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  • Title: Comparison of arm circumference against standard anthropometric indices using data from a high density town near Harare, Zimbabwe.
    Author: Siziya S, Matchaba-Hove RB.
    Journal: Cent Afr J Med; 1994 Sep; 40(9):250-4. PubMed ID: 7834714.
    Abstract:
    In a limited controlled sample, the performance of the middle upper arm circumference (MUAC) was compared to those of standard indices (weight for age, height for age and weight for height), using 90 children aged one to four years living in a high density town near Harare, Zimbabwe. Using a cut off point of 15,5 cm, the MUAC performed best in relation to the weight for age (sensitivity 66,7 pc (95 pc confidence interval (CI) 53,3-80,0 pc), specificity 76,2 pc (95 pc CI 61,7-80,5 pc)) than to any other standard index. Nevertheless, this performance was unsatisfactory because about 30 in every 100 (28,9 pc) children would have been inaccurately identified as healthy or diseased. Although we do not have evidence from the present study to recommend the use of the MUAC in identifying children who are malnourished and living in similar high density areas, the MUAC may be applicable to children living in areas of higher prevalence of malnutrition. In January 1993, 143 children 12-60 months old, living in a high-density town near Harare, Zimbabwe, were weighed and had their height and middle upper arm circumference (MUAC) measured as part of a baseline survey designed to determine the people's education, occupation, and health. The anthropometric data were analyzed to assess the validity of the MUAC in detecting undernutrition. The researchers used 15.5 cm as the cut-off point for the MUAC because it had the maximum sensitivity and specificity for malnutrition when compared to weight for age. MUAC was age dependent in infants and children older than 4 (slope 0.36 and 0.41, respectively), while it was not dependent on age in children 1-4 (slope, 0.0096). Since the numbers for children younger than one year and those for children older than four years were low, the researchers compared the MUAC with standard indexes in Zimbabwe from the 90 children 1-4 years old. All the children were of normal height, making it impossible to adequately compare MUAC with the weight for height index. 46.7% had a low MUAC (15.5 cm), however. When compared to the weight for age, the MUAC correctly identified 71.1% of children as being diseased or healthy (sensitivity = 66.7%; specificity = 76.2%). When compared to the height for age, it correctly identified 54.4% of children as being diseased or healthy (sensitivity = 50.9%; specificity = 59%). These findings show that the MUAC performs poorly when compared to the standard indices. Thus, the researchers do not recommend using the MUAC in detecting undernutrition in Zimbabwean children living in high density areas.
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