LCK Low

1. Introduction

Since July 1997, Hong Kong is a Special Administrative Region of the People's Republic of China. It has a populations of 6.3 million and an area of 390 square miles. Over the past decade there has been a steady rise in the total population but progressive fall in the proportion of the population below 15 years of age (projected falling to about 16% by mid-2001). Hong Kong has experienced a dramatic socioeconomic improvement over the past twenty years. Our infant mortality rate of 4 per 1000 is among the lowest in the world. Physical growth and development is a sensitive index of the well-being of a child because linear growth represents the net expression of genetic, nutritional, environmental and hormone factors, and the effects of previous infections, infestation and diseases. Using the growth reference recommended by the World Health Organization (WHO) one can compare the growth , nutrition and state of health of children around the world. In a recent study, the growth of Hong Kong children in the first three years of life has been found to be comparable to that of the WHO growth standards.

2. Source of Normal Values

The normal values for anthropometric measurements and pubertal development in Hong Kong Chinese children was first published in the 1960's by Professor KFS Chang of the University of Hong Kong. The growth charts were updated in 1985 by Dr KP Fung and his colleagues from the two Universities in Hong Kong. The territory-wide growth study of Hong Kong children in 1993 headed by Dr. SSF Leung of the Chinese University of Hong Kong provided Hong Kong with its most up-to-date growth standards. The important sources of normal values can be found in the following articles.^1-5

3. Growth Monitoring in Hong Kong

In the past 66 years, the Family Health Service of the Department of Health has been providing a comprehensive range of preventive health services for children from birth to 5 years in a network of 35 full-time and 16 part-time Maternal and Child Health Centres (MCHC) located throughout Hong Kong. Children's growth and development are monitored through regular physical examination during the first 5 years of life. Children with any abnormalities will be referred to the paediatric clinics under the administration of the Hospital Authority. In 1997, 246,874 children attended the different MCHC for service and the total attendants was 994,087. Over 90% of the babies delivered in Hong Kong annually attend the MCHC for various services.

The Student Health Service (SHS) was introduced in phases between 1995 and 1997 to replace the existing School Medical Service. The SHS is a centre-based programme. The students enrolled in the programme would be given an appointment to attend one of the 11 centres annually to identify and monitor health problems among students and to promote prevention of ill health and maintenance of health. Those found to have health problems will be referred to the Special Assessment Centre (SAC) for further assessment and follow-up or the appropriate specialty clinics for further management. There were 401,771 primary school students (86.2% enrolment rate) and 309,435 secondary students (enrollment rate 69.1%) enrolled in the SHS in 1997.

The services at the MCHC and SHS are provided free by the government. Parents have the option of bringing their children to the clinics of private practitioners or paediatricians for regular assessment and other preventive child health services. Paediatric endocrine service is available in the six large regional hospitals under the Hospital Authority administration and the two Universities teaching hospitals. These clinics provide tertiary service for disorders of growth and puberty at low cost. Growth hormone treatment is provided free for children with growth failure due to growth hormone deficiency, Turner syndrome and chronic renal failure. Gonadotrophin releasing hormone analogue therapy is also provided free at these clinics for the treatment of precocious puberty.

4. Conclusions

A comprehensive system of monitoring for disorders of growth and puberty is provided by the Department of Health. Children with abnormalities detected will be referred to the specialist clinics administered by the Hospital Authority for further investigations and management.

References

1. Leung SS et al. Secular changes in standing height, sitting height, and sexual maturation of Chinese - the Hong Kong growth study 1993. Ann Hum Biol 1996;23:297-306.

2. Leung SS, et al. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health 1996;32:103-9.

3. Wong GW, et al. Secular trend in the sexual maturation of southern Chinese boys. Acta Paediatr 1996;85:620-621.

4. Huen KF, Ct al. Secular trend in the sexual maturation of southern Chinese girls. Acta Paediatr 1997;86:1121-4.

5. Leung SS, et al. Body mass index reference curves for Chinese children. Ann Hum Biol 1998;25:169-74.