We showed that rural community members without previous experience in anthropometry were able to take reliable anthropometric measurements after a short training exercise. Intra- and inter-anthropometrist reproducibility were relatively high for all metrics, though measurement error was slightly higher for smaller children than for larger children, and for length measurements compared to height measurements. The measurement error for weighing children was similar to that of weighing test weights.
Although growth monitoring of children would ideally be done by trained anthropometrists with formal health education, such individuals are usually not available in resource-poor settings. As an alternative, community members without formal training could be employed as anthropometrists 
. However, the reliability of measurements made from community-drawn anthropometrists has not typically been reported in prior studies. We therefore attempted to address the reliability of community-drawn anthropometrists in a clinical trial setting in Ethiopia. As a first step, we assessed the agreement between anthropometrists and an independent observer in order to determine whether our anthropometrists would be able to accurately read the measurements from the anthropometry equipment. Anthropometry teams displayed very high agreement with the observers, suggesting that a brief training exercise was sufficient to teach our teams how to accurately use the equipment. We should point out, however, that the 6 anthropometrists in this study were selected from 22 potential candidates, many of whom were unable to adequately perform measurements after our training. Pre-testing of anthropometrists is therefore crucial when using community individuals with little training.
We also assessed intra- and inter-anthropometrist reproducibility, both of which were relatively high in this study. As expected, inter-anthropometrist measurement error was slightly greater than intra-anthropometrist error, and measurement error for height and weight were less than that for MUAC. The reliability estimates in this study were comparable to those found in previous studies in a variety of settings, suggesting that after appropriate training, community-drawn anthropometrists have the capacity to perform highly reliable measurements 
Inter-anthropometrist error was greater for smaller children compared with larger children, and for length measurements compared with height measurements. This result is consistent with our experience in the field, where younger children were less cooperative and more difficult to measure. This result suggests that additional training could focus on techniques to accurately measure the youngest children, such as performing examinations quickly, and enlisting the help of guardians to comfort and stabilize the child, especially when measuring length. Even with this lack of precision for the youngest children, relative TEM was below 2% for the smallest quartile of all metrics, which is probably acceptable in most contexts.
In this study, taking the median of 3 serial height or weight measurements resulted in less measurement error than taking a single measurement, or taking the mean. However, the reduction in error was moderate: medians had approximately 10–20% lower measurement error than the single measurement. Therefore, although it appears reasonable to continue taking 3 measurements to reduce measurement error as much as possible, anthropometry teams could consider using a single measurement if taking multiple measurements per child became burdensome.
We repeatedly weighed test weight sets in order to rule out the possibility of bias in scale measurements over time. The measurements of the test weights did not change markedly over the course of the study. In fact, the minimum and maximum documented weights were only 0.15 kg apart, suggesting that the measurement error of the scale itself is about 0.15 kg in field conditions. That this degree of measurement error was similar to the intra-anthropometrist repeatability (0.15 kg) suggests that most of the intra-anthropometrist measurement error is due to the scale itself.
We found evidence for terminal digit preference among the anthropometrists, more so for height than for MUAC. This is a well-described phenomenon that can reduce precision of measurements 
. As has been found in other studies, the anthropometrists in this report seemed to prefer the numbers 0 and 5. The training program should address this concept in an attempt to improve measurement precision.
In conclusion, we found that rural community members were able to learn anthropometry techniques during a short training period. Height and weight measurements had high intra- and inter-anthropometrist reliability, and were more reproducible than measurements for MUAC. Measurement error was greater for smaller children than for larger children and for lengths compared to heights, likely because smaller children were less cooperative with the examination. This study suggests that height and weight measurements performed in the rural setting are appropriate outcomes for a clinical trial.