Showing papers by "Katherine Gray-Donald published in 2018"

Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services.

Abstract: 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-for-age 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. 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. 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). 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.

Rapid increase of overweight and obesity among primary school-aged children in the Caribbean; high initial BMI is the most significant predictor

Abstract: To examine predictors of increasing overweight among children in two developing countries Primary school children (6–10 y at baseline, n = 336) and their caregivers Longitudinal data were collected in 2012, with follow-up 18 months later Data on children’s height, weight and dietary intake were collected within 8 primary public schools in Trinidad and 7 schools in St Kitts Caregivers’ demographic and anthropometric data were also collected At baseline, children’s age and sex and caregivers’ BMI, age, and marital status and reported dietary intake were similar across all weight groups The incidence of overweight and obesity among children was 88% and 81%, respectively Dietary intake at baseline was not related to becoming overweight or obese Similarly there were no differences in reported intake among children who became overweight or obese except that they consumed fewer fruits (054±092 vs 098±166, p = 0017) Misreporting of energy intake was higher among overweight/obese children as compared to those who were not overweight/obese (27% vs 17%, p = 0047) The baseline predictors of increasing BMI (adjusted) of the children were older age, higher baseline BMI z-score and higher height-for-age (HFA) z-score; caregiver BMI, children’s energy intake (with adjustment for misreporting) did not predict changes in children’s BMI The increasing prevalence of overweight/obesity among children is a serious problem in the Caribbean Heavier children are at elevated risk of continued rapid increase in their weight status, pointing to the need for early intervention