Mid-upper arm circumference for diagnosis of severe acute malnutrition among infants aged 1-6 months hospitalized in East Hararghe, Ethiopia

No Thumbnail Available



Journal Title

Journal ISSN

Volume Title


Addis Abeba University


Background: Mid-upper arm circumference and weight-for-length/height are the two mostly used anthropometric indices to identify acute malnutrition in older children. However, severe acute malnutrition is only identified by the use of weight-for-length other than clinical methods in infants aged less than 6 months. Objective: To evaluate the ability of mid-upper arm circumference as an effective diagnostic tool for severe acute malnutrition (weight for length z-score of < -3) among infants aged 1-6 months. Methods: We conducted a hospital based cross-sectional study among 504 hospitalized infants aged 1-6 months from March to May, 2019. A systematic random sampling technique were used to select study participants. Anthropometric measure; weight, length and mid-upper arm circumference were taken according to the world health organization standard techniques Data was entered using EpiData version ( and statistical software (Stata v 15.1) was employed for data cleaning and analysis. Receiver operating characteristic analysis was used to test the discriminatory performance of mid-upper arm circumference. Sensitivity, specificity and Youden index (sensitivity+specificity-1) were calculated for mid-upper arm circumference cut-offs against the presence of severe acute malnutrition (weight for length z-score < -3). The cut-off point with the highest Youden index was obtained as the possible optimal cut off point to diagnoses severe acute malnutrition. Results: The median age of the infants was 100 days with interquartile range of 76 days. The mean and SD of weight, length, mid upper arm circumference and weight-for-length z-score was 5.02 ± 1.29 kg, 58.41 ± 5.26cm, 11.51 ± 1.89 cm and -1.14 ± 2.08, respectively. Using Receiver operating characteristics curve, MUAC had a good diagnostic performance with area under the curve 0.861, (95% CI: 0.826, 0.890). Using Youden index, the possible optimal MUAC cut-off point to identify SAM was ≤11.2cm with sensitivity of 85.1%, specificity of 76.0%, PPV of 49.4% and NPV of 94.9%. Conclusion: Among infants under 6 months, mid upper arm circumference (MUAC) had a good performance in detecting severe acute malnutrition. We recommend the validation of our result before using to other contexts. Furthermore, more research is needed to evaluate the performance of MUAC for detection of acute malnutrition at community level and evaluate performance of MUAC for prediction of mortality.



Mid-upper arm circumference , acute malnutrition