Assessment of Sensitivity and Specificity of Mid-Upper Arm Circumference (MUAC) in Detecting Under-Nutrition of Adult People with HIV that Have ART Follow Up in Selected Health Facilities of Addis Ababa
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Date
2014-01
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Addis Ababa University
Abstract
Introduction: Mid-upper arm circumference (MUAC) is anthropometric measure used to evaluate adult nutritional status that has been found to be particularly effective in determining malnutrition among adults in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic.
Methods: A cross-sectional study was conducted among adults with HIV, who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. Using multi stage sampling technique, a total of 594 samples were selected. MUAC, Height and weight were measured for each participant. The BMI was calculated as Wt/Ht2. The internationally accepted cut-off points of BMI and MUAC were utilized to determine nutritional status. Receivers operating characteristic curve analyses were undertaken to discover the most suitable values of MUAC for both Men and Women.
Results: The prevalence of CED based on BMI (BMI <18.5) was 39.4% and 24.3% for male and female respectively, while based on MUAC ( ≤ 230 mm& ≤ 220mm) were 48.4% and 35.7% for male and female respectively. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224mm were 92.7% and 87.2%, whereas for Males MUAC with optimal criteria of ≤234mm were 94.9% and 68.5% respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6% (CI 89.9-99.3) with the highest NPV 98.2% (CI 66.8-77.9), thus having the highest Youden Index of 0.21.
A MUAC value of ≤242mm was identified as the best cut off to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3 %( CI 91.2-99.4) with the highest NPV 98.1% (CI 50.0-66.4), thus having the highest Youden Index of 0.32.
Conclusion: a MUAC value of close to 242 mm (male) and 239mm (female) seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLWHIV.
Key words: Sensitivity, specificity, BMI, chronic energy deficiency, mid-upper arm circumference, nutritional status, ROC curve
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Keywords
Sensitivity, Specificity, BMI, Chronic energy deficiency, Mid-upper arm circumference