GROWTH references for infants and young children are the most widely used tool in public health. Paediatric professionals rely on the evaluation of growth to assess their health and nutritional status.

In 2006, WHO released new growth charts for the assessment of growth and nutritional status that are based on the growth of breastfed children in six different countries, with widely differing ethnic backgrounds.

These WHO 2006 growth standard charts were field-tested in four countries, including two affluent countries, Argentina and Italy, and two less affluent countries, Pakistan and the Maldives.

Before 2006, the growth reference data were the growth charts that were based on data compiled by the US National Centre for WHO.

For children under 24 months of age, the 1977 NCHS charts were based on data from a single community (Yellow Springs, Ohio) collected between 1929 and 1975 as part of the Fels Longitudinal Study.

These reference data had a number of limitations. Some of the technical problems were subsequently rectified by the National Centre for Health Statistics (NCHS), and the new Centre for Disease Control (CDC) 2000 growth charts were released. However, the CDC growth charts reflected a notable difference (especially six months of age) when they plotted breast-fed infants against them because the growth survey data included relatively few breast-fed infants. Thus, the international growth reference was hampered by an inadequately low frequency of measurements during infancy and outdated analytic measurements.

However, the new standard is based on the WHO Multi-centre Growth Reference Study that was designed specifically to construct a standard and which is in use throughout the world for infants and young children.

As a student of food and nutrition, I came across different hospitals to collect some initial information before the start of my research topic related to the infant nutritional status.

Hospitals were using the latest growth chart for infants and young children under five, which are recommended by WHO 2006.

All previous growth charts (NCHS) were in use to assess the growth of infants and young children. I don’t know why the latest growth charts were not used.

Meanwhile, the National Nutritional Survey (NNS 2011) has revealed the new statistics, reflecting child-stunting as a major drawback in the health sector related to future generations of the country.

To align with the NNS 2011, there is a need to ensure the use of growth references which are most updated for comparing and evaluating the growth and nutritional status in hospitals, as the period of infancy and children less than five years of age is a critical age for growth.

However, infants and children can only be detected for growth falter when the comparison is made by those standards used internationally.

To meet the standard globally, updated recommendations and information must be practically applied to the relative field to get the most out of scientific researches.

TABINDA ASHRAF SHAHID Islamabad

Ban on employment THIS is apropos of the news item ‘Provinces reach consensus on legislation’ (Feb 10) which narrates that all provincial labour departments have agreed to amend the Employment of Children Act (ECA) 1991 in compliance with the International Labour Organisation’s Conventions No138 and No182.

They have also agreed on banning child labour below 14 years of age, which is not prohibited in the ECA other than in the case of worst forms of labour. But in order to comply with Article 25-A, all provincial governments must consider banning employment of the child below 16 years of age. Article 25-A says: “The State shall provide free and compulsory education to all children from the age of five to 16 years.”

After the 18th Amendment, Punjab has already adopted the ECA in 2011 without any changes except changes in the title and names. It did not even bother to correct the mistake that was made under Section 5 of the ECA. Section 5 (1) of the ECA says that the National Committee on the Rights of the Child will perform its functions as visualised in the ‘US’ Convention on the Rights of the Child. There is no ‘US’ Convention on the Rights of the Child, rather it is the UN convention.

As it is mandatory for the provinces to bring the law in consonance with the ILO’s Convention, so it is for Islamabad Capital Territory.

In July 2011 the ministry of human resource development was created to deal with the issue of child labour which is seriously increasing in the capital. However, there are no administrative and legal steps taken by the ministry to eliminate it from the capital.

I would also like to ask the provincial labour departments and others to consult the Indian Child Labour (Prohibition and Regulations) Act (CLPRA) 1986 which Pakistan copied and adopted in 1991.

But over a period of time, India has progressively expanded the list of hazardous occupations and processes under the law whereas Pakistan has introduced no amendments.

Under the scheduled list of banned occupations and processes given in the CLPRA India, 15 occupations and 57 processes are banned, whereas under the ECA in Pakistan only four occupations and 34 processes are declared hazardous and banned.

ABDULLAH KHOSO National Programme Manager Juvenile Justice and Child Labour SPARC Islamabad