Mid-upper arm circumference versus weight for height Z-score for detecting malnutrition in children aged 06-59 months in rural and urban areas of Jabalpur district, Madhya Pradesh, India

Abstract

Background: WHO and UNICEF propose two independent criteria for diagnosing malnutrition in children aged 6-60 months, viz. mid upper arm circumference and weight-for-height. However, both these criteria do not identify same set of children as having malnutrition, and using only one of the diagnostic criteria proposed by WHO may potentially leave some high-risk children untreated. Therefore, the purpose of this study was to determine the prevalence of malnutrition by using both mid-upper arm circumference (MUAC) and weight for height (W/H) and their differences among children.Methods: Cross sectional study carried out in rural and urban areas of Jabalpur district among 1237 children of age group 06-59 months in randomly selected eight ward and two blocks of Jabalpur district. Where 720 children were from urban wards and 517 from rural villages. Multistage random sampling technique was used for the selection of study subjects. Pre-designed and pretested questionnaire was used for interview, Salter’s Scale for weighing, non-stretchable Measuring Tape for measuring height and Shakir’s tape for mid upper arm circumference.Results: In rural area, prevalence of malnutrition according to MUAC is 74 (14.3%) while according to w/h is 102 (19.7%). While in urban, prevalence according to MUAC is 104 (14.4%) while according to w/h is 136 (18.9%).Conclusions: The findings are clear that, prevalence of wasting by W/H is more than by MUAC. With the use of the currently recommended WHO cut-off for MUAC, a significant number of children would not have been identified. A higher cut off value, therefore recommended for screening.

Diagnostic Accuracy of Mid-Upper Arm Circumference for the Detection of Acute Malnutrition Among Children Aged 6–60 Months: A Diagnostic Accuracy Study

“…Based on the findings, the AUC of 0.865 (95% CI = 0.83‒0.90) was comparable to the results of Sendaula et al 23 and Marshall et al, 2 while the other two previous studies 5 , 25 reported a lower AUC than ours. The PPV of GAM and NPV were 83% and 81% in the current study, which contradicts the results of the study conducted in Kolkata, 18 Madhya Pradesh, 20 Karnataka, 25 and Uganda. 23 Our results represented a Youden index of 0.44, which was lower than that of the study by Sougaijam et al 22 and higher than the study performed in Maharashtra 26 and Nepal.…”

“…In the present study, the Sp of the MUAC cut-off of 12.5 cm was 96%, which was consistent with the findings of Mane et al, 21 Sougaijam et al, 22 and Sendaula et al 23 Compared to our study, the Sp reported in other earlier studies 2 , 3 , 20 , 24 , 25 was lower than our findings.Whereas, Laillou et al 5 and Talapalliwar and Garg 26 reported specificities of 97% and 98.2%, respectively, which were slightly higher than our findings.…”

“… 3 According to the LR + of 12, MUAC < 12.5 was associated with a 12-fold increased risk of GAM. This was higher than the results of studies conducted by Shukla et al 20 and Ranadip et al 18 However, the LR− of 0.54 indicates that MUAC ≥ 12.5 cm significantly reduced GAM risk by 46%, which is consistent with the results of other studies. 18 , 20 …”

“…There was a large range in the Se of MUAC, ranging between 16.6% and 79% in various studies. 2 , 5 , 20 - 23…”