HOW TO MEASURE PRECISION AND ACCURACY

OF ANTHROPOMETRY MEASUREMENTS

Prior to collecting anthropometric data it is important to assess the precision and accuracy
through standardization procedures of the anthropometric measurements. This is even
more critical if there are several anthropometry measurers will be taking the
measurements. Standardization procedure is aimed to ensure that all measurers perform
anthropometric measurements in standardized procedure, that repeated but independent
measurements on the same subject (=precision) is within acceptable limit, that the
measurement is nearly correct (=accuracy) and that sources of errors can be identified
and corrected.

The usual standardization procedure consists of ten subjects. Each measurer measures
each subject twice independently i.e. in such a way as to avoid being influenced by the
first measurement. The results of the first measurements are noted on appropriate form
and put aside until the second series of measurements is taken. Similar procedure is taken
by the supervisor whose measurements will be used as reference.

Table 1. Example: calculations taken for the raw data of MUAC measurements
collected by one enumerator 1

Subj a b d d2 a b d d2 sign s S D D2 SIGN

1 7.2 7.4 -0.2 0.04 9 9.2 -0.2 0.04 - 18.2 14.6 3.6 12.96 +
2 20.6 20.8 -0.2 0.04 23.3 24.2 -0.9 0.81 - 47.5 41.4 6.1 37.21 +
3 20.4 20.2 0.2 0.04 20.4 20.2 0.2 0.04 + 40.6 40.6 0 0
4 12 12 0 0 10.2 11.4 -1.2 1.44 - 21.6 24 -2.4 5.76 -
5 22.6 22.2 0.4 0.16 20.3 20.2 0.1 0.01 + 40.5 44.8 -4.3 18.49 -
6 15.2 15.6 -0.4 0.16 13 14 -1 1 - 27 30.8 -3.8 14.44 -
7 20 20.4 -0.4 0.16 21.1 20.2 0.9 0.81 + 41.3 40.4 0.9 0.81 +
8 14.8 15.2 -0.4 0.16 9.8 9.2 0.6 0.36 + 19 30 -11 121 -
9 8.2 8 0.2 0.04 6.3 7.3 -1 1 - 13.6 16.2 -2.6 6.76 -
10 4.2 4.6 -0.4 0.16 18.2 18.2 0 0 36.4 8.8 27.6 761.76 +

0.96 5.51 979.19

1
values in bold are those obtained by supervisor as the gold standard

Interpretation:
 Precision is based on sum of d 2. For adequate precision the measurer’s sum of d 2
should be less than twice the supervisor’s sum of d 2. In this example since
supervisor’s sum d2 is 0.96, and the measurer’s sum d 2 (5.51) exceeds 1.92 (2x0.96)
then the measurer’s precision is inadequate
 Accuracy is based on sum of D2. For accurate measurement, the measurer’s sum of D2
should be less than three-times the supervisor’s sum of d 2. In this example since
supervisor’s sum d2 is 0.96, and the measurer’s sum D2 (979.19) exceeds 2.88
(3x0.96) then the measurer’s precision is inaccurate

1
The difference between supervisor’s (trainer’s) and measurer’s (trainee’s) measurement
can also provide information on the quality of the measurements (good, fair, or poor
measurements). The criteria for trainer-trainee difference for height/length, weight, arm
circumference and skinfold measurements are suggested by Zerfas (1985) as follow:

Table 2. The criteria for trainer-trainee difference as suggested by Zerfas (1985)

Measurement Unit Trainer-trainee difference
Good Fair Poor
height or length mm 0-5 6-9 10-19
weight kg 0-0.1 0.2 0.3-0.4
arm circumference mm 0-5 6-9 10-19
any skinfolds mm 0-0.9 1.0-1.9 2.0-4.9
Note: difference greater than those noted under “poor” indicates a gross error.

FAQ

Is there available software which can help us calculate results of standardization

procedure for assessment of precision and accuracy?
Yes, in Nutrisurvey Emergency Nutrition Assessment (ENA) you can enter results of
standardization procedure using the “training” function and obtain the reports of
precision and accuracy automatically. This software can be freely downloaded in
www.nutrisurvey.de

References:

Fahmida U and Dillon DHS (2007). Handbook Nutritional Assessment. SEAMEO-

TROPMED RCCN UI, Jakarta

WHO Expert Committee (1995). Physical Status: The Use and Interpretation of
Anthropometry. Report of a WHO Expert Committee. WHO, Geneva.

Zerfas AJ (1985). Checking Continuous Measures: Manual for Anthropometry. Divisions

of Epidemiology, School of Public Health, University of California, Los Angeles.