Abstract
ABSTRACTBackgroundWell-trained anthropometrists are essential for the delivery of high-quality anthropometric data used to evaluate public health nutrition interventions. Scant data are currently available on the precision of data collected by large teams of anthropometrists employed for nutrition surveys in low-income country settings.ObjectivesThe purpose of this study was to assess the precision of child midupper arm circumference (MUAC) and length/height measurements taken by fieldworkers training for nutrition survey deployment.MethodsFollowing 3 d of training, an anthropometry standardization exercise was conducted in small teams of trainees at 7 sites in the Amhara region of Ethiopia. In groups of 2–4, trainee anthropometrists (n = 79) each measured 16 children aged 6–47 mo (n = 336) twice for MUAC and length/height. Both intraobserver and interobserver precision were analyzed using technical error of measurement (TEM), relative TEM, coefficient of reliability (R), and repeatability metrics. Bland–Altman limits of agreement were calculated for intraobserver measurements.ResultsIntraobserver TEM was between 0.00 and 0.57 cm for MUAC (Bland–Altman 95% limits of agreement: −0.50 to 0.54 cm) and between 0.04 and 2.58 cm for length/height measurements (Bland–Altman 95% limits of agreement: –1.43 to 1.41 cm). Interobserver TEM was between 0.09 and 0.43 cm for MUAC and between 0.06 and 2.98 cm for length/height measurements. A high proportion of trainees achieved intraobserver R >0.95 (MUAC: 95%; length/height: 97%). Most teams also achieved interobserver R >0.95 (MUAC: 90%; length/height: 95%).ConclusionsLarge numbers of anthropometrists (>75) in low-income settings can attain satisfactory precision in anthropometry following training and standardization. These protocols permit researchers to assess trainees, identify individuals who have not achieved the desired level of precision, and retrain or adjust roles prior to survey deployment.
Highlights
High-quality measurement of child anthropometry is required to evaluate the effectiveness of nutrition interventions at scale
Children were measured by each member of the anthropometry team to which they were assigned, for a minimum of 8 and a maximum of 16 separate measurements
Each trainee twice measured a total of 16 children, and the same children were measured by all team members to provide estimates of intraobserver precision
Summary
High-quality measurement of child anthropometry is required to evaluate the effectiveness of nutrition interventions at scale. Apart from major growth studies such as NHANES [3] or WHO’s Multicentre Growth Reference Study [4], only a few studies have detailed the approach and methods used to standardize anthropometric measurement techniques for infants and young children [5,6,7,8,9,10,11,12,13] Such methods are of special relevance to program evaluation studies, for which growth is one of multiple data indicators collected and for which anthropometrists (who double as household interviewers) must receive training in selection methods, questionnaires, and interviewing techniques [14]. Conclusions: Large numbers of anthropometrists (>75) in low-income settings can attain satisfactory precision in anthropometry following training and standardization These protocols permit researchers to assess trainees, identify individuals who have not achieved the desired level of precision, and retrain or adjust roles prior to survey deployment.
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