Additional file 1 of Health system utilization and perceived quality among adults in Lao PDR: evidence from a nationally representative phone survey

Additional file 1

Precision and accuracy of ultrasound and measurement board.

Precision and accuracy of ultrasound and measurement board.</p

Measurement process for one child.

BackgroundHeight is a key component of nutrition assessments in children from limited-resource settings. This study aimed to assess whether handheld digital ultrasound devices for measuring children’s height provide comparable accuracy to traditional measurement boards, which are bulky and difficult to transport.MethodsWe trained 12 health workers to measure the standing height of 222 children aged 2–5 years in rural Lao People’s Democratic Republic using both the ultrasound device and measurement board. The Bland-Altman method was used to depict limits of agreement and potential bias. We reported the technical error of measurement (TEM) for precision and accuracy, then assessed these results against the Standardized Monitoring and Assessment for Relief and Transition (SMART) Manual 2.0 and the WHO Multicentre Growth Reference Study (MGRS).ResultsThe average difference between the ultrasound and board measurements was 0.096 cm (95% limits-of-agreement: 0.041cm, 0.61cm) with a systematic bias of 0.1cm (95% confidence interval: 0.067cm, 0.134cm), suggesting the ultrasound measurements were slightly higher than those from the board. The ultrasound and board TEMs for precision were 0.157cm and 0.091cm respectively. The accuracy TEM was 0.205cm. All TEMs were within SMART and WHO MGRS limits.ConclusionThe ultrasound device is comparable to the measurement board among standing Lao children aged 2–5 years for precision and accuracy TEMs but showed a bias of 0.1cm. Further studies are required to assess whether calibration can minimise this bias and determine the ultrasound’s accuracy on recumbent length for infants and younger children.</div

Bland-Altman plot.

The average height measurements of the ultrasound readings were subtracted from the average of measurement board readings for each child (y-axis) plotted against the average height measured for each child by both tools (x-axis).</p

Sample characteristics.

BackgroundHeight is a key component of nutrition assessments in children from limited-resource settings. This study aimed to assess whether handheld digital ultrasound devices for measuring children’s height provide comparable accuracy to traditional measurement boards, which are bulky and difficult to transport.MethodsWe trained 12 health workers to measure the standing height of 222 children aged 2–5 years in rural Lao People’s Democratic Republic using both the ultrasound device and measurement board. The Bland-Altman method was used to depict limits of agreement and potential bias. We reported the technical error of measurement (TEM) for precision and accuracy, then assessed these results against the Standardized Monitoring and Assessment for Relief and Transition (SMART) Manual 2.0 and the WHO Multicentre Growth Reference Study (MGRS).ResultsThe average difference between the ultrasound and board measurements was 0.096 cm (95% limits-of-agreement: 0.041cm, 0.61cm) with a systematic bias of 0.1cm (95% confidence interval: 0.067cm, 0.134cm), suggesting the ultrasound measurements were slightly higher than those from the board. The ultrasound and board TEMs for precision were 0.157cm and 0.091cm respectively. The accuracy TEM was 0.205cm. All TEMs were within SMART and WHO MGRS limits.ConclusionThe ultrasound device is comparable to the measurement board among standing Lao children aged 2–5 years for precision and accuracy TEMs but showed a bias of 0.1cm. Further studies are required to assess whether calibration can minimise this bias and determine the ultrasound’s accuracy on recumbent length for infants and younger children.</div

SMART acceptable limits for TEMs of precision and accuracy.

SMART acceptable limits for TEMs of precision and accuracy.</p

Difference of measurements between ultrasound and board measurements (cm).

Difference of measurements between ultrasound and board measurements (cm).</p

Additional file 1 of Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

Additional file 1: Interview guides. Translation of the qualitative interview guides