Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study

AIM: To describe how reliability assessment data in the WHO Multicentre Growth Reference Study (MGRS) were collected and analysed, and to present the results thereof. METHODS: There were two sources of anthropometric data (length, head and arm circumferences, triceps and subscapular skinfolds, and height) for these analyses. Data for constructing the WHO Child Growth Standards, collected in duplicate by observer pairs, were used to calculate inter-observer technical error of measurement (TEM) and the coefficient of reliability. The second source was the anthropometry standardization sessions conducted throughout the data collection period with the aim of identifying and correcting measurement problems. An anthropometry expert visited each site annually to participate in standardization sessions and provide remedial training as required. Inter- and intra-observer TEM, and average bias relative to the expert, were calculated for the standardization data. RESULTS: TEM estimates for teams compared well with the anthropometry expert. Overall, average bias was within acceptable limits of deviation from the expert, with head circumference having both lowest bias and lowest TEM. Teams tended to underestimate length, height and arm circumference, and to overestimate skinfold measurements. This was likely due to difficulties associated with keeping children fully stretched out and still for length/height measurements and in manipulating soft tissues for the other measurements. Intra- and inter-observer TEMs were comparable, and newborns, infants and older children were measured with equal reliability. The coefficient of reliability was above 95% for all measurements except skinfolds whose R coefficient was 75-93%. CONCLUSION: Reliability of the MGRS teams compared well with the study's anthropometry expert and published reliability statistics.