Charting New Paths: Standard Growth Charts for Pakistani Children (6-24 Months) using Multiple Indicator Cluster Survey Data
Keywords:
Child development, Cluster Survey, Growth charts, Multiple Indicator, Pakistani childrenAbstract
Background: Reliable growth charts are vital for child health monitoring, with chart development based on empirical data and statistical traits. The World Health Organization (WHO) growth standards are used to monitor children's growth worldwide. Recent studies emphasize the need for customized country-specific standards. In Pakistan, reference charts exist, but a standard chart for under-two children is absent due to financial constraints.
Objective: This study employs the Novel Case Selection Method (NCSM) to derive variables from Multiple Indicator Cluster Survey (MICS) data for crafting growth charts for children aged 6 to 24 months.
Methods: Employing NCSM along with an algorithm for age-appropriate complementary feeding, this study selects 6,085 cases from 28,256 (aged 6-24 months) MICS data, forming the basis for standard growth chart creation. Using GAMLSS models with RefCurve_0.4.2, three families (Box Cox Cole and Green, Box Cox Power Exponential, Box Cox T) and three smoothing techniques (cubic splines, penalized splines, polynomial splines) are compared based on criteria including global deviance, Akaike Information, and Bayesian Information. Two models each for Height-for-Age (H/A) and Weight-for-Age (W/A), categorized by gender, yield standard growth curves compared with WHO 2006 standards.
Results: The study's NCSM, combined with considerations for complementary feeding and other WHO criteria, selects 6085 cases from MICS data with 28256 available. Optimal choices for male and female W/A, and female H/A curves are BCPE. Conversely, male H/A curves align with different parameters (BCT). The indigenous standard curves developed for Pakistan show distinct trajectories compared to WHO standards.
Conclusion: The necessity of establishing indigenous pediatric growth standards is evident in the observed disparities with WHO standards. These disparities highlight the need for context-specific benchmarks to accurately assess nutritional status and growth in Pakistani children.
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