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Study of 3D imaging system for child anthropometry (AutoAnthro) carried out in Atlanta by Emory University in 2016/7.

Additional file 6. Graphical representation of Receiver Operative Characteristics curves for WAZ, MUAC. a & b represents ROC curve for WAZ and MUAC respectively with respective sensitivity, specificity and the optimal cut-off point examined using Youden���s Index. It provides also the value of AUC a ��-value. c Graphical representation of comparison of ROC curves for WAZ and MUAC.

Additional file 2. Differences between prevalence of concurrent WaSt by original and proposed case-definitions by district.

Additional file 4. Burden of concurrent WaSt by district using the two WaSt case-definitions.

Additional file 3. Numerators and denominators of prevalence rate ratios by sex as shown in Figs. 1 and 2.

Additional file 5. Analysis of how increasing MUAC to diagnose WaSt affects the False Positive Values.

Additional file 1. Distribution of prevalence���s of Wasting by WHZ, by MUAC, Stunting and concurrent WaSt using original and proposed case-definition by district.

3D imaging for body measurements is regularly used for design of garments and ergonomic products. The development of low‐cost 3D scanners provided an opportunity to extend the use of 3D imaging to the health sector. We developed and tested the AutoAnthro System, the first mobile, low‐cost, full‐body, 3D imaging system designed specifically for child anthropometry. This study evaluated the efficiency, invasiveness, and user experience of the AutoAnthro System. We used a mixed‐methods, collaborative approach that included a quantitative time‐motion study and qualitative interviews of anthropometrists. For cooperative children, anthropometrists considered the use of 3D imaging an easy, “streamlined experience,” but with uncooperative children, anthropometrists reported that capturing a good quality scan was out of their control. The mean time to complete a full set of scans was 68 s (standard deviation [SD] 29), compared with 135 s (SD 22) for a set of manual measurements (stature, head circumference, and arm circumference). We observed that crying was more common during manual measurement, and anthropometrist interviews confirmed that 3D imaging was less stressful for children than manual measurement. In a previous publication, we showed the potential of 3D imaging to produce reliable and accurate measurements. In this study, we found that anthropometrists were not ready to abandon manual equipment for 3D scanners because of difficulty in measuring uncooperative children. Revising the AutoAnthro System to address anthropometrists' concerns on capturing good quality scans of uncooperative children should help to facilitate widespread use of 3D imaging for child anthropometry.

The usefulness of anthropometry to define childhood malnutrition is undermined by poor measurement quality, which led to calls for new measurement approaches. We evaluated the ability of a 3D imaging system to correctly measure child stature (length or height), head circumference and arm circumference. In 2016-7 we recruited and measured children at 20 facilities in and around metro Atlanta, Georgia, USA; including at daycare, higher education, religious, and medical facilities. We selected recruitment sites to reflect a generally representative population of Atlanta and to oversample newborns and children under two years of age. Using convenience sampling, a total of 474 children 0-5 years of age who were apparently healthy and who were present at the time of data collection were included in the analysis. Two anthropometrists each took repeated manual measures and repeated 3D scans of each child. We evaluated the reliability and accuracy of 3D scan-derived measurements against manual measurements. The mean child age was 26 months, and 48% of children were female. Based on reported race and ethnicity, the sample was 42% Black, 28% White, 8% Asian, 21% multiple races, other or race not reported; and 16% Hispanic. Measurement reliability of repeated 3D scans was within 1 mm of manual measurement reliability for stature, head circumference and arm circumference. We found systematic bias when analyzing accuracy-on average 3D imaging overestimated stature and head circumference by 6 mm and 3 mm respectively, and underestimated arm circumference by 2 mm. The 3D imaging system used in this study is reliable, low-cost, portable, and can handle movement; making it ideal for use in routine nutritional assessment. However, additional research, particularly on accuracy, and further development of the scanning and processing software is needed before making policy and clinical practice recommendations on the routine use of 3D imaging for child anthropometry.

Prechewing of food by caregivers is a common infant feeding practice both globally and in the United States, where the highest rates of the practice are found among African‐Americans and Alaska Natives. The objective of this study was to determine if prechewing of infant food is associated with increased diarrhoea prevalence of 10‐month‐old infants in the United States. The study used cross‐sectional data from the Infant Feeding Practices Study II to test for associations between prechewing and 2‐week‐period prevalence of infant diarrhoea. At 10 months of age, infants who received prechewed food (n = 203) had a diarrhoea prevalence of 16.1%, compared with 10.9% of children who did not receive prechewed food (n = 1567) [relative risk (RR) = 1.48, 95% confidence interval (CI) 1.03–2.11]. After adjusting for covariates, including breastfeeding and consuming sweets and dairy, prechewing was associated with a 58% higher risk (RR = 1.58, 95% CI 1.10–2.26) of 2‐week diarrhoea prevalence. Consumption of sweets (RR = 1.35, 95% CI 1.03–1.78) and dairy (RR = 1.41, 95% CI 1.03–1.93) was also associated with increased diarrhoea risk. Continued breastfeeding at 10 months of age was associated with a reduced risk of diarrhoea (RR = 0.68, 95% CI 0.50–0.91). Prechewing of infant food is associated with increased diarrhoea among 10‐month‐old infants. The high RR found in this study suggests that prechewing may be an important factor in public health efforts to reduce the burden of diarrhoeal disease. However, further research is needed to establish that prechewing causes increased diarrhoea risk and to explore potential benefits of prechewing.