Measurement error for ultrasound fetal biometry performed by paramedics in rural Bangladesh.

OBJECTIVES: To document the accuracy and precision of sonographic fetal biometry performed by nine paramedics from rural Bangladesh. METHODS: Paramedics underwent intensive training (6 weeks) including hands-on practice then underwent a series of standardization exercises. Measurements of each fetus were taken by a highly-trained medical doctor (study supervisor) and the nine paramedics. Crown-rump length (CRL) in fetuses of less than 10 weeks' gestation, and biparietal diameter (BPD), occipitofrontal diameter, head and abdominal circumference (AC) and femur diaphysis length (FL) were measured twice using standard procedures by each paramedic and the medical doctor for each fetus, with at least 20 min between them. Precision was quantified using variance components analysis; the intraobserver error for each of the paramedics was calculated by comparing repeat measurements taken on the same participant, and the measurements obtained by each individual paramedic were also compared with those taken by the others (interobserver error). Accuracy was estimated by comparing the mean of the two measures taken by each paramedic to those taken by the study supervisor using paired t-tests. Bland-Altman plots were used to visually assess the relationship between precision of repeat measurements (intraobserver error) and fetal size. RESULTS: A total of 180 women, at 7 to 31 weeks' gestation, participated in the study. Intraobserver error of the measurements obtained by the paramedics, expressed as the mean SD, ranged from 0.97 mm for BPD in the first trimester to 7.25 mm for AC in the third trimester, and was larger than the interobserver error (i.e. accounting for a greater proportion of total variance) for most measurements. Interobserver error ranged from 0.00 mm for FL to 3.36 mm for AC, both in the third trimester. For all measurements except CRL, intraobserver error increased with increasing fetal size. The measurements obtained by the paramedics did show some statistically significant differences from those obtained by the study supervisor, but these were relatively small in magnitude. CONCLUSIONS: Both inter- and intraobserver measurement errors were within the range reported in the literature for studies conducted by technical staff and medical doctors. With intense training, paramedics with no prior exposure to ultrasonography can provide accurate and precise measures of fetal biometry.

Caregiver behaviors and resources influence child height-for-age in rural Chad.

The purpose of this study was to identify caregiver characteristics that influence child nutritional status in rural Chad, when controlling for socioeconomic factors. Variables were classified according to the categories of a UNICEF model of care: caregiving behaviors, household food security, food and economic resources and resources for care and health resources. Sixty-four households with 98 children from ages 12 to 71 mo were part of this study. Caregivers were interviewed to collect information on number of pregnancies, child feeding and health practices, influence on decisions regarding child health and feeding, overall satisfaction with life, social support, workload, income, use of income, and household food expenditures and consumption. Household heads were questioned about household food production and other economic resources. Caregiver and household variables were classified as two sets of variables, and separate regression models were run for each of the two sets. Significant predictors of height-for-age were then combined in the same regression model. Caregiver influence on child-feeding decisions, level of satisfaction with life, willingness to seek advice during child illnesses, and the number of individuals available to assist with domestic tasks were the caregiver factors associated with children's height-for-age. Socioeconomic factors associated with children's height-for-age were the amount of harvested cereals, the sources of household income and the household being monogamous. When the caregiver and household socioeconomic factors were combined in the same model, they explained 54% of the variance in children's height-for-age, and their regression coefficients did not change or only slightly increased, except for caregiver's propensity to seek advice during child illnesses, which was no longer significant. These results indicate that caregiver characteristics influence children's nutritional status, even while controlling for the socioeconomic status of the household.

The deterioration in children's nutritional status in rural Chad: the effect of mothers' influence on feeding.

OBJECTIVES: This study examined how maternal influence on child feeding modified the deterioration of child nutritional status in Chad. METHODS: The pattern of height with age was examined in 98 rural Chadian children aged 12 through 71 months from 64 households randomly chosen. RESULTS: Younger children were more stunted than older ones, probably reflecting secular deterioration in weanlings' nutritional status from 1982 to 1987. Children of mothers with influence over child feeding were taller than children of mothers with less influence, but this held only for the youngest children. CONCLUSIONS: Height-for-age can be a useful indicator of recent changes in social and environmental effects on child health. The mother's influence may have buffered the negative impact of socioeconomic conditions on child growth.

Investigating the weanling's dilemma: lessons from Honduras.

When complementary foods should be introduced in the diets of infants in poor environments remains controversial. Resolution has been hampered by inadequate study designs. A study in Honduras has demonstrated an experimental design assessing multiple infant and maternal outcomes and provides information for planning sample size and accounting for dropouts in future studies. Further research to understand the cultural, social, and biologic aspects of complementary feeding is needed.

Gender bias in food intake favors male preschool Guatemalan children.

Gender bias in food intake and its subsequent effects on growth and illness were examined using data from rural Guatemalan children. Multiple regression controlled for energy requirements, illness, and maternal and economic factors. Gender bias in energy and protein intake favored boys; the magnitude for ages 2-5 y was 247 kJ/d. Analysis of subsequent effects showed that boys had higher rates of weight gain due to gender bias in energy intake than did girls for ages 1-2 y (0.27-0.97 kg/y), when there were no differences in illness rates due to gender bias in energy intake. For age 3-5 y, boys and girls did not differ in weight gain due to gender bias in energy intake. For ages 1-2 y for weight and stature, the growth rate for boys was faster than that of girls by 6-49% due to gender bias. This study provides evidence of gender bias in food intake in a Latin American population, but more work on the existence of and reasons for gender bias in food intake is needed before advocating that education or health programs should focus on this issue.

Altitude and infant growth in Bolivia: a longitudinal study.

The growth of 79 healthy, well-nourished lowland (400 M) and highland (3600 M) Bolivian infants was analyzed in a longitudinal study through the first postnatal year. Compared to low altitude infants, the high altitude infants were found, by analysis of covariance controlling for size at the previous exam, to be significantly shorter at birth, 1 and 6 months, while they were significantly lighter only at birth and 1 year. Recumbent length gain was slower in the high altitude infants in the early months of life, while weight gain did not differ between altitudes. The observed lower weights at high altitude throughout the first year appear to be due to a persistence of lower weights seen at birth and not to postnatal growth retardation. Significantly greater triceps and subscapular skinfold thickness measurements were found in the highland group, despite their smaller length and weight. The possible causes and implications of the greater fat accumulation in the highland infants are discussed.