Does mid upper arm circumference identify all acute malnourished 6–59 month old children, in field and clinical settings in Nigeria?

Abstract

Objectives: To determine the utility of mid-upper arm circumference (MUAC) in identifying acutely malnourished children compared with weight-for-height (WHZ), body mass index (BMI) for age (BAZ) and MUAC z-score (MUACZ) in clinical and field practice.

Design: Cross-sectional study.

Setting: Children from immunisation and paediatric outpatient clinics of Jos University Teaching Hospital and two schools in Jos, Plateau state, Nigeria.

Subjects: Children 6–59 months with parental consent, and no chronic medical condition or pedal oedema. Outcome measures: MUAC, height and weight were measured. The WHZ, BAZ and MUACZ were determined using the World Health Organisation (WHO) Anthro software 3.0. Prevalence of acute malnutrition was compared between these data and those given by MUAC. The World Health Organisation (WHO) z-score cut-off of < -3 and < -2 and MUAC of ≤ 11.5 cm and 11.6 –12.5 cm was used to define severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. Stata 12SE was used to determine frequency distribution, means and significance.

Results: The mean age of subjects was 22.4 ± 15.5 months. The mean MUAC was 14.7 ± 1.5 cm. The MUAC differed between males and females in the age-groups of 6–11 (p = 0.02) and 36–47 (p = 0.006) months. The prevalence of SAM by WHZ was 3.4%, MUAC was 1.5%, BAZ was 4.3% and MUACZ was 1.0%. When compared, WHZ and BAZ were concordant in 77.8% (p = 0.001) of SAM subjects. MUAC and MUACZ indicated that none of the subjects were classified as SAM by WHZ and BAZ.

Conclusion: Neither WHZ or MUAC as a single parameter identifies all children with acute malnutrition. A re-definition of MUAC criteria for malnutrition or consistent application of both parameters is required.

Keywords: acute malnutrition, BAZ, field and clinical setting, MUAC, MUACZ, WHZ