Impact of anthropometry training and feasibility of 3D imaging on anthropometry data quality among children under five years in a postmortem setting

Priya M Gupta; Kasthuri Sivalogan; Richard Oliech; Eugene Alexander; Jamie Klein; O Yaw Addo; Dickson Gethi; Victor Akelo; Dianna M Blau; Parminder S Suchdev

doi:10.1371/journal.pone.0292046

Impact of anthropometry training and feasibility of 3D imaging on anthropometry data quality among children under five years in a postmortem setting

PLoS One. 2023 Sep 28;18(9):e0292046. doi: 10.1371/journal.pone.0292046. eCollection 2023.

Authors

Priya M Gupta¹, Kasthuri Sivalogan¹, Richard Oliech², Eugene Alexander³, Jamie Klein⁴, O Yaw Addo^{1

5}, Dickson Gethi⁶, Victor Akelo⁶, Dianna M Blau⁵, Parminder S Suchdev^{1

4

5}

Affiliations

¹ Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America.
² Kenya Medical Research Institute, Kisumu, Kenya.
³ Body Surface Translations, Inc., Athens, Georgia, United States of America.
⁴ Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America.
⁵ US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
⁶ US Centers for Disease Control and Prevention-Kenya, Kisumu and Nairobi, Kenya.

Abstract

Background: The Child Health and Mortality Prevention Surveillance Network (CHAMPS) identifies causes of under-5 mortality in high mortality countries.

Objective: To address challenges in postmortem nutritional assessment, we evaluated the impact of anthropometry training and the feasibility of 3D imaging on data quality within the CHAMPS Kenya site.

Design: Staff were trained using World Health Organization (WHO)-recommended manual anthropometry equipment and novel 3D imaging methods to collect postmortem measurements. Following training, 76 deceased children were measured in duplicate and were compared to measurements of 75 pre-training deceased children. Outcomes included measures of data quality (standard deviations of anthropometric indices and digit preference scores (DPS)), precision (absolute and relative technical errors of measurement, TEMs or rTEMs), and accuracy (Bland-Altman plots). WHO growth standards were used to produce anthropometric indices. Post-training surveys and in-depth interviews collected qualitative feedback on measurer experience with performing manual anthropometry and ease of using 3D imaging software.

Results: Manual anthropometry data quality improved after training, as indicated by DPS. Standard deviations of anthropometric indices exceeded limits for high data quality when using the WHO growth standards. Reliability of measurements post-training was high as indicated by rTEMs below 1.5%. 3D imaging was highly correlated with manual measurements; however, on average 3D scans overestimated length and head circumference by 1.61 cm and 2.27 cm, respectively. Site staff preferred manual anthropometry to 3D imaging, as the imaging technology required adequate lighting and additional considerations when performing the measurements.

Conclusions: Manual anthropometry was feasible and reliable postmortem in the presence of rigor mortis. 3D imaging may be an accurate alternative to manual anthropometry, but technology adjustments are needed to ensure accuracy and usability.

Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Grants and funding

Sources of Support: This work was funded by grant OPP1126780 from the Bill & Melinda Gates Foundation. The funder participated in discussions of study design and data collection. They did not participate in the conduct of the study; the management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.