Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services
Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services
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DOI：
10.1186/s12913-018-2909-0
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发表时间：
2018-02-17
影响因子：
2.8
通讯作者：
Gray-Donald, Katherine
中科院分区：
文献类型：
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作者：
Laar, Matilda E.;Marquis, Grace S.;Gray-Donald, Katherine
背景资料：身长测量在监测儿童身长体重和年龄身长的生长、监测和促进（GMP）中非常重要。这两个指数提供了儿童消瘦或发育不良风险的指标，比广泛使用的体重-饲料指数（体重不足）更能说明儿童的成长情况。虽然世界卫生组织建议在GMP中引入长度测量，但利益攸关方对在农村外展环境中收集的长度测量的可靠性表示关切。我们的目的是描述的可靠性和挑战与社区卫生人员测量长度为农村推广GMP activities.Methods：两个可靠性研究（A和B），使用10名儿童不到24个月，在加纳的农村地区的GMP服务进行。15名护士和15名健康志愿者（HV）没有以前的经验，在长度测量进行了培训。对观察者内和观察者间的测量技术误差（TEM）、人体测量专家的平均偏倚和长度测量的可靠性系数（R）进行评估和比较。观察和访谈被用来了解的能力和经验的卫生人员与测量长度外展GMP.Results：观察员间TEM大于观察员内TEM的护士和HV在两个会议，是不可接受的（相比误差标准）高，在两个组在两个时间点。专家测量的平均偏差在可接受的范围内，然而，两组都倾向于低估长度测量。护士收集的长度的R（92.3%）在会话B时高于HV（87. 3%）。5%）。长度测量护士和HV，并采取了有经验的人体测量师在GMP会议是中等协议（Kappa = 0.53，P < 0.0001）。结论：长度测量的可靠性提高后，两个进修培训护士，但不是HV。此外，由于医务人员负担过重和GMP诊所拥挤，在GMP会议期间进行的长度测量可能容易出错。需要对护士和HV进行长度测量和程序的职前和在职培训，以提高长度测量的可靠性。
Background: Length measurements are important in growth, monitoring and promotion (GMP) for the surveillance of a child's weight-for-length and length-for-age. These two indices provide an indication of a child's risk of becoming wasted or stunted, and are more informative about a child's growth than the widely used weight-forage index (underweight). Although the introduction of length measurements in GMP is recommended by the World Health Organization, concerns about the reliability of length measurements collected in rural outreach settings have been expressed by stakeholders. Our aim was to describe the reliability and challenges associated with community health personnel measuring length for rural outreach GMP activities.Methods: Two reliability studies (A and B), using 10 children less than 24 months each, were conducted in the GMP services of a rural district in Ghana. Fifteen nurses and 15 health volunteers (HV) with no prior experience in length measurements were trained. Intra-and inter-observer technical error of measurement (TEM), average bias from expert anthropometrist, and coefficient of reliability (R) of length measurements were assessed and compared across sessions. Observations and interviews were used to understand the ability and experiences of health personnel with measuring length at outreach GMP.Results: Inter-observer TEM was larger than intra-observer TEM for both nurses and HV at both sessions and was unacceptably (compared to error standards) high in both groups at both time points. Average biases from expert's measurements were within acceptable limits, however, both groups tended to underestimate length measurements. The R for lengths collected by nurses (92.3%) was higher at session B compared to that of HV (87. 5%). Length measurements taken by nurses and HV, and those taken by an experienced anthropometrist at GMP sessions were of moderate agreement (kappa = 0.53, p < 0.0001).Conclusions: The reliability of length measurements improved after two refresher trainings for nurses but not for HV. In addition, length measurements taken during GMP sessions may be susceptible to errors due to overburdened health personnel and crowded GMP clinics. There is need for both pre-and in-service training of nurses and HV on length measurements and procedures to improve reliability of length measurements.