Use of a monitoring tool for growth and development in Brazilian children – systematic review

Almeida, Ana Claudia de; Mendes, Larissa da Costa; Sad, Izabela Rocha; Ramos, Eloane Gonçalves; Fonseca, Vânia Matos; Peixoto, Maria Virginia Marques

doi:10.1016/j.rppede.2015.12.002

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Review Articles • Rev. paul. pediatr. 34 (1) • Jan-Mar 2016 • https://doi.org/10.1016/j.rppede.2015.12.002 copy

Use of a monitoring tool for growth and development in Brazilian children – systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care.

Data source:

A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full.

Data synthesis:

Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools.

Conclusions:

The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

KEYWORDS
Children's health; Growth and development; Development; Child care

Title	Author (s)	Reason for exclusion
Evaluating child healthcare in the context of Family Healthcare in the city of Teixeiras, Minas Gerais (MG, Brazil)	Da Costa et al. ²⁹29 Da Costa GD, Cotta RM, Reis JR, Ferreira ML, Reis RS, Franceschini SC. Avaliação da atenção à saúde da criança no contexto da saúde da família no município de Teixeiras, Minas Gerais. Cienc Saude Colet. 2011;16:3229-40.	Classification used in the analysis for CHC filling out was “incomplete” without specifying frequencies for the variables of interest.
A case study of the Community Health Agents Program in Uruburetama, Ceará (Brazil)	Ávila ³⁰30 Ávila MM. O Programa de agentes comunitários de saúde no Ceará: o caso de Uruburetama. Cienc Saude Colet. 2011;16:349-60.	Monitoring actions of child growth and development were evaluated on the technical aspects and agents’ practices.
Nutritional evaluation of children aged from six to sixty months	Sousa and Araújo ³¹31 Sousa FG, Araújo TL. Avaliação nutricional de crianças de seis a sessenta meses. REBEn. 2004;57:534-36.	Nutritional assessment of children was performed by comparing the criteria of Waterlow and weight/age curve of CHR.
The evolution of maternal and child healthcare and birth weight in the State of Pernambuco in 1997 and 2006	Noronha et al. ³²32 Noronha GA, Lima MC, Lira PI, Veras AA, Gonçalves FC, Batista Filho M. Evolução da assistência materno-infantil e do peso ao nascer no Estado de Pernambuco em 1997 e 2006. Cienc Saude Colet. 2012;17:2749-56.	Information was collected from the child's guardian. Birth weight was collected from CHC when recorded.
Children health care evaluation (0–5 years) according to users’ perceptions in the Family Health Strategy of Teresópolis, Rio de Janeiro State	Ribeiro et al. ³³33 Ribeiro JM, Siqueira SA, Pinto LF. Avaliação da atenção à saúde da criança (0-5 anos) no PSF de Teresópolis (RJ) segundo a percepção dos usuários. Cienc Saude Colet. 2010;15:517-28.	Linking with public institutions of child care was evidenced by the possession of CHC.
Monitoring of child growth: knowledge and practices of nurses in primary health care	Reichert et al. ³⁴34 Reichert AP, Almeida AB, Souza LC, Silva ME, Collet N. Vigilância do crescimento infantil: conhecimento e práticas de enfermeiros da atenção primária à saúde. Rev Rene. 2012;13:114-26.	Growth charts were used in verification issues of professionals’ knowledge.
Child development: agreement between the child health handbook and the guide for monitoring child development	Oliveira et al. ³⁵35 Oliveira LL, Costa VM, Requeijo MR, Rebolledo RS, Pimenta AF, Lemos SM. Desenvolvimento infantil: concordância entre a caderneta de saúde da criança e o manual para vigilância do desenvolvimento infantil. Rev Paul Pediatr. 2012;30:479-85.	Classifications of development were compared according to the CHR and the Manual for Child Development Monitoring in the Context of IMCI.
Evaluation of childhood development: an interdisciplinary challenge	Alvim et al. ³⁶36 Alvim CG, Guimarães FG, Meinberg NL, Aguiar LT, Caetano LC, Carrusca LC, et al. A avaliação do desenvolvimento infantil: um desafio interdisciplinar. Rev Bras Educ Med. 2012;36 Suppl. 1:51-6.	Classifications of development were compared according to the CHR and the Manual for Child Development Monitoring in the Context of IMCI.
Neuromotor, growth and biopsychosocial profile of latents	Rothstein and Beltrame ³⁷37 Rothstein JR, Beltrame TS. Características neuromotoras, pondo-estaturais e biopsicossociais de lactentes. Rev Bras Crescimento Desenvolvimento Hum. 2011;21:269-81.	Child Health Card was used only as a source document information.
User embracement and maternal characteristics associated with liquid offer to infants	Niquini et al. ³⁸38 Niquini RP, Bittencourt SA, Lacerda EM, Oliveira MI, Leal MC. Acolhimento e características maternas associados à oferta de líquidos a lactentes. Rev Saude Publica. 2010;44:677-85.	Mothers were asked if they have received the mother-infant welcoming card in the maternity. There was no analysis of filling out variables.

Authors	Objective	Data collection site	Conclusion
Santos et al. ²⁰20 Santos SR, Cunha AJ, Gamba CM, Machado FG, Leal Filho JM, Moreira NL. Avaliação da assistência à saúde da mulher e da criança em localidade urbana da região Sudeste do Brasil. Rev Saude Publica. 2000;34:266-71.	Assess the primary care offered to the mother and child population.	Vaccination station, city of Teresópolis (RJ).	Despite being a child care visit, 30% of children did not have their weight recorded in the CHC.
Ratis and Batista ¹⁷17 Ratis CA, Batista Filho M. Aspectos estruturais e processuais da vigilância do crescimento de menores de cinco anos em serviços públicos de saúde do Estado de Pernambuco. Rev Bras Epidemiol. 2004;7:44-53.	Evaluate the structure and process of growth monitoring.	Health units of PE State.	The lack of interest in growth monitoring was more prominent upstate.
Carvalho et al. ²¹21 Carvalho MF, Lira PI, Romani SA, Santos IS, Veras AA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saude Publica. 2008;24:675-85.	Evaluate the growth monitoring.	Health units of PE State.	Growth monitoring indicators do not greatly exceed 50%, and were lower upstate.
Sardinha and Pereira ²²22 Sardinha LM, Pereira MG. Avaliação do preenchimento do cartão da criança no Distrito Federal. Brasilia Med. 2011;48:246-51.	Assess the filling out of CHC.	Health centers in the cities of the DF.	The weight chart filling was more accomplished in younger children.
Vieira et al. ²³23 Vieira GO, Vieira TO, Costa CO, Santana Netto PV, Cabral VA. Uso do cartão da criança em Feira de Santana, Bahia. Rev Bras Saude Mater Infant. 2005;5:177-84.	Assess the filling out of CHC.	Health units of Feira de Santana (BA).	The filling out of the growth curve was complete in 41.1% (905) and development chart in 7.8% (170).
Goulart et al. ²⁴24 Goulart LM, Alves CR, Viana MR, Moulin ZS, Carmo GA, Costa JG, et al. Caderneta de saúde da criança: avaliação do preenchimento dos dados sobre gravidez, parto e recém-nascido. Rev Paul Pediatr. 2008;26:106-12.	Assess the filling out of CHR and know the mothers’ perception about it.	UBS of Belo Horizonte (MG) and home visit. Santana (BA).	Birth weight was the field most filled out (91%). Failures suggest that CHR does not meet its goal.
Alves et al. ²⁵25 Alves CR, Lasmar LM, Goulart LM, Alvim CG, Maciel GV, Viana MR, et al. Qualidade do preenchimento da caderneta de saúde da criança e fatores associados. Cad Saude Publica. 2009;25:583-95.	Assess the quality of CHR's filling.	UBS of Belo Horizonte (MG).	The best fill percentages were on the identification, vaccination record, and birth data.
Linhares et al. ²⁶26 Linhares AO, Gigante DP, Bender E, Cesar JA. Avaliação dos registros e opinião das mães sobre a caderneta de saúde da criança em unidades básicas de saúde, Pelotas, RS. Rev AMRIGS. 2012;56:245-50.	Assess the filling out of CHR and know the mothers’ perception about it.	Home visits in areas of four UBS of Pelotas (RS).	The CHR's filling was limited to sections that were already present in the CHC.

Authors		Ratis and Batista ¹⁷17 Ratis CA, Batista Filho M. Aspectos estruturais e processuais da vigilância do crescimento de menores de cinco anos em serviços públicos de saúde do Estado de Pernambuco. Rev Bras Epidemiol. 2004;7:44-53.	Carvalho et al. ²¹21 Carvalho MF, Lira PI, Romani SA, Santos IS, Veras AA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saude Publica. 2008;24:675-85.	Vieira et al. ²³23 Vieira GO, Vieira TO, Costa CO, Santana Netto PV, Cabral VA. Uso do cartão da criança em Feira de Santana, Bahia. Rev Bras Saude Mater Infant. 2005;5:177-84.	Goulart et al. ²⁴24 Goulart LM, Alves CR, Viana MR, Moulin ZS, Carmo GA, Costa JG, et al. Caderneta de saúde da criança: avaliação do preenchimento dos dados sobre gravidez, parto e recém-nascido. Rev Paul Pediatr. 2008;26:106-12.	Alves et al. ²⁵25 Alves CR, Lasmar LM, Goulart LM, Alvim CG, Maciel GV, Viana MR, et al. Qualidade do preenchimento da caderneta de saúde da criança e fatores associados. Cad Saude Publica. 2009;25:583-95.	Linhares et al. ²⁶26 Linhares AO, Gigante DP, Bender E, Cesar JA. Avaliação dos registros e opinião das mães sobre a caderneta de saúde da criança em unidades básicas de saúde, Pelotas, RS. Rev AMRIGS. 2012;56:245-50.
Research year		1998	1998	2001	2005	2006	2008
Document		CHC	CHC	CHC	CHR	CHR	CHR
N		1194	662	2215	797	355	107
Age		<5 years	<12 months	≤12 months	<9 months	<16 months	<12 months

Identification
	Name	–	–	99.8	55.6	93.8	93.5
	Birth date	–	–	99.3	90.1	99.7	100
	Birthplace	–	–	76.6	–	–	98.1
	Mother's name	–	–	–	90.7	98.9	99.1
	Address	–	–	–	38.9	–	73.8
	Telephone	–	–	–	22.1	–	47.7
	Neighborhood	–	–	–	33.4	–	67.3
	Zip code	–	–	–	14.6	–	21.5
	City	–	–	–	34.3	–	64.5
	Ethnicity/Color	–	–	–	50.1	–	66.4
	N° CLB	–	–	–	60.9	–	33.6
	N° BC	–	–	–	2.0	–	8.4

Gestation
	Prenatal	–	–	–	59.6	58.0	–
	N° prenatal visit	–	–	–	68.5	69.9	–
	Serology	–	–	–	50.0	–	–
	Type of delivery	–	–	93.3	84.9	89.3	–
	Birth
	Gestational age	–	–	–	75.8	72.4	–
	Apgar5′	–	–	28.4	76.7	53.5	–
	Weight	86.8	89.4	97.2	91.1	96.9	–
	Length	–	–	91.8	89.6	91.2	–
	Head circumference	–	–	88.9	84.9	85.6	–

Authors		Santos et al. ²⁰20 Santos SR, Cunha AJ, Gamba CM, Machado FG, Leal Filho JM, Moreira NL. Avaliação da assistência à saúde da mulher e da criança em localidade urbana da região Sudeste do Brasil. Rev Saude Publica. 2000;34:266-71.	Ratis and Batista ¹⁷17 Ratis CA, Batista Filho M. Aspectos estruturais e processuais da vigilância do crescimento de menores de cinco anos em serviços públicos de saúde do Estado de Pernambuco. Rev Bras Epidemiol. 2004;7:44-53.	Carvalho et al. ²¹21 Carvalho MF, Lira PI, Romani SA, Santos IS, Veras AA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saude Publica. 2008;24:675-85.	Sardinha and Pereira ²²22 Sardinha LM, Pereira MG. Avaliação do preenchimento do cartão da criança no Distrito Federal. Brasilia Med. 2011;48:246-51.	Vieira et al. ²³23 Vieira GO, Vieira TO, Costa CO, Santana Netto PV, Cabral VA. Uso do cartão da criança em Feira de Santana, Bahia. Rev Bras Saude Mater Infant. 2005;5:177-84.	Alves et al. ²⁵25 Alves CR, Lasmar LM, Goulart LM, Alvim CG, Maciel GV, Viana MR, et al. Qualidade do preenchimento da caderneta de saúde da criança e fatores associados. Cad Saude Publica. 2009;25:583-95.	Linhares et al. ²⁶26 Linhares AO, Gigante DP, Bender E, Cesar JA. Avaliação dos registros e opinião das mães sobre a caderneta de saúde da criança em unidades básicas de saúde, Pelotas, RS. Rev AMRIGS. 2012;56:245-50.
Tool		CHC	CHC	CHC	CHC	CHC	CHR	CHR
Age		<12 months	<5 years	<12 months	<5 years	≤12 months	<16 months	<12 months
Growth
Data from medical visits
		( N =299)						( N =107)
	Visit date							91.6
	Age							90.7
	Weight	74.6 ^a a At least one record in the three months prior to the interview.						89.7 ^b b Records according to the child's age.
	Height							87.9 ^b b Records according to the child's age.
	Head circumference							82.2 ^b b Records according to the child's age.

Birth data in charts
			( N =1193)	( N =662)			( N =355)
	Weight		36.9	44.1			69.3
	Head circumference						15.5

Data from visits in charts
		( N =307)	( N =624)	( N =402)	( N =3543)	( N =2200)	( N =355)	( N =107)
	Weigh	70.4 ^a a At least one record in the three months prior to the interview.	59.9 ^c c Records in the consultation day.	58.2 ^d d Last updated record.	21.1 ^e e Records properly punctuated, according to the Ministry of Health.	41.1 ^f f At least one record every three months.	59.4 ^g g Weight and HC records marked on the chart whose difference between the age at the time of the record and the child's chronological age was ≤3 months.	96.3 ^h h At least one record verified.
	Length/height							42.1 ^h h At least one record verified.
	Head circumference						30.7 ^g g Weight and HC records marked on the chart whose difference between the age at the time of the record and the child's chronological age was ≤3 months.	35.5 ^h h At least one record verified.
	Development
						( N =2191)	( N =355)
	Milestones 0–36 months					7.8 ⁱ i All records matching the child's age.	18.9 ^j j Records in three or more age groups present in CHR.

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[1] * Corresponding author. analmeida@iff.fiocruz.br (A.C. Almeida).