Child growth reference charts have been used since the 1960s to assess children´s growth - enabling comparison of different population groups and the implementation of nutritional surveillance. In 2006, an important critical juncture occurred in the history of anthropometry and nutritional assessment, when the WHO released new growth charts for international comparison after promoting, since 1975, the use of the charts developed by the Centers for Disease Control (CDC) and US National Center for Health Statistics (NCHS). According to the WHO, these charts indicate how children should grow for the best health outcome in contrast to the NCHS/CDC charts that indicated how the average child grows. This shift from a descriptive to a prescriptive -and rather normative - approach allowed the WHO to state that all children in the world have the potential to grow and develop to within the same range of height and weight, thus implying that all children should develop in specific standardised ways, regardless of ethnicity, socioeconomic status and type of feeding. By 2011, approximately 125 countries had adopted the WHO charts for individual growth monitoring as well as the means of producing statistics for under- and over-nutrition, which would be used to assess and monitor a population's health status. This shift between charts has direct implications for how children's growth is measured and how malnutrition is assessed. The adoption of the WHO charts has immediate consequences for the calculation of underweight, overweight, stunting, and wasting prevalence. In this sense, the adoption of the new charts considerably changes the estimates to predict nutrition-related emergencies, the assessment of appropriate weaning practices, and the screening and monitoring of populations at risk or with growth deficiencies or excesses. In my doctoral research, I use Colombia as a case study to unpack how a standard developed by an international organisation is negotiated, adopted and constantly transformed once it is scaled down to a specific country. Using the theoretical approach to standards by authors such as Star, Bowker, Timmermans, Berg, and Epstein, in this dissertation I show how, far from being 'stable' and 'value-free' (as the World Bank would describe them), growth charts are political tools of measurement, charged with specific values regarding children's bodies. Given that Colombia had previously used the NCHS charts, this research explores how the WHO charts have been adopted within individual growth monitoring programmes in Colombia. I also describe how the change in charts has destabilised the production of under and over-nutrition indicators by national bodies, such as the Ministry of Health and the Instituto Nacional de Salud. My data includes twenty-eight interviews with policy makers, experts and civil servants who actively participated in the process of adopting and adapting the standards in Colombia at the national level; seventeen interviews with nurses and doctors; observation of 158 anthropometric assessments of children under five years old within six health facilities in the Caribbean region that were implementing a growth monitoring programme. By exploring how the WHO charts are interpreted and used in practice, this research contributes to the study of standards and standardisation as a field of study in its own right.

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In this thesis, we introduce a concept of directional quantile envelopes, the intersection of the halfspaces determined by directional quantiles, and show that they allow for explicit probabilistic interpretation, compared to other multivariate quantile concepts. Directional quantile envelopes provide a way to perform multivariate quantile regression: to ``regress contours'' on covariates. We also develop theory and algorithms for an important application of multivariate quantile regression in biometry: bivariate growth charts. We prove that directional quantiles are continuous and derive their closed-form expression for elliptically symmetric distributions. We provide probabilistic interpretations of directional quantile envelopes and establish that directional quantile envelopes are essentially halfspace depth contours. We show that distributions with smooth directional quantile envelopes are uniquely determined by their envelopes. We describe an estimation scheme of directional quantile envelopes and prove its affine equivariance. We establish the consistency of the estimates of directional quantile envelopes and describe their accuracy. The results are applied to estimation of bivariate extreme quantiles. One of the main contributions of this thesis is the construction of bivariate growth charts, an important application of multivariate quantile regression. We discuss the computation of our multivariate quantile regression by developing a fast elimination algorithm. The algorithm constructs the set of active halfspaces to form a directional quantile envelope. Applying this algorithm to a large number of quantile halfspaces, we can construct an arbitrary exact approximation of the direction quantile envelope. In the remainder of the thesis, we exhibit the connection between depth contours and directional regression quantiles (Laine, 2001), stated without proof in Koenker (2005). Our proof uses the duality theory of primal-dual linear programming. Aiming at interpreting halfspace depth contours, we explore their properties for empirical distributions, absolutely continuous distributions and certain general distributions. Finally, we propose a generalized quantile concept, depth quantile, inspired by halfspace depth (Tukey, 1975) and regression depth (Rousseeuw and Hubert, 1999). We study its properties in various data-analytic situations: multivariate and univariate locations, regression with and without intercept. In the end, we show an example that while the quantile regression of Koenker and Bassett (1978) fails, our concept provides sensible answers. / Statistics

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

The thesis summarizes present knowledge about assessment of growth and development in childhood (antropometric assessment, assessment of biological age and assesment of nutritional status). Nutrition in childhood and adolescence is also described. The thesis deals with silure to drive- its causes, definitiv, consequences and treatment. Most of nutritional screening forms (foreing and also Czech screening form) are mentioned. Practical part is realized on childern wards, Motol University Hospital. The aim of the thesis is to evaluate two nutritional risk screening which have been gradually introduced in Motol Univrsity Hospital to determinate the nutritional risk of hospitalized pediatric patients.

La surveillance de la croissance des enfants est une activité quasi-universelle visant principalement à repérer des affections graves chez des enfants apparemment sains. Il existe des preuves empiriques que les performances de cette surveillance sont faibles, ce qui pourrait s’expliquer par l’absence de consensus sur trois questions clés et interdépendantes : quelles sont les affections à cibler en priorité ? comment définir une croissance anormale ? et quelles sont les courbes de croissance à utiliser ?Nous avons montré qu’il existait une grande hétérogénéité des pratiques de surveillance de la croissance en Europe et que les sept algorithmes proposés pour définir une croissance anormale avaient des performances et/ou un niveau de validation faible. Nous avons réalisé une étude de validation externe et une comparaison face-à-face de ces algorithmes et démontré que la règle de Grote avait les meilleures performances. Nous avons montré que la croissance des enfants français contemporains était plus proche des courbes de l’OMS que des courbes de référence françaises, excepté dans les six premiers mois de vie, et que l’introduction des courbes de l’OMS augmenterait la sensibilité des algorithmes au détriment de leurs spécificités. Nous avons obtenu un consensus d’experts internationaux sur la typologie des affections cibles prioritaires et un consensus national sur une liste réduite de huit affections cibles prioritaires des algorithmes de surveillance de la croissance.Ces connaissances nouvelles permettront très probablement de proposer des outils plus valides pour la surveillance de la croissance et de standardiser les pratiques pour améliorer la santé des enfants. / Growth monitoring in children is a worldwide health activity which aims at early detection of serious underlying disorders of apparently healthy children. Existing empirical evidence shows that growth-monitoring performance were low, this can be explained by a lack of consensus on three key and interconnected questions: which conditions should be targeted? how should abnormal growth be defined? and which growth charts should be used?We showed that there is a large heterogeneity in growth-monitoring practices in Europe and that the seven algorithms proposed for defining an abnormal growth had low performance and/or a level of validation. We performed an external validation study and head-to-head comparison of these seven algorithms and demonstrated that the Grote clinical rule had the best performance. We found that the growth of contemporary French children were closer to the WHO than French growth charts, except during the first six month of life. The introduction of WHO growth charts would increase the sensitivity at the expense of their specificity. We obtained an international consensus on the typology of priority target conditions and national consensus on a short list of eight priority target conditions of growth-monitoring algorithms.This new knowledge will most likely allow developing validated tools for growth monitoring and standardizing practices for improving child outcomes.

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No / OBJECTIVE: To describe the growth pattern from birth to 2 years of UK-born white British and Pakistani infants. DESIGN: Birth cohort. SETTING: Bradford, UK. PARTICIPANTS: 314 white British boys, 383 Pakistani boys, 328 white British girls and 409 Pakistani girls. MAIN OUTCOME MEASURES: Weight and length trajectories based on repeat measurements from birth to 2 years. RESULTS: Linear spline multilevel models for weight and length with knot points at 4 and 9 months fitted the data well. At birth Pakistani boys were 210 g lighter (95% CI -290 to -120) and 0.5 cm shorter (-1.04 to 0.02) and Pakistani girls were 180 g lighter (-260 to -100) and 0.5 cm shorter (-0.91 to -0.03) than white British boys and girls, respectively. Pakistani infants gained length faster than white British infants between 0 and 4 months (+0.3 cm/month (0.1 to 0.5) for boys and +0.4 cm/month (0.2 to 0.6) for girls) and gained more weight per month between 9 and 24 months (+10 g/month (0 to 30) for boys and +30 g/month (20 to 40) for girls). Adjustment for maternal height attenuated ethnic differences in weight and length at birth, but not in postnatal growth. Adjustment for other confounders did not explain differences in any outcomes. CONCLUSIONS: Pakistani infants were lighter and had shorter predicted mean length at birth than white British infants, but gained weight and length quicker in infancy. By age 2 years both ethnic groups had similar weight, but Pakistani infants were on average taller than white British infants.

<p><strong>Background:</strong> Postnatal growth of preterm infants does not match recommended intrauterine growth, due to the initial weight loss that accompanies healthy body composition rearrangements after birth. Thus, optimal postnatal growth for preterm infants is currently unknown.</p> <p><strong>Objectives: </strong>(1)<strong> </strong>Collect longitudinal postnatal growth data of 30–36 week GA preterm infants with unimpaired postnatal adaptation; (2) Develop regressions that predict the growth trajectory such an infant will adjust to by days of life 7/14/21; (3) Extrapolate and validate the regressions downwards to 25 weeks.</p> <p><strong>Methods:</strong> Infants of 30–36 week GA, born/admitted to 1/5 participating centres between 2008–2012, who met pre-specified criteria for unimpaired postnatal adaptation and who had at minimum 14 days of data were included. Day-specific anthropometric data from birth to discharge were abstracted retrospectively. Z-score regressions for days 7/14/21 were developed. Regressions were then extrapolated to 25 weeks and validated using an independent study population.</p> <p><strong>Results:</strong> Of 6203 infants, 665 met the screening criteria. By day 14, infants adjusted to stable growth trajectories that were 84±13% of the recommended weight-for-age. Using the following predictors: GA, z-score at birth and hospital-centre, regressions accurately predicted z-scores at days 7, 14 (n=665; R²=0.939, 0.889) and 21 (n=333; R²=0.841). Validation using 25-29 week GA infants (n=173) suggested models were also accurate within this age-range.</p> <p><strong>Conclusion: </strong>These results provide robust estimates of a hypothesis of healthy postnatal growth for preterm infants. Future steps include assessing long-term outcomes in a randomized control trial and assessing the quality of growth using body composition analyses.</p> / Master of Science in Medical Sciences (MSMS)