Primary Health Care Centers (PHCCs) in Saudi Arabia provide regular check ups for children aged 0 to 5 years and include anthropometric measurements. These measurements are done when a child is vaccinated as well as four additional times during the first five years of life. Beyond this point there is no routine reporting of under or over nourished children or reporting of anthropometric data. Nutritional Surveillance and anthropometric measure are important tools in assessment of the health and nutritional status children. We conducted a study among children under 5 years who attended a well baby clinic to measure nutritional surveillance and to discover ways to improve the system.
Methodology
From 1 of 54 PHCCs with well baby clinics in Riyadh city we selected all children aged 0 to < five years of age who visited the well baby clinic from 29/10/1417 to 19/11/1417 Hijjra (8 to 28 March 1997). We collected 484 cases and conducted a cross-sectional study. A questionnaire requesting information about feeding, history of diarrhea, family size and anthropometric data was completed by the nurses by interviews with the persons accompanying target children and through vaccination cards. Weight and length or height at visit were obtained by measuring the children during the visit. Nurses did routine measurements and each tenth child was re-measured for verification of measurement accuracy. Data was entered and analyzed using EPI-info version 6. A p-value of <0.05 was considered significant.
Results
Of children who visited the PHCC, 14% had Low Birth Weight. The mean weight for age was slightly lower than the WHO reference standard. Underweight children (<-2.0 z) accounted for 3.7% of the population compared to the 2.1% expected. Height for age of 6% children was below (-2.0 z) the 2.1% reference standard (Chi square = 44, 1 df, p <0.001). Exceptionally tall and weight for height did not exceed expected reference standard. Multiple regression analysis of WAZ, HAZ, and WHZ against four explanatory variables revealed that only age and birth weight were associated with changes in WAZ, HAZ and WHZ. Excluding birth weight from regression analysis, differences in anthropometric scores related to total siblings. Decrease of -0.55 WAZ (95% CI -0.076 to -0.034) was most evident between 0 and 18 months of age. WAZ and WHZ decreased with increasing number of children in the family. The WAZ for families of 1 to 3 children was not different than the reference standard. However, for all family sizes above 3 the WAZ was less than -0.32 and were different than the reference standard (p < 0.01 Students t-test). There was an increased association between Saudi nationals (82% of children) with decreased WAZ and WHZ. Among mothers, 84% began weaning within the normal age range recommended by pediatricians. We found no association between WAZ, HAZ and WHZ and the initiation of weaning. There was no association between breast or artificial feeding and deviations from reference anthropometric values or between recent diarrheal illness and decreased anthropometric indices.
Conclusion
An association of low anthropometric scores with age, Saudi nationality, birth weight and total siblings was found. The mean of weight for age in our study was only slightly different than the reference. This difference could be due to low birth weight, genetic factors, or under-nutrition. The association with Saudi nationality could represent genetic factors or problems related to nutrition practices in Saudi households. Other factors that could indicate less than perfect feeding such as recent diarrhea, breastfeeding, age at weaning, showed little effect on anthropometric scores, and only the total number of siblings in a family showed a relationship. This could reflect socioeconomic level, education, or the time and attention paid to individual children by the mother. The irreversible association between WAZ, HAZ and WHZ and age may be because undernutrition occurs with increasing age. We saw no association of Anthropometry scores with weaning or breastfeeding, so it is unlikely that lower scores were related to infant feeding practices. It is possible that infants were above normal size due to some factor such as a high prevalence of gestational diabetes.
Collection of anthropometric data is routinely done in well baby clinics but no targeting is done for nutritional surveillance. The mean of weight for age was only slightly different than the reference. The irreversible association between WAZ, HAZ and WHZ and age may be because undernutrition occurs with increasing age. The decrease with age would be due to infants of diabetic or prediabetic mothers losing their excess birth weight. The prevalence rate of normal nutrition was mostly normal.