MSF Nutrition Training Package

Module 1 Session 1 Duration: 90 min Reccomended Prerequisite Sessions:

Anthropometry None
General Objective: Other Recommended Preparation:
To practice measuring the variables: weight, height, bilateral oedema and mid-upper arm Video: Anthropometric Measurements
circumference (MUAC). https://www.youtube.com/watch?v=t4dholcfl84&feature=youtu.be
Target Profiles:
Must attend Supervisors, Nurses, Nutrition Assistants, Community Health Workers (CHW), Doctors
Should attend -
Could attend -
Specific Objectives
By the end of this session participants will be able to: 1. Calibrate a scale. 2. Measure weight. 3, Measure the MUAC. 4. Measure height/length 5. Perform a test to
determine if a child has bilateral oedema. 5 Be aware of common mistakes in measuring MUAC, height/length, weight and oedema.
Contents
How to calibrate a scale. How to measure a child’s weight, length or height. How to use a MUAC tape to measure the MUAC. How to perform a test to determine if a child
has bilateral oedema. How to use a stick to measure a child’s height. Common mistakes measuring MUAC, height/hength, weight and oedema
Methodology Overview:
This is a 90-minute session based on the participants being shown the correct technique for measuring MUAC, weight, height/length and bilateral oedema. Participants
have the opportunity to practice and receive immediate feedback from the facilitator.
1. A circuit is set up to measure the variables
2. The facilitator demonstrates the practical skill
3. Participants move around the circuit taking measurements.
4. The facilitator provides feedback and provides quick tips for improvement to takeaway.
Time Activities Description of Learning Activities Method Materials
5 Activity 1: Explanation of the learning objectives and introduction to the session Whole None
Introduction group
20´ Activity 2: -A circuit is set up with four stations: MUAC tapes, scales, oedema Whole MUAC tape, scales, standard 2 kg weight, stick,
Demonstration assessment and the height board group rope and bucket, height board, A stick marked at
-The facilitator demonstrates each practical skill at each station in the 67cm, 87 cm and 110cm. Pen and paper to
circuit, at the same time asexplaining how to do it record measurements
At least three dolls or real children if
possible. Document to print:
NP_M1_S1_MeasurementTechniques
50´ Activity 3: -Participants move around in pairs taking measurements carrying out In pairs Circuit
Skills Practice assessments and noting the answers.
-Facilitator moves around observing, getting participants to correct
any bad practices straight away and answering any questions.
15´ Activity 4: -Facilitator provides answers/feedback Whole Takeaway: Anthropometry Quick Tips
Wrap up + Takeaways -Facilitator gives the “quick tips” for improvements for participants to group -hand-out, laminated if possible, or emailed
take away.
10’+10’ Activity 5: On the Job Participants identify Common Errors in Anthropometry (photos) In pairs PPT: NP_M1_S1_Commonistakes. Photos printed.

1
 Materials

1. Measuring Equipment

This will depend on the number of participants. This basic kit should be enough for 8
participants. If there are a large number of participants you may need multiple circuits
and facilitators. The minimum necessary would be to have the following measuring
materials:

Weight station:
Scales: 1 Salter scale 25 kg 100g precision (ITFC code: EANTSCAL25-),1 electronic infant
scale 10g precision (ITFC code: EANTSCAL1B-), 1 electronic duel display mother/child
scale (ITC code: EANTSCAL4--)

 Rope to hang up the scale if necessary

 A bucket with rope (see figure 3 and 4)
 A standard 2 kg weight
 A doll (of any size). The doll should have some extra weight of at least 2-3 kilos
 To print:
o The image how to measure weight: (Slide 1)
NP_M1_S1_MeasurementTechniques

Height/length station:

 A stick
 A height board with a measuring tape on both sides of the board
 A pen and paper to record measurements
 A stick marked at 67cm, 87cm and 110cm
 Two dolls (one < 87 cm and one > 87 cm)
 To print:
o The image how to measure height: (slide 2)
NP_M1_S1_MeasurementTechniques

MUAC station:

 1 MUAC tape/bracelet with 1mm precision

 To print:
o The image how to measure MUAC: (slide 3)
NP_M1_S1_MeasurementTechniques

Oedema Station:

 To print:
o The image how to measure Oedema: (slide 4)
NP_M1_S1_MeasurementTechniques

2
Note:

 If possible it is better to practice with real children in order to accurately simulate

the real environment in which the participants will be working (but take into
account how disturbing it can be for caretakers and children)
 If there are no children or dolls available, you can simulate one by using a ball
and stick (see photos) and then tie on sandbags with specific weights:

Figure 1 Example of how to use a doll created from a ball and a stick

2. Materials for the optional activity 5:

 To print: PPT: NP_M1_S1_commonmistakes with photos/images of the
measuring process (the answers are in the notes section of the PPT). The photos
need to be printed.

3. Documents
 To print:
o Takeaway “Anthropometry Quick Tips” to be printed and ideally laminated
so participants can take them away and use them for reference when
working.
o Takeaway key messages
o Optional Takeaway “Common Mistakes”

Description of Activities

Activity 1: Introduction
(In-group, 5 minutes)

 The facilitator will introduce the objectives of the module, topics to be covered
and methodology of the session.

3
  Next, the facilitator will explain:

 In order to categorise the type of malnutrition that a child is suffering from, we

need different variables: anthropometric measurements (weight, height or
length, and mid-upper arm circumference (MUAC)), the clinical sign of bilateral
pitting oedema, and the sex and age variables.
 In this session, we will focus on: weight, height, bilateral oedema and MUAC.
 Anthropometric measurements are done at admission, during follow up and at
exit/discharge.
 The procedure has to be explained to the child’s caretaker before doing it.

Activity 2: Demonstration
(Plenary 20 minutes)

• The facilitator will need to set up the circuit before beginning the session.
• Facilitator demonstrates and explains (content below) how to do the
measurements and the consequences of bad practices. If possible have an
assistant with you to help with the measurements when needed, as this is
recommended in real life situations.
• After the demonstration of each measurement:
o The facilitator asks the particpants to repeat back each step, guiding the
facilitator on the execution of the technique.
o Each participant mentions one step consecutively, and the facilitator acts
according to what the participant directs.
o This will serve to check if the participants have integrated the information
that the facilitator has described during the demonstration.

Example : WEIGHT TECHNIQUE A SALTER SCALE : 1st participant: Install the

scale at eye-level of the person who will do the reading of the weight; 2nd
participant: Safely attach the plastic bucket to the scale; 3rd participant: Calibrate
the balance…
In case there is more than one piece of equipment per technique (example: salter
and electronique scale..), chose one piece of equipment to do this activity, and for
the others, ask one participant to explain the differences.

4
Circuit Description

Note: The facilitator will put a piece of paper in each station in order to record the
measurement (with the name of the participant and type of measurement). The
participant gives this to the facilitator when they have filled it out.

If the two types of scales are available, an additional station in the circuit can be added.
If two height boards are available, the height and length can also be in two different
stations.

Station 1: Weight

The facilitator demonstrates how to weigh a patient. The facilitator will need the
assistance of two participants to hold the stick or doll if they are using a Salter Scale (see
below in station 1). Another option is to hang the scale as seen in figure 5.

Before weighing, remember to demonstrate how to calibrate the scale with a standard 2
kg weight (Figure 3).

General principles
• All children should be weighed without clothes. Cold weather or cultural
customs may mean it is not always possible to weigh the child without clothes, but
it is the recommendation for accurate weight measurements. This is why the
mother-child electronic scale can be preferable as the child is kept warm next to
the caretaker for all but a few moments. It is rare that young children can not be
undressed due to cultural reasons, but these should still be respected when
encountered. Children can be given a “dress” (i.e. a cloth bag with holes cut out
for the head and arms). In that case, the “dress”, or other child’s clothes is

5
 weighed and deducted from the measurement.
• There are three types of scales for children:
o Electronic scale for infants (i.e. SECA scale of 10 grams precision in
order to be also used for low weight children).
o Electronic mother-child scale that gives the weight of an adult, and then
is tarred to give the accurate weight of a child, when placed in the arms of
the adult. Measuring range 0 to 150 kg. Graduation: 100 g minimum
o Salter Scale (25 kg hanging spring scale graduated by 100g).
o Scales used for adults should provide a degree of precision of 500 gram.
• To measure weight, accuracy is essential (ex: A 100 g mistake when measuring
the weight can incorrectly classify the nutrition status of a child).
• Calibration of the scale: In a nutrition programme calibration should be done
every day (even more frequently if necessary) with a standard 2 kg weight. If
the measure does not match the weight, either the scale should be discarded or
the springs should be changed.
• Be gentle, respectful, kind and speak softly and do not shout or order the
caretaker around. Also be very gentle with the child if a salter scale is being used
as this is a stressful and scary experience for the child.

Technique for using a Salter scale

• The Salter scale should be installed by hanging it at the eye-level of the

measurer. For mobile weighing, the scale can be hooked onto a tree or attached
to a stick held by two people of similar height (if possible).
• Preferably, a plastic bucket is used to weigh the child. The use of a bucket is
advised because it is easier to clean, easier to put the child in and is often more
comfortable than the standard salter weighing pants (sometimes called culottes
Another option is using the standard salter weighing pants.
• Calibrate to zero: WITH the plastic bucket or pants attached
• Put the child carefully into the plastic bucket.
• If using the pants, put the child in the pants before hanging them from the
scale. If a child is capable of putting the pants on themselves, ask them to do so.
• For small children have the caretaker place the child on their lap. The
measurer then kneels down and puts their hands through leg holes. Take the
child’s feet and move the the pants up the child’s body until they are comfortably
‘sitting’ in the pants
• Read the scale at eye level, ensuring that the child is not holding on to a
caretaker or staff member. (If the child moves around and the needle does not
stabilise, estimate weight by using the value situated at the midpoint of the
oscillation, but always try your best to get the child as still as possible, involve the
caretaker to calm them)
• Read out the value to an assistant. The assistant should repeat the value,
verify it and then record the child’s weight.
• Try to involve the caretaker and have them close to the child at all timesGet the
caretaker to put the pants on the child and have them close to the child at all
times

6
Visual aids weight

Figure 2: Two people holding the Figure 3: Standard Figure 4: Child Figure 5: Example
stick weight to calibrate an being weight in a of hanging up a
electronic scale and a plastic bucket scale
wooden board as a hard (hanging basin)
surface

Technique for using an electronic mother/child scale

Scale Setup

• Place the scale on a hard and flat surface. E.g., concrete, solid ground, wooden
board.
• Place the scale in the shade or indoors. If the scale overheats and does not
work properly, move it to a cooler place and wait 15 minutes before trying again.
• Handle the scale with care and protect it from excess humidity.
• Ensure that the batteries are working before measuring the child’s weight.

Instructions 1:
1. Start by zeroing the scale. The method used to zero the scale depends on the type
of scale being used. Some scales can be zeroed by covering the solar panel for 1
second. When the readout says 0.0 and an image of a mother and baby is
displayed, the scale is ready to be used. Other scales require that someone step
on the scale.
2. Ask the caretaker to step onto the centre of the scale and stand still. Wait until the
weight of the caretaker displays and remains fixed in the display panel. If no
caretaker is available, a trained assistant or another adult may play this role.
3. Tare the scale while the caretaker is on it, following the appropriate method for
that scale.
4. Place the child in the caretaker’s arms and ask the caretaker to remain still. The
caretaker should try to calm the child and prevent him/her from moving.

1 Adapted from FANTA Module 6 Anthropometry Guide May 2018

7
 5. The child’s weight will appear in the display.

6. Read the child’s weight aloud. The trained assistant should record and/or plot the
child’s weight to the nearest 0.1 kg (100g) clearly and accurately on the
appropriate patient documentation. If no trained assistant is available, record
and/or plot the measurement yourself.

7. Check the recorded or plotted weight for accuracy and legibility.

Technique for using an infant scale

Instructions:
1. Turn on the scale by pressing the START button (or follow instructions for that
scale). Wait until 0.000 appears.
2. Gently place the infant on his/her back on the centre of the scale pan with the help
of the trained assistant or caretaker, who should help calm and secure the infant if
he/she starts crying or moving. Stay close to and observe the infant to ensure
he/she does not roll or fall off the scale.
3. Read the child’s weight aloud when the infant is still and the digital display is no
longer changing. The trained assistant should record and/or plot the child’s weight
to the nearest 0.01 kg (10g) clearly and accurately on the appropriate patient
documentation. If no trained assistant is available, record and/or plot the
measurement yourself.
4. Check the recorded or plotted weight for accuracy and legibility.

8
 NB: Try to perform all of
these acts as quickly as
possible to avoid the child
getting cold and
potentially hypothermic.

Examples and consequences of bad practices:

The facilitator explains the consequences of bad practices and writes them down
on a flipchart:
Bad Practice Consequences
Not having the scale at eye level. Risk of inaccurate reading.

Both arms of the child hanging in front of the Risk of him falling off the
weighing pants scale.

Station 2: Height/Length

The facilitator demonstrates how to measure the height and the length of a child. He/she will
need the assistance of two participants, one to assist when doing the measuring, and another
one writing down the measurement. Also he/she will demonstrate how to estimate the
height/length with a stick.

General principles
• All children under 2 years (up to 87 cm, as a proxy for this age) will be measured

9
 lying down (length). Children > 2 years (or > 87 cm) are measured standing up
(height)
• The measurer should read out the length to the nearest 0.1 cm.
• Remove the child’s shoes
• The height/length is always taken by two people
• Measuring children standing up is much easier. Length is much more difficult to
measure than height.
• Check the height board in good condition: The tape measure at the side of the
board is easy to read with no breaks or marks on it
• When measuring height/length is very important to be very accurate.
• At community level, CHWs use height/length to identify the children who they will
then measure MUAC on. However, they do not measure height or length with a height
board, instead of that, CHWs estimate the height/length using a stick that is
marked with two lines, one at 67 cm and another at 110 cm (height range estimate
for children aged 6-59 months). Note: This is only used at community level, as this
technique to measure height/length is not completely accurate (it is a proxy).

Set up and Technique

• For the Length: Place the measuring board in a stable place (if it is not the case you
need to look for a support) on the ground or on a table; gently lay the child supine in
the middle.
• For the height: Place the measuring board upright (preferable against a wall or
hard stable surface). Stand the child on the middle of the “foot board”
• The specific measurer and assistant’s roles are:

Length Height

Measurer 1. Kneel beside child’s feet 1. Kneels beside child’s head on the
on the child’s right. child’s right.
2. Place left hand on child’s 2. Left hand gently but firmly holds
knees or shins to ensure the child neck/jaw straight and
legs remain straight. ensures that the child is looking
3. Ensure that feet are FLAT straight ahead.
against the cursor. 3. Checks to see that ankles, knees,
4. Take the Reading (out buttocks, shoulders, and head are
loud for the registration touching the height board.
person to write) 4. Right hand on cursor and slowly
lowers it so that is touching the
child’s head.
5. Takes the Reading (out loud for the
registration person to write)
Assistant 1. Kneels at top of child’s 1. Kneels beside child’s feet on the
head. child’s left.
2. Gently but firmly holds 2. Places right hand on ankles and left
both sides of child’s head hand on knees to ensure that the
and ensures child is two legs are touching each other as
looking straight up well as the back of the height
towards the sky. board.

10
 Registration
officer (or the Writes down the reading
measurer after
taking the
reading)
Visual aids height/length

Figure 7: taking the height Figure 8: Taking the length

Examples and consequences of bad practices:

The facilitator explains the consequences of bad practices and write them down in a
flipchart:

Measure Bad Practice Consequences

Height: The surveyor’s hand is placed on the child’s mouth. Risk of child being afraid

Ankles, knees, buttocks, shoulders, and head are Risk of inaccurate reading
not touching the height board
Length: Not having the head against the board Risk of inaccurate reading.
Not putting the hands on their knees Risk of inaccurate reading.
Not pushing the foot piece against the child´s feet Risk of inaccurate reading.

11
 Station 3: MUAC

The facilitator demonstrates how to measure the MUAC. He/she will need one volunteer to
measure his/her MUAC.

Note: For the purpose of the exercise The MUAC tape for children will be used. But note that
is too short to measure the mid-point of the adult’s arm. Therefore, this process will be just
an approximation.

General principles
• MUAC is measured in children from birth to 59 months – although it should be
noted that the cut-offs used for children <6months have not been validated at an
international level, although we use them in MSF where the evidence for African
contexts is strong. The evidence for the cut-offs for 6-59 months is strong and
internationally validated (WHO, UNICEF).
• For children greater than 5 years, MUAC-for-age is used and the MUAC-for-age
curves are used in practice.
• MUAC is also used for pregnant and lactating women to assess their nutritional
status
• MUAC measurement is fast and simple, but variations in measurements often occur
between different measurers. This is mainly due to identified positioning on the mid-
upper arm and how tightly the tape is pulled or “squeezed” around the arm. Make sure
the MUAC tape is not too tight or too slack.
• It is very important to be very accurate and read the tape to the nearest mm.
• Always look for bends or kinks in the MUAC tape every day.
• The brachial perimeter on the left arm is always taken to standardise the technique

Technique for measuring MUAC

• Explain the procedure to the child’s caretaker.

• Ensure that the child is not wearing any clothing on their left arm.
• If possible, the child should stand straight and sideways to the measurer. The
measurer can also move around the child!
• Bend the child’s left arm at 90 degrees to the body.
• To measure the mid-point of the upper arm, place the MUAC tape along the upper arm
and find the mid-point of the upper arm. The mid-point is between the tip of the
shoulder and the elbow.
• Mark with a pen the mid-upper arm point using the measurer’s free hand. Ask child
to relax arm so it is hanging by their side.
• Using both hands place the MUAC tape window (0 cm) on the mid-point.
• While keeping the left hand planted, wrap the MUAC tape around the outside of the
arm with the right hand.
• Keep the right hand still and feed the MUAC tape through the hole in the tape. MSF
MUAC tapes have 3 holes (2 small and 1 large – the window). Feed the tape

12
 through the first small hole, then the second small hole. Read the
measurement in the big hole (window).
• Read and record the measurement where there are two arrows in the window of the
MUAC tape to the nearest millimetre (mm).

Visual aids MUAC

Figures 9 & 10: How to measure MUAC

Examples and consequences of bad practices:

The facilitator explains the consequences of bad practices and write them down in a
flipchart:
Bad Practice Consequences
Having the tape too loose on the arm Risk of inaccurate reading.
Not having the arm bent at 90 degrees while Risk of not measuring the
measuring the mid-point of the arm MUAC in the correct midpoint
of the arm

Station 4: Oedema

The facilitator demonstrates how to measure oedema in one participant; therefore,

he/she will need one volunteer to do so.

General principles
• Oedema is very important and accuracy is needed when doing the measurement.
• Oedema is measured in all age groups (but in adults it can be due to many other
comorbidities so the full clinical picture needs to be taken into account)
• Oedema in malnutrition is always bilateral: both feet, both legs, both hands etc.
• It starts in the feet and moves up. If it has started somewhere else, it is not nutritional
oedema

13
 • It is important to classify the extent of the oedema:
o Oedema first present in the feet/ankles → grading: +.
o Next, oedema develops on the feet/ankles and legs → grading: ++.
o Finally, oedema generalises from the feet/ankles, legs to other parts of the
body including the face → grading: +++.
• Caution with infants less than 6 months as ‘fatty’ baby feet can be misinterpreted as
oedema

Technique to assess for oedema

• Ask the child to sit on a chair or on their caretaker’s lap.
• Hold the child’s feet with both hands at the same time.
• Apply a modest amount of pressure with the thumbs to the top of the ankle of the
child’s feet or on top of the feet. Hard pressure is not required to test for oedema and
can cause unnecessary pain to the child.
• Count to 3 when doing the oedema test. “One-one thousand, two-one thousand,
three-one thousand”. If there is oedema, a pit remains for some time where your
thumbs have been (at least a few seconds) where the oedema fluid has been pressed
out of the tissue.
Visual aids oedema

Examples and consequences of bad practices:

The facilitator explains the consequences of bad practices and write them down in a
flipchart:

Bad Practice Consequences

Only checking one foot Risk of bad diagnosis

Activity 3: Skills Practice

(In pairs, 50 minutes: The time can be decreased if the number of participants is
small)

14
Participants practice the process as follows:

• They are organized in pairs:

o Weight: 1 person practices the technique, and the second one acts as
observer. The observer also records the measurement that the one
measuring reads. After that, they change roles.
o Height/Length: Both people do the technique. One of them writes down the
measurement. Note: Do not forgetto practice measuring height with a
stick
o Oedema/MUAC: One person is the measurer and the other acts as a
“child”. After they change roles.
• Once both of them have done the station, they will change to the next one.
• During this skill, the observer has the document with the steps to follow during
the measurement, and gives feedback to his/her colleague and verifies if he/she is
correctly performing the technique. This document can be given in advance for
the participants to read at home.

Note: 1 couple needs 15 min to perform all the measurements. According to the number
of participants, two facilitators (and two circuits) may be needed.

Facilitator moves around giving feedback:

• Facilitator looks for bad practices, but does not tell them what they are doing
wrong, instead asks them to reflect on what they are doing and corrects the
practice based on what they learnt previously.
• Example: If a pair is taking the height measurement and the child´s legs are
bent, the facilitator can say: stop…have a look at the child…how are they
positioned?...what is the correct way to do this?...
• Reminder of some examples of bad practices that are in the flipcharts and the
potential consequences:

Measure Bad Practice Consequences

Scales: Not having the scale at eye level. Risk of inaccurate reading.

Both arms of the child hanging in front of the
weighing pants
Length: Not having the head against the board
Not putting the hands on their knees
Not pushing the foot piece against the child´s feet
MUAC: Having the tape too loose on the arm
Not having the arm bent at 90 degrees while
measuring the mid-point of the arm
Oedema: Only checking one foot
Risk of him falling off the
scale.
Risk of inaccurate reading.
Risk of inaccurate reading.
Risk of inaccurate reading.
Risk of inaccurate reading.
Risk of not measuring the
MUAC in the correct midpoint
of the arm
Risk of bad diagnosis

The participants explain the measurements to the rest of participants:

 When all have practiced each technique, in plenary, participants by pairs will do
the measurement at same time that they explain to the other participants what
they are doing and which tips to avoid mistakes. The rest can add or comment.

15
 Activity 4: Wrap Up
(Whole group, 5 minutes)

Facilitator does a wrap up providing overall feedback and including reviewing the
examples of bad practice he/she has seen and making sure all the key messages are
mentioned:

 In order to categorise malnutrition, we need different variables: anthropometric measurements

(weight, height or length, and MUAC), the clinical sign of bilateral pitting oedema, and the sex and
age variables.
 To measure weight, height and MUAC, accuracy is essential (ex: A 100 g mistake when measuring
the weight can wrongly classify the nutrition status of a child).
 MUAC is fast, simple and an evidenced-based indicator to identify the risk of mortality. When
measuring MUAC, make sure:
o It is measured on the left arm.
o The mid-point of the upper arm it is measured from the tip of the shoulder to the elbow
bend and it is not estimated
o Do not pull the MUAC tape too tight or too loose
 When measuring weight, make sure:
o The children are not wearing any clothes
o If a Salter scale is used:
 The scale reads 0 after putting the weight pants or the plastic bucket
 Measurer reads the scale at eye level.
o If an electronic scale is used
 The scale is situated in a flat surface
 The scale reads ‘0.00’ before a child (or the caretaker if double weighting) steps
on the scale.
o Calibration of the scale is done daily (even more often if necessary)
 When measuring height/length, make sure:
o Two measurers are doing the measurement
o Children are well placed on the height board. When measuring length make sure: toes
are not pointed, knees are not bent, head is not lifted off the board. When measuring
height make sure: Child is not leaning to one side, heels are touching the board,
o Children under 2 years (or 87 cm) will be measured lying down
o The tape measure on the height board is in a good condition and possible to read
 When testing for oedema, make sure:
o It is done in both feet.
o Do not press thumbs to hard which can cause unnecessary pain to the child.
 Anthropometric measurements are done at admission, during follow up and at discharge.

Takeaways
Facilitator gives “quick tips” (see materials) for participants to take away. The
PDF version can also be emailed.

16
 o Takeaway “AnthropometryQuickTips” to be printed and ideally laminated so
participants can take them away and use them for reference when
working.
o Takeaway “keyMessages”
o Optional Takeaway “CommonMistakes”

Activity 5: Optional
(In pairs, 10 + 10 min)

If there is time remaining the facilitator can add two optional activities:

1) Optional Game (10 min):

• Give the participants one minute to memorise as many quick tips as possible
• Ask participants to turn over the quick tips sheet
• Talk to their partner and see how many tips they can name without looking.

2) Common errors in anthropometry (10 min)

The participants will identify common errors in anthropometry. In pairs participants get a
hand-out (NP_M1_S1_commonerrors) and work through the images to decide to identify
which is the error in each photo. If possible images can be stuck to the walls and
participants move around the room and discuss with their partner. Tell them there is one
image that is correct…which one?

On the Job Training

The activity 3: Skills practice can be carried out on the job. The nutrition assistants and
nurses that are working on that shift can practice with the real children, while the
supervisor guides them if they make mistakes and reminds them of the key messages.

The optional quick activity (common errors in anthropometry) can also be done on the
job while the ward is quiet, for example, late afternoon

It is recommended that in the anthropometric measurement area, there should be

mementos/aide memoires hung/stuck on the walls to show how to correctly take the
measurements

17