Utilization and practicability of using Mid-upper Arm Circumference alone as an admission and discharge criterion in Nutritional Rehabilitation Programmes

Background: World Health Organization (WHO) recommends the using weight-for height Z-score (WHZ) < -3 SD and/or mid-upper arm circumference (MUAC) < 115 mm as anthropometric criteria for admission to therapeutic feeding programs. There is a need for more information on the programmatic implications of using MUAC alone as a standalone admission criterion in nutrition programming. Aims and Objectives: To rule out difference between MUAC and weight-height criteria and to establish effectiveness of MUAC as single criteria for identification, follow-up and discharge of malnourished children. Methods: The children aged 6 to 59 months admitted in a nutritional rehabilitation centre were included in the study. Data on demographic details, chief complains, anthropometric measurements, height/ length, weight and MUAC were recorded at the time of admission. Anthropometric measurements, height/ length, weight and MUAC were recorded on discharge and during first two follow up visits conducted on 15 and 30 days after discharge. Results: The sensitivity of MUAC was 62.4%, specificity was 60.0%, Positive predictive value (PPV) was 97.5% and negative predictive value (NPV) was 6.0% at the time of admission. The sensitivity of MUAC was 58.4%, specificity was 83.3%, PPV was 97.1% and NPV was 16.9% at the time of discharge. On admission, of 260 children, MUAC (<11.5cm) was able to identify 61.54% whereas WHZ score (<-3SD) was able to identify 96.15% severely malnourished children. Conclusion: MUAC is good at identifying undernourished children but the MUAC is not good to rule out under nutrition at time of admission and discharge