title: Reliability of measurements performed by community-drawn anthropometrists from rural Ethiopia.
abstract: BACKGROUND
  Undernutrition is an important risk factor for childhood mortality, and remains a major problem facing many developing countries. Millennium Development Goal 1 calls for a reduction in underweight children, implemented through a variety of interventions. To adequately judge the impact of these interventions, it is important to know the reproducibility of the main indicators for undernutrition. In this study, we trained individuals from rural communities in Ethiopia in anthropometry techniques and measured intra- and inter-observer reliability.
  
  
  RESULTS
  We trained 6 individuals without prior anthropometry experience to perform weight, height, and middle upper arm circumference (MUAC) measurements. Two anthropometry teams were dispatched to 18 communities in rural Ethiopia and measurements performed on all consenting pre-school children. Anthropometry teams performed a second independent measurement on a convenience sample of children in order to assess intra-anthropometrist reliability. Both teams measured the same children in 2 villages to assess inter-anthropometrist reliability. We calculated several metrics of measurement reproducibility, including the technical error of measurement (TEM) and relative TEM. In total, anthropometry teams performed measurements on 606 pre-school children, 84 of which had repeat measurements performed by the same team, and 89 of which had measurements performed by both teams. Intra-anthropometrist TEM (and relative TEM) were 0.35 cm (0.35%) for height, 0.05 kg (0.39%) for weight, and 0.18 cm (1.27%) for MUAC. Corresponding values for inter-anthropometrist reliability were 0.67 cm (0.75%) for height, 0.09 kg (0.79%) for weight, and 0.22 kg (1.53%) for MUAC. Inter-anthropometrist measurement error was greater for smaller children than for larger children.
  
  
  CONCLUSIONS
  Measurements of height and weight were more reproducible than measurements of MUAC and measurements of larger children were more reliable than those for smaller children. Community-drawn anthropometrists can provide reliable measurements that could be used to assess the impact of interventions for childhood undernutrition.
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Berhan
authors.initials: B
authors.lastname: Ayele
authors.forename: Abaineh
authors.initials: A
authors.lastname: Aemere
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.forename: Craig W
authors.initials: CW
authors.lastname: See
authors.forename: Sun N
authors.initials: SN
authors.lastname: Yu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
mesh_terms: D000886:Anthropometry / Q000379:methods; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D001837:Body Weights and Measures / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004493:Education / Q000379:methods; D005002:Ethiopia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data