I have done these standardisation exercises many times. I agree that they can be difficult. The trick is to take your time over the exercise and provide a friendly environment in which children can be measured in isolation from other children and rested between measurements. Mostly, however, they are rushed affairs. If you can recruit children that are tolerant of measurement (e.g. at a GMP station) then that can help. I wonder though if the results are useful given that your enumerators will be often be measuring "strugglers" during the survey. I find the exercise very useful to identify staff who are and who are not good with children as accurate measurement is usually about keeping the child relaxed and at ease rather than about clamping them firmly to a length measuring board or forcing them into a set of weighing shorts. I find it much easier to work with MUAC since you can do a lot of training / standardisation with foam covered dowels or tubes made from old x-ray film (TALC have a set of training tubes at [url]http://www.talcuk.org/accessories/mid-upper-arm-circumference-recognition-tubes.htm[/url]) and the measurement is far less distressing to the child. Just my tuppence.

Hi, It's true that the standardization test can be very long and difficult for mothers, children and survey teams. However, obtaining good quality measurements during surveys is so crucial that this test cannot be skipped. Luckily, there are some tips that facilitate the undertaking of this test. You can find a document that was written by the ACF-CA team about some tips to conduct a successful standardization test on: www.smartmethodology.org. You'll need to create a login (free) and go on the Standardized training package and there is a full module on Standardization Test with a PPT and annexes. One of the those tips is to divide the group of enumerators into 2 or more sub-groups for example, and do 2 tests; so, the 1st group of enumerators will be measuring 10 children one day and the 2nd group of enumerators will be measuring 10 other children the next day; or one in the morning and the other in the afternoon. This has been done a couple of times and it works really well as the children will be measured by much less people. I hope this helps,

Everything you people have talked about standardization test here is okay, however, what can you say about a situation whereby you skipped standardization test due to war emergencies, went to field and managed to collect data . The quality of data you collected is okay. Can that data be used?

Here are a few more tips to conducting a successful standardization test that will reduce the stress levels of the children and mothers/caretakers: 1. When recruiting children make sure that the mothers/caretakers are aware of what will take place at the standardization test. If they feel that their child may be too stressed then it is best to know ahead of time so that another child can be selected. This process should also be repeated on the day of the standardization test so that the mothers/caretakers are aware of what is going to take place as well as have any questions answered before the test begins. 2. If possible when recruiting children try and have the majority between 36-59 months because the older children are more likely to be less stressed. However, it is important that a few children under two years are recruited so that participants can also be tested on length (as opposed to height). 3. Always recruit a few extra children for the standardization test. If after 15-20 min there are 1 or 2 children that are extremely stressed and are likely not to improve these children can be replaced (the Survey Manager will make the decision) and the measurements taken at the station (will likely only be a few) can be repeated with the new child. 4. (Most important). The participants must be extremely organized. It is highly recommended that the day before the test the Survey Manager should organize a short mock-standardization test to review with the teams the standardization test design that will be used for the test. On the morning of the test it is best that the participants arrive before the mothers/children and review the procedures and finish any last minute preparations. When the mothers/children arrive there should be an introduction (see 1) and begin the test as soon as possible. In most situations, including war or other emergencies, a standardization test is able to take place. Can you kindly provide the context in which a standardization test was not able to be performed? The standardization test results are a mandatory Annex to be included in a SMART survey report. If a standardization test did not take place before data collection in a survey then this must be discussed in detail in the report. In short, the data will likely be able to be used (if the quality is sufficient) but the reason for not conducting a standardization test MUST be justified in the report. Just to reiterate that it is extremely rare that a standardization test is not able to be conducted before data collection.

Hi Scott, just add on to your point emphasizing on the challenge at field most often which is difficulties in measuring accurate length & MUAC for younger children. Therefore, it makes it easier to have more children aged more than 36 months but as you said already we should not miss few less than 2 years children as well. This will gives the staff understand and cope with the possible challenges they might face at the field for younger children in field. And, of course , additional children may be required specially for younger children as there is higher possibility of drop out from younger group of children. Hope you this helps!!

It is know that height and weight are difficult (and W/H complicated to derive in clinical and field conditions without computational support) and extensive training, standardisation, and ongoing supervision are required. Most work on MUAC, however, shows that this is not the case with MUAC with community health workers. ALIMA has done some ground breaking work on having mothers measure the MUAC of their own children and the key finding is that mother with minimal group training perform as well as clinical staff and community health workers at identifying which MUAC class their child belongs to. NOTE : This is a different task than measuring and recording MUAC values.