Improving the quality of anthropometric measures during medical consultations with children aged under five years old in Burkina Faso

Millions of medical consultations are conducted each year in Burkina Faso using the Electronic Register of Consultations (REC). Based on the consultation data collected, we present a method to quantify the quality of individual and ensembles of consultations conducted by frontline healthcare workers (FHWs). We focus on anthropometric measurements and vital signs (age, weight, height, mid-upper arm circumference and temperature) of children aged between six months and five years old. We compare individual and ensemble of consultations to a multivariate probability distribution defined by an external population-specific, gold standard consultation dataset. By comparing the distributions of consultations to the reference probability distribution, we define a score to rate the quality of measurements and data entry of FHWs. The defined scores allow us to detect which measurements are most problematic. They also allow us to detect potential biases in the consultation and treatment of different patient groups. No systematic gender-bias was found among FHWs. Height measurements were the most challenging; consultations with the lowest scores were associated with underestimated heights in children. Among these consultations, height was found to be even more underestimated among boys than girls. Our findings enable us to support capacity building of frontline healthcare workers. Based on our work, we present how the REC can be enriched with real-time alert on specific errors, and individual FHW can be proposed targeted trainings. We also propose dynamic dashboards that can support district managers to navigate the entire population of FHWs, understand FHWs' main challenges and prioritise their interventions in primary healthcare centres.