The "P" in GMP--a major shift in growth monitoring program of a primary health care project.

Growth monitoring and promotion (GMP) is the monitoring of a child's growth to promote, maintain and restore health. The "P" in GMP relates to the promotive, preventive and curative actions which accompany the monitoring process. Data from two of the Primary Health Care field sites of The Aga Khan University, Essa Nagri and Azam Basti (squatter settlements), in Karachi for May 1989 was analyzed to determine the relationship between weight change and nutritional status. 21% of 2,838 children had a decrease in weight from April to May 1989. Children in Grade I malnutrition (n = 274) contributed much more to this decrease than children with Grades II and III (54 and 5, respectively). By focusing attention only on those with Grades II and III malnutrition, the obvious ones, we have been missing the opportunity to prevent a deterioration of those in Grade I, though it is easier and less time consuming to reverse this trend in early stages of malnutrition. To ensure more quality-time for community health workers' focus on the at-risk population, three alternative "high-risk" groups are proposed. Promotion of growth and weight change needs to be stressed more, instead of the nutritional status only in GMP programs.