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journa l homepage: www. int l .e lsev ierhea l th .com/ journa ls /cmpb

evelopment and implementation of a web-based system totudy children with malnutrition

harifah-Mastura Syed-Mohamad ∗

he School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

r t i c l e i n f o

rticle history:

eceived 28 October 2007

eceived in revised form

0 July 2008

ccepted 22 July 2008

eywords:

rowth Monitor

alaysia

alnutrition

ediatric

a b s t r a c t

Objectives: To develop and implement a collective web-based system to monitor child growth

in order to study children with malnutrition.

Method: The system was developed using prototyping system development methodology.

The implementation was carried out using open-source technologies that include Apache

Web Server, PHP scripting, and MySQL database management system. There were four

datasets collected by the system: demographic data, measurement data, parent data, and

food program data. The system was designed to be used by two groups of users, the clinics

and the researchers.

Results: The Growth Monitor System was successfully developed and used for the study,

“Geoinformation System (GIS) and Remote Sensing in Mapping of Children with Malnutri-

tion.” Data collection was implemented in public clinics from two districts in the state of

eb-based system Kelantan, Malaysia.

Conclusions: The development of an integrated web-based system, Growth Monitor, for the

study of children with malnutrition has been achieved. This system can be expanded to

new partners who are involved in the study of children with malnutrition in other parts of

Malaysia as well as other countries.

© 2008 Elsevier Ireland Ltd. All rights reserved.

. Introduction

onitoring the growth of children is important for judgingheir overall progress at population and individual levels. Eval-ations of child growth are generally based on comparisono a reference population [1]. Growth measurements are rel-tively simple and inexpensive to make, although importantraining is required to obtain good quality of measurements.n Malaysia, growth measurement data of a child are written

n the child’s birth record. Every time the child visits the clinicor immunization, his/her growth measurement will be takeny the nurse [2]. This method of record keeping makes it diffi-ult for the researchers to study child growth. A need existed

∗ Tel.: +609 766 3823; fax: +609 764 7884.E-mail address: sharifah@kck.usm.my.

169-2607/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights resoi:10.1016/j.cmpb.2008.07.011

to establish a system that can be used to monitor child growthand the integrated data can be used for malnutrition studiesof children [3,4].

Based on this need, the author and project team mem-bers of “Geoinformation System (GIS) and Remote Sensing inMapping of Children with Malnutrition” in Universiti SainsMalaysia have collaboratively developed a web-based systemto assist them in growth measurement data collection andanalysis for the study of children with malnutrition. This

paper discusses the features of the Growth Monitor System.The objective in developing the Growth Monitor was to estab-lish a collective web-based system to continuously monitorchild growth in order to study children with malnutrition.

erved.

84 c o m p u t e r m e t h o d s a n d p r o g r a m s i

Table 1 – Growth Monitor datasets

Dataset Attributes

Demographic Birth certificate numberNameGenderBirth weightDate of birthBirth addressGestationalNumber of siblingChild numberRegistration numberCurrent address

Measurement Birth certificate numberDate of measurementWeightHeightMid-upper arm circumferenceHead circumferenceHeight-for-age (Z-score)Weight-for-age (Z-score)BMIBMI (Z-score)Head circumference (Z-score)

Parents Child’s birth certificate numberMother’s nameMother’s ICMother’s raceMother’s religionMother’s ageMother’s educationMother’s jobMother’s incomeMother’s nameFather’s ICFather’s raceFather’s religionFather’s ageFather’s educationFather’s jobFather’s income

Food program Birth certificate number

Date receiveNotesRegistered clinic

2. Method

Growth Monitor was developed using prototyping systemdevelopment methodology. The implementation was carriedout using open-source technologies that include Apache WebServer, PHP scripting, and MySQL database management sys-tem. There were four datasets collected by the system: (1) childdemographics data, (2) measurement data, (3) parent data, and(4) food program data (see Table 1).

3. System description

The system was designed to be used by two groups of users,the clinics and the researchers. Fig. 1 shows the functionali-ties provided by the system for the two groups of users. The

n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92

Growth Monitor has gone through several iterations of cus-tomization and currently is accessible using any web browserat http://growth-monitor.kk.usm.my/. Users can log into thesystem using the login identification and password providedby the system administrator.

4. Functions for the clinic users

Each clinic will be given a different login identification andpassword. Once successfully logged in, the clinic user canchoose to:

• List all the children that have been registered by the clinic• Register a new child record• Trace a child’s record to view or update data or add a new

measurement• List food basket recipients

When the clinic user chooses to list all the children, theoutput will show the total number of children that have beenregistered with breakdown in four categories: normal, obese,moderate under-nutrition, and severe under-nutrition (seeFig. 2).

The user can click on the number of each category and thelist of children will be displayed and necessary action can betaken. From the list of children displayed on the screen, theclinic user can click on the Ref. No. to view the full informationabout a child.

If the user chooses to register a new child, she has to fill inthe child’s and the parents’ information, using the form shownin Fig. 3. In the current practice using paper records, clinics donot keep much information about the parents. Any researchthat requires correlation of child’s and parents’ data cannotbe done using existing secondary data. With this new web-based system, further research can be done with the availabledata. Although clinic users do not have to enter all the dataduring clinical sessions, they must enter data in fields thatare marked with double asterisks (**).

The clinic can also directly trace a child’s record to viewthe information, to make updates, or to add a new measure-ment record. The clinic can trace a record using the child’sBirth Certificate Number/Ref. Number/Child’s Name or usingthe Mother’s IC Number. Fig. 4 shows the screen to trace achild’s record. The user can choose from three options: AddNew Record, Show Record, or Update Record, and then keyin the particulars to trace the child’s record. Once the Tracebutton is clicked, the child’s record will be displayed and infor-mation can be updated or added.

Fig. 5 shows the screen to add a new measurement recordfor a child who is already registered by the clinic. From thisscreen, the clinic user can look at the previous measurementrecord, display the growth chart (see Fig. 6), and enter the newmeasurement data.

Another function provided is a display of food basket recip-

ients. The list of children who have been given a food basketwill be displayed as shown in Fig. 7. This functionality is veryuseful for the clinic to report on food basket recipients to theMinistry of Health Department.

c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92 85

Fig. 1 – Functionalities of Growth Monitor.

Fig. 2 – Screen showing list of all children registered by the clinic. (For interpretation of the references to color in thisartwork, the reader is referred to the web version of the article.)

86 c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92

Fig. 3 – Form to register new child.

c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92 87

Fig. 4 – Screen to trace child’s record.

Fig. 5 – Screen to add a new measurement record for a child.

88 c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92

Fig. 6 – Growth chart for a child. (For interpretation of the references to color in this artwork, the reader is referred to the

web version of the article.)

5. Functions for the researchers

As mentioned earlier, the main objective in developing GrowthMonitor is to establish a database that can be used by theinterested researcher to mine the data and conduct studiesregarding the child growth. The functionalities provided forthe researchers include the following:

• Trace registered children from all clinics by state, districts,and clinics

• Register new children• Add new measurements

Fig. 7 – List of food ba

• Update children’s records• Trace a child’s record to view relevant information (demo-

graphics, measurements, growth chart, and parents andsiblings)

• Monitor nutritional status through state and district maps• Extract children’s records for further analysis

In order to use the system, the researcher will be givenhis/her personal login identification and password by the sys-

tem administrator. The researcher can trace all the registeredchildren by district in a state, as shown in Fig. 8.

Fig. 8 shows how to trace all the children’s records in thedistrict of Tumpat, Kelantan. The result is displayed in Fig. 9.

sket recipients.

c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92 89

rom

btt

Fr

Fig. 8 – Trace children’s records f

Further information can be viewed by clicking the num-er representing the child’s category or by directly clickinghe child’s Ref. No. The details are the same with the func-ionality provided for the clinic user. The researcher can click

ig. 9 – List of children in the district of Tumpat, Kelantan. (For ineader is referred to the web version of the article.)

the district of Tumpat, Kelantan.

further to look at the district map that shows the locations ofthe participating clinics (see Fig. 10).

In addition to the data keyed in by the participating clinics,the researcher can also maintain their own data collection.

terpretation of the references to color in this artwork, the

90 c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92

Fig. 10 – Map of the selected district showing the locations of participating clinics. (For interpretation of the references tocolor in this artwork, the reader is referred to the web version of the article.)

The researcher can add a new record and update and add newmeasurements for the group of children under their study.

The researcher has the same functionality available as thatprovided to clinic users.

Moreover, the researcher can monitor the children’s nutri-tional status from the map application. For example, if the

researcher wants to know the nutritional status of the childrenin Kelantan, he/she can click the map application and a pie

chart will be displayed, as shown in Fig. 11. The researcher canclick on the category to get more information about a categoryof children. Finally, the researcher has the option to uploaddata to other statistical packages for further data analysis.

c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92 91

F romc n of

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ig. 11 – Screen to monitor the children’s nutritional status folor in this artwork, the reader is referred to the web versio

. Conclusions

his paper has described the features of Growth Monitor, aeb-based system that could be used to collect growth mea-

urement data remotely to study children with malnutrition.ata collection commenced in August 2005 and continues

ndefinitely. At the beginning, the research officer took respon-ibility for collecting data from clinics in the district of Tumpat,

map application. (For interpretation of the references tothe article.)

Kelantan and keying data into the system because the clinicsdid not have Internet connections. In early 2006, training wasgiven to nurses from identified clinics in Kelantan. In the mid-dle of 2006, on-line data entry was done by nurses from twoclinics in the district of Machang, Kelantan.

Due to progress made by the research group, the projectleader expressed an interest in the potential for the GrowthMonitor to be implemented nationally as well as internation-ally. Currently the system is available in Bahasa Malaysia and

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malnutrition distribution using remote sensing andgeoinformation system (GIS) in Tumpat, North of Kelantan,Malaysia, in: Proceedings of MapAsia 2005. <http://growth-monitor.kk.usm.my/malnutrition/web gis/gis files/Map%20Asia%202005.pdf>, 2005 (retrieved 16.09.07).

92 c o m p u t e r m e t h o d s a n d p r o g r a

English and could be translated into other languages. Becausethe system is using open-source technology, any enhance-ment to the system and the translation work could be doneby a distributed project team.

Acknowledgements

This paper is made possible from the IRPA Research Grant“Geoinformation System (GIS) and Remote Sensing in Map-ping of Children with Malnutrition.” Acknowledgement is alsomade to Professor Dr. Zabidi Azhar Mohd Hussin as the ProjectLeader, Mr. Mohd Nazri Mohd Hussin as the Research Officer,and all other co-researchers of the project.

e f e r e n c e s

1] WHO, Physical status: the use and interpretation ofanthropometry, Report of a WHO Expert Committee, WHOTechnical Report Series No. 854, Geneva, 1995.

n b i o m e d i c i n e 9 3 ( 2 0 0 9 ) 83–92

2] A. Zulkifli, A.A. Khairul Anuar, A.S. Atiya, The nutritionalstatus of children in resettlement villages in Kelantan,Southeast Asia, J. Trop. Med. Public Health 30 (1) (1999)122–128.

3] A.M.H. Zabidi, A.M. Noorizan, M.S. Md-Azlin H.B. Syahrul, M.Nik-Nasruddin, The application of Geographic InformationSystem (GIS) and Remote Sensing Techniques in mapping ofchildren with malnutrition—an introduction, in: Proceedingsof MapAsia 2003, Kuala Lumpur. <http://growth-monitor.kk.usm.my/malnutrition/web gis/gis files/Malnutrition%20Mapping.pdf>, 2003 (retrieved 16.09.07).

4] S.U. Murni, H.B. Syahrul, A. Aflah, A. Anizar, N.M. Nasarudin,M. Othman, A.M.H. Zabidi-Hussin, Risk mapping of