Mid-upper arm circumference for diagnosis of severe acute malnutrition among infants aged 1-6 months hospitalized in East Hararghe, Ethiopia
No Thumbnail Available
Date
2019-10
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
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 (4.4.2.1) 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.
Description
Keywords
Mid-upper arm circumference , acute malnutrition