’sFund,NewYork,NewYork,USA 4Poverty,HealthandNutritionDivision,InternationalFoodPolicyResearchInstitute,SouthAsiaOffice,NewDelhi,India 5InternationalPaediatricAssociation,Marengo,Illinois,USA 6DepartmentofChildHealth,FacultyofMedicine,UniversityofIndonesia,Jakarta,Indonesia HumanDevelopmentNetwork’sHealth,Nutrition,andPopulation,WorldBank,WashingtonD.C.,USA ConclusionsChildhood growth monitoring is widely adopt-ed, but implemented with considerable variation acrosscountries. Strengthening its impact will require standard- DepartmentofMaternal,Newborn,ChildandAdolescentHealthandAgeing,WorldHealthOrganization,Geneva,Switzerland *Jointfirstauthorship. Correspondence to: AnnariinaKoivuTampereCentreforChild,Adolescent,andMaternalHealthResearch,FacultyofMedicineandHealthTechnology,TampereUniversityKalevantie4,TampereFinlandannariina.koivu@tuni.fi Monitoring children’s growth is a standard practice inpaediatric care globally. It is based on the well-estab-lished understanding that excessively slow or rapid ratesof weight or height gain, which are linked to multipleadverse outcomes, can serve as sensitive indicators of a UllaAshornTampereCentreforChild,Adolescent,andMaternalHealthResearch,FacultyofMedicineandHealthTechnology,TampereUniversityKalevantie4,Tampere tify deviations from expected growth patterns and intervene early to prevent or manage poten-tial health concerns. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recom-mend growth monitoring throughout childhood and adolescence as a component of broader well-child visits, with the WHO Child Growth Standards used as a reference throughout the process[1,2]. While its importance is widely recognised, the purpose and implementation of growth mon-itoring vary across countries and remain a subject of debate [3−5]. Some programmes utilise itprimarily as an early warning system to identify children at risk of growth faltering (e.g.Ethiopia)[6], while others shift the focus to overweight children (e.g.Qatar) [7]. The different approaches to The components of growth monitoring, such as the use of length measurement, are also beingreconsidered in the literature [9−11]. A further ongoing debate relates to the use of a global stand-ard for growth assessment, as opposed to local references [12,13]. Finally, variations in oper-ational factors, including utilisation levels, the accuracy of measurement and interpretation,health system capacity for referrals, and community support, can differ considerably across Understanding how countries implement growth monitoring programmes is a necessary firststep in determining how to optimise them and enhance their impact. Because no comprehensiveglobal review of practices and policies has been conducted in more than two decades, we aimedto assess the availability and scope of national guidance on growth monitoring practices, inves-tigate the currently recommended schedules and content of growth assessments, and evaluatethe methods used to interpret anthropometric data. Analysing these components is essentialfor identifying gaps in practice and aligning monitoring strategies with evidence-based recom- METHODS Study design We conducted a cross-sectional, questionnaire-based survey between October 2024 and June 2025(Appendix S1 in theOnline Supplementary Document). The questionnaire was initially draftedby one author (PA) and iteratively revised by all authors. Then, it was piloted with six respond-ents identified by the UNICEF and the International Paediatric Association (IPA), revised basedon their feedback, and collaboratively approv