ICMR develops India-Specific Growth Standards for Children
India is embarking on a notable public health initiative: the development of its first nationally representative growth standards for children. The Indian Council of Medical Research (ICMR) has launched a large-scale exercise to create these standards, aiming for a more accurate assessment of child malnutrition within the country.
Currently, India relies on the World Health Institution’s (WHO) Multicentre Growth Reference Study (MGRS) standards, established in 2006. While considered a worldwide benchmark, concerns have been raised about their applicability to the Indian context.These standards, developed between 1997 and 2003, are now over two decades old and may not fully reflect the unique circumstances influencing child growth in India.
Critiques of the WHO MGRS standards highlight potential limitations in the original study sample. Dr. H.P.S. Sachdeva, a paediatrician and researcher involved in the ICMR panel, points out that the Indian sample used for the WHO study primarily consisted of children from affluent families in South Delhi, potentially failing to represent the diverse population across the country. He also emphasizes that factors like maternal haemoglobin levels, gestational restrictions, and zinc serum levels – prevalent in Indian women – significantly impact child height and weight and were not adequately considered.
furthermore, the initial international reference used by the WHO, the United States’ National Center for Health Statistics (NCHS) growth reference adopted in the 1970s, was also questioned due to its sample being largely bottle-fed, contrasting with international breastfeeding recommendations, and having a limited socio-economic and genetic background.
A 2023 paper published in The Lancet, co-authored by Indian pediatricians and researchers from Harvard university, explored the question of whether India should adopt country-specific growth references. The paper acknowledged the benefits of a universal standard for comparing populations and assessing growth potential, but stressed the importance of considering the specific context when developing policies and interventions for undernutrition, notably for height-based measures which are influenced by intergenerational factors. The authors noted that it is common practice for countries to utilize their own growth references, citing the US example of using the Centers for Disease control and Prevention (CDC) 2000 growth reference chart.
According to NFHS-5 (2019-2021) data, 35.5 percent of children in India are stunted, a figure some experts believe may underestimate the true extent of the issue. The ICMR’s initiative aims to address these concerns by establishing a reference point tailored to the Indian population, leading to more accurate monitoring and effective interventions to combat malnutrition.
