A Study of Reliability of Mid Upper Arm Circumference for Detection of Severe Acute Malnutrition in Infants Between 1-<6months of Age

Abstract

Introduction: Severe Acute Malnutrition (SAM) in children below 6months of age is diagnosed in presence of either of (1) weight for height/length <-3 standard deviations (SD) of median WHO growth reference (in infants>45cm); (2) visible severe wasting; (3) presence of bipedal edema. Simple measuring tape with reorientation of health workers can detect beginning of childhood malnutrition. This study aims to study reliability of mid upper arm circumference (MUAC) for detection of SAM in infants aged 1-6 months of age.

Aims and Objectives

• Assessment of MUAC for identification of SAM in infants between 1-6 months of age.
• Comparison of mid upper arm circumference with presently used anthropometric measurement of weight for height for detection of SAM.
• Identification of definitive cut off value of MUAC which can be used as criterion at community level for detection of SAM in infants between 1-6. months of age.
• To study determinants of SAM in children between 1-6 months of age.

Materials and Methods: A single center hospital based prospective observational study was conducted in department of pediatrics at a tertiary care center in Udaipur in India where total of 501 infants aged between 1-6 months of age satisfying inclusion and exclusion criteria were enrolled after ethical committee approval and after obtaining written informed consent from their parents over a period of 1 year from December 2015 to November 2016.

Results: MUAC of <11.3 cm has sensitivity of 87.29%, specificity of 80.75%, Youden index of 0.68 and area under ROC curve as 0.840 with 95% confidence interval as 0.803-0.877. MUAC of <11.3cm (or <= 11.2cm) can thus be used as cut off at community level to diagnose SAM in infants between 1-6 months of age.

Conclusion: This study thus establishes the reliability of MUAC for detection of severe acute malnutrition in infants between 1-<6months of age.