O3 Growth Chart (GSOC 2025)
- Grace Potma
Summary
Growth Charts are a common need in Primary Health Care for children (pediatrics). Growth Charts are available in O2, but never yet added to O3.
With more and more implementers using O3 for care that involves infants, babies, and young children, we need Growth Charts in O3!
Project Size
Medium
Context
Most countries Child Wellness / Baby Check-up visits involve tracking child weight. See more on the user stories below.
Paper Examples from around the world
Electronic Examples from OpenMRS
Growth Chart in O1
Growth Chart in O2
You can explore this feature in PIH’s Demo Instance by going to this link and clicking “Growth Charts” on the right. (Login: admin / Admin123 at any location.)
Growth Chart in O3
Your Work Here!
Mockups here: https://docs.google.com/presentation/d/1T5HPwMIDFTQhGVAhZEY_Bq0kOocN7OPfoTLuRnS-3sg/edit?usp=sharing
Electronic Examples from other Systems
You Will Need to:
Learn: Familiarize yourself with the previous Growth Chart code repository; and, Familiarize yourself with React-based micro-frontend app development in O3; and, Review Requirements/Needs of this specific app. (Resources provided below.)
Plan Design: Use Carbon design (specifically use the Carbon Charts documentation) to create mockups on how you plan to design this. Present your draft visuals / plan on the O3 Squad calls.
Build: Build a Growth Chart app for O3
Test: Test your work to confirm the charts work as expected; and, Add a few happy-path automated frontend E2E test coverage so that if this feature breaks in the future, the community will be notified quickly.
Key Resources & Links:
Previous, old Growth App Code Repo (O2): https://github.com/openmrs/openmrs-module-growthchart
Even older, in O1 (wiki page includes full Admin settings workflow explanation too) https://openmrs.atlassian.net/wiki/x/kZ2EAQ
Learn how to code an O3 App:
Developing with O3: See course on Academy: https://openmrs.org/academy/intro-to-openmrs-3/ . This will help you set up your O3 environment and learn the most important concepts and conventions for developing an O3 Widget.
Documentation: We have many docs on developing O3 apps, but this is probably the best place to start: https://openmrs.atlassian.net/wiki/x/oIIBCQ
Design Docs:
OpenMRS UI Design conventions and patterns to follow: https://om.rs/o3design
Carbon Design: You will likely especially want to reference the documentation and requirements around Carbon Charts: https://carbondesignsystem.com/data-visualization/getting-started/
Learn our E2E Testing conventions: See course on Academy: Intro to O3 Quality Assurance Automation
Background: About Growth Charts & User Stories
Charts for easy review of height and weight information, in a table format, updated in real time, into an encounter.
Healthcare Staff (like doctors, nurses, and nutritionists) use the growth chart during pediatric (child) patient visits to help monitor the proper growth and nutrition of patients.
Clinicians need to know: “Is this child gaining weight, or losing weight?” Charts make this easy to visualize.
Clinicians also need to know: “Is this child underweight for their size? If so, how badly?” It can be hard to tell whether some children are underweight or at a normal weight for their size (e.g. a very long/tall baby, etc). Clinicians generally don’t have the different possible combinations all memorized. This is why it is helpful for Growth Charts to compare size vs. weight values against WHO statistical norms, to see if the child is over- or under-nourished, and if so, how badly. (Other standards have been set in the past, such as by the USA CDC; however, for the scope of this project, just focus on the WHO statistical norms.)
Parents need to know: “Is my child growing normally? If not, how bad is it?” Parents are often very anxious about whether or not they are successfully nourishing their child. Growth Charts help to show parents where the child is compared to other children their age/size/weight. For example, this picture was shared online by a parent who noticed the correlation between their child’s health issues and sicknesses, and when they should start to worry and take more drastic action. (Source)
The advantages of implementing a growth chart module are:
The historical table and chart provide information to clinicians improves patient care, e.g. by making sure underweight children are noticed and identified.
Creates buy in by providers who want access to tables and charts, encouraging consistent use of the EMR.
Implementer Example: PIH has had the O2 Growth Chart deployed in Haiti for several years and the providers definitely use them. PIH also expects to use the O3 Growth Charts when they deploy in the exciting big Maternal Center for Excellence hospital in Sierra Leone.
Important Requirements:
Auto-plot: Automatically plot individual patient weight, height, and head circumference measurements (and associated auto-calculations, like BMI or z-score) on the relevant charts.
Auto-connect: Link data points together with lines.
Sex makes a Difference: Charts are different for Boys vs Girls: The normative curves for weight gain are different, and, a different coloring scheme (i.e., pink for girls, blue for boys).
Charts to Use/Create:
Scope of this project: Weight for Age.
WHO Charts:
Weight for Age (0 - 24 months)
Length for Age (0 - 24 months)
Weight for Length (0 - 24 months)
Head Circumference for Age (0 - 24 months)
BMI for Age (0 - 24 months)
USA CDC Charts: (are these used? Needed? Check w/ PIH)
Weight-for-age charts, birth to 36 months
Length-for-age charts, birth to 36 months
Weight-for-recumbent length charts, birth to 36 months
Head circumference-for-age charts, birth to 36 months
Weight-for-stature charts
Weight-for-age charts, 2 to 20 years
Stature-for-age charts, 2 to 20 years
BMI-for-age charts, 2 to 20 years
Old Config File: I (Grace) believe this is the place where these different charts were configured in O2. https://github.com/openmrs/openmrs-module-growthchart/blob/60c2b5e4b8d0255d305831999f80601d4548a1f6/omod/src/main/java/org/openmrs/module/growthchart/shared/SharedControllerStuff.java#L23 I am not sure if the WHO
Really Really Nice to have but not a deal-breaker: Configurability: Growth Charts are not all the same in every country, or even for every patient.
Regional Differences: Growth Charts can be different in some countries, even if they are generally following the WHO guidance. For example, even Canada further adapted the WHO Growth Charts, creating “WHO Growth Charts for Canada”.
Ideally, the chart data/guidelines should be configurable because of this potential for regional difference.
Not in scope but nice to know / bonus points / future to-do: Patient-specific Differences:
Premature Infant Curve Adjustment / Postnatal Age Correction: Some countries recommend an “Age Correction” if a child is born prematurely. For example, in Canada: “The WHO Growth Standards did not include data on premature infants or very low birth weight infants (<1500 g); growth of these infants differs from infants born at an appropriate age or size, such that they appear not to catch up during early childhood. The growth of preterm infants (<37 weeks) after discharge from the neonatal intensive care unit can be monitored using the WHO Child Growth Standards: Measurements should be plotted using corrected postnatal age for prematurity (i.e. postnatal age in weeks – [40 weeks – gestational age in weeks]) until 24 or 36 months of age. For example, at 12 weeks postnatal age, an infant born at 30 weeks gestational age would be 12 – [40-30] or 2 weeks corrected postnatal age. Alternate charts to assess growth of preterm and low birth weight infants in the neonatal intensive care unit or early post-discharge setting include: Fenton’s Preterm growth chart for tracking growth from 22 weeks gestational age to 10 weeks post term.” - Source, page 4, Dietitians of Canada and Canadian Paediatric Society, 2014.
Condition-specific curves: Children with intellectual, developmental, genetic or other disorders often have growth patterns that are different from healthy children. Other specific growth curves exist for some of these disorders.