Session 4: The thinness chart

The Thinness Chart was developed for use in maternal child health clinics in Nepal by Save the Children (UK). The Thinness Chart uses two measures, weight and height, to assess the nutrition status of young children. A large multi-colored wall chart is first attached to the wall. Children are weighed and then placed standing in front of their weights on the chart. Height is then measured by placing a flat hand on the head and marking the point where the hand touches the chart. Nutrition status can be measured either in terms of percentages of standard weight for height or by using color-coded cutoff points indicating high, potential and low risk. Age is not required for this method. Graphing of weight is accomplished simultaneously with the measurement of height on the chart.

Purpose:

In this session, trainees practice using the Thinness Chart to classify the nutrition status of young children. The advantages of the Thinness Chart for community action projects are discussed.

Time: 1 hour without practice

Materials:

- The Thinness Chart, available from TALC - Teaching Aids at Low Cost

- One copy of the booklet, "The Thinness Chart - How You Use It" for each trainee

- Chalkboard and chalk

- Several willing young children

Steps:

1. Introduce the session by telling trainees that one way to identify children who are presently malnourished or at high risk of malnutrition is by comparing their current weight to their current height. By comparing a child's weight and height to standards for well-nourished and malnourished children, we can identify those children who are growing well as well as those who are malnourished and in need of additional counseling and medical attention.

2. Display the Thinness Chart. Explain that weights are shown on the vertical lines of the chart and heights on the horizontal lines. The colored bands across the chart tell the health or nutrition workers whether a child is healthy (green), in danger of malnutrition (yellow), malnourished (lower red) or severely malnourished (upper red). In contrast to the Road to Health Chart, the higher a child falls on the chart's curve, the more malnourished he or she is.

3. Distribute copies of the booklet "The Thinness Chart, How You Use It." Demonstrate steps for using the chart as presented in the booklet.

4. Practice: Arrange a practice session in which trainees weigh and assess several children using the Thinness Chart. Observe trainees and correct problems to improve their skills where necessary.

5. Ask trainees to brainstorm the advantages and disadvantages of the Thinness Chart as a tool for nutrition assessment at the community level. These might include:

Advantages:	- Does not require calculation of age. Can be used by people with minimal literacy skills.
	- Mothers can participate.
	- Colored bands make assessment easy and understandable
Disadvantages:	- Requires special chart and weighing equipment.
	- Wall and adjoining floor must be flat.
	- Difficult to make children stand still in front of chart.
	- For children under one year, a measuring board is also required.

 

6. Summarize by reviewing the purpose and steps in using the Thinness Chart for nutrition assessment.

Note: The Thinness Chart is being used in two of the countries where CEDPA's training workshops have been held, Nepal and Senegal. The chart is generally easier to use and interpret than the WHO Road to Health Chart because it does not require graphing numerical measurements and assessing their position on the graph. Instead, the wall chart combines the measurement of height with the assessment of normal or abnormal growth. The Ministry of Health of Senegal is currently attempting to adapt the chart for use by non-literate village workers, who would use color coded weighing scales and wall charts to assess nutritional status of young children.

THE THINNESS CHART

How you use it

Thinness chart

Developed by the Save the Children Fund with the London School of Hygiene and Tropical Medicine. The Thinness Chart is available from: TALC, P.O. Box 49, St. Albans, Herts, ALl 4AX, UNITED KINGDOM.

- Put the chart near your scales.

- The chart goes on the wall. The wall must be even.

- The bottom of the chart must touch the ground.

Scale and chart

- Weigh the child.

Weigh the child

- Note the weight to the nearest half kilo (kg).

Note the weight

- Find the weight on the chart with your finger.

Find the weight

- Ask the mother to put her child under your finger.

- The child must be in the correct place.

The child must be in the correct place

CHECK THAT: 1 the middle of the child's head is under his weight on the chart.

The middle of the child's head

CHECK THAT: 2 the child's shoulders and feet are against the chart.

The child's shoulders and feet

CHECK THAT: 3 the child's heels are against his weight at the bottom of the chart.

The child's heels

THEN: Put the palm of your hand on the child's head.

Touch the chart with your finger.

Which colour does your finger touch?

Your hand on the child's head

Is the child in the:

UPPER RED?

LOWER RED?

YELLOW?

GREEN?

Where is the child?

You can darken the upper red section yourself. This will show you if the child is extremely thin.

This child is in the UPPER RED.

He is extremely thin (wasted).

You must help him urgently.

Child in upper red.

This child is in the LOWER RED.

He is very thin (wasted).

You should help him quickly.

Child in lower red.

This child is in the YELLOW.

He is thin.

You must watch him regularly.

Child in yellow.

This child is in the GREEN.

He is well nourished.

Child in green.

Session 5: Choosing a growth monitoring system

Purpose:

To compare the advantages and disadvantages of three growth monitoring tools: the three-color arm circumference tape, the Road to Health Chart and the Thinness Chart.

For use in training managers who will choose their own systems for measuring and monitoring the growth of young children.

Time: 20 minutes

Materials:

- Handout - "Choosing a Growth Monitoring Systems"

- Wall-sized version of the handout

Steps:

1. Distribute the Handout - "Choosing a Growth Monitoring System." Ask participants to use information from Sessions 2-4 to answer the questions on the chart.

Note: A copy of the completed handout is provided with this session for the trainer's reference.

2. Complete the wall-sized handout as a group activity. Use this as a time to review important points about each growth monitoring system.

3. Remind participants that the following criteria determine which growth monitoring system is appropriate in a given situation:

- Characteristics of malnutrition in the area

- Number of workers and their skills

- Resources available for training and supervision

- Resources available for assistance to "high risk" children

HANDOUT

CHOOSING A GROWTH MONITORING SYSTEM

SYSTEM	MEASUREMENTS REQUIRED	WHAT IT MEASURES	TOOLS/EQUIPMENT REQUIRED	TRAINING REQUIRED	DISADVANTAGES	ADVANTAGES
Mid-upper Arm Circumference Tape	- Distance Around Mid-upper Left Arm	-Severe Malnutrition in Children 1-5 Yrs.	- Tape Marked either with Three Colors or in CM Divisions	- Minimal Training Required to Teach Health Workers, Mothers and Other Community Members How to use	- Only Useful with Children - Measures Malnutrition that is already Severe	- Quick, Easy to Use - Portable, Can Be Used Anywhere - Easy to Understand - Detects Improvements in Nutrition Status
Road to Health Chart	- Monthly Weights Age at First Weighing	- Past and Present Malnutrition - Most sensitive with Children Under 2 Yrs.	- Weighing Scale - Road to Health Chart	- Extensive Training And Supervision Required	- Age is Often Difficult to Determine - Workers Must Be Literate - Equipment Expensive	- Sensitive to Early Changes in Nutrition Status - Weighing Activity is Popular in the Village
Thinness Chart	- Weight - Height	- Present Malnutrition - Wasting	- Thinness Chart - Weighing Scale - Measuring Board	- Training and Supervision Required	- Requires Flat Wall and Floor - Difficult to Make Children Stand - Chart must be Purchased or Produced Locally - Equipment Expensive	- Easier to use Than the Road to Health Chart - Can Be Used by Semi-literate Workers - Colors Make it Easy to Understand and Use - Weighing Activity is Popular