Mid Upper Arm Circumference (MUAC) Accuracy in Detecting Acute Malnutrition in Children under 5 Years: A Literature Review
Akurasi Mid Upper Arm Circumference (MUAC) dalam Mendeteksi Malnutrisi Akut pada Anak di bawah 5 Tahun: A Literature Review
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Background: Fast and accurate detection of acute malnutrition is important to prevent death. The use of Mid Upper Arm Circumference (MUAC) can be an alternative but its accuracy is still being explored because many differences in research results are found.
Objectives: This literature aimed to identify the accuracy (sensitivity and specificity) and optimal MUAC cut-off in detecting acute malnutrition in children under 5 years.
Methods: Search for articles using Google Scholar and Pubmed with the keywords "MUAC” "children” "acute malnutrition”. Selection based on the question "How is the sensitivity and specificity of MUAC in detecting acute malnutrition in children under 5 years” with inclusion criteria articles for the last 10 years, fully accessible and free of charge. Excluding non-English articles and type review articles. Six articles were found that further review.
Discussion: The sensitivity of the MUAC indicator by World Health Organization in detecting acute malnutrition is smaller than its specificity. The lowest sensitivity of MUAC in detecting severe (<11.5 cm) and moderate (11.5-12.5 cm) acute malnutrition is in Nepal, namely 13.6% and 21% respectively. Based on the results of analysis using the ROC curve in each article, it was found that the optimal MUAC cut-off varied in detecting cases of acute malnutrition.
Conclusions: The MUAC cut-off accuracy recommended by the World Health Organization to identify severe and moderate acute malnutrition is not optimal. Therefore, further studies are needed in each country to determine the optimal cut-off that is appropriate for the region according to the age group and problem classification.
World Health Organization 2023. 2023 https://www.who.int/news/item/12-01-2023-urgent-action-needed-as-acute-malnutrition-threatens-the-lives-of-millions-of-vulnerable-children.
Chiabi, A. et al. Weight-for-height Z score and mid-upper arm circumference as predictors of mortality in children with severe acute malnutrition. J Trop Pediatr 63, 260–266 (2017).
UNICEF. Nutrition Capacity Assessment in INDONESIA. (2018).
Fiorentino, M. et al. Current MUAC cut-offs to screen for acute malnutrition need to be adapted to gender and age: The example of Cambodia. PLoS One 11, (2016).
Talapalliwar, M. & Garg, B. Diagnostic accuracy of mid-upper arm circumference (MUAC) for detection of severe and moderate acute malnutrition among tribal children in central India. Int J Med Sci Public Health 5, 1317 (2016).
Sandler, A. The legacy of a standard of normality in child nutrition research. SSM Popul Health 15, (2021).
WHO. Guideline. Updates on the management of severe acute malnutrition in infants and children. (2013).
Tessema, M. et al. Routinely MUAC screening for severe acute malnutrition should consider the gender and age group bias in the Ethiopian nonemergency context. PLoS One 15, (2020).
Bliss, J. et al. Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review. Glob Health Sci Pract 6, 552–564 (2018).
Prabowo, A., Ratna, W. O. & Savitri, Y. Sensitivitas, spesifisitas, dan akurasi pengukuran panoramic mandibular index pada penderita osteoporosis. Dentomaxillofacial Radiology Dental Journal 5, 19–24 (2014).
Stojanoviü, M. et al. Understanding sensitivity, specificity and predictive values. Vojnosanit Pregl 71, 1167 (2014).
Lamsal, K. P. et al. Accuracy of Using Mid-Upper Arm Circumference to Detect Wasting Among Children Aged 6-59 Months in Nepal. Glob Health Sci Pract 9, 881–889 (2021).
Khan, J. R., Awan, N. & Misu, F. Determinants of anemia among 6-59 months aged children in Bangladesh: Evidence from nationally representative data. BMC Pediatr 16, (2016).
Zehra, M., Saleem, A., Kazi, Z. & Parkar, S. Mid-Upper Arm Circumference Assessment and Comparison With Weight for Length Z-Score in Infants ≤6 Months as an Indicator of Severe Acute Malnutrition. Cureus (2021) doi:10.7759/cureus.18167.
Bari, A., Nazar, M., Iftikhar, A. & Mehreen, S. Comparison of weight-for-height Z-score and mid-upper arm circumference to diagnose moderate and severe acute malnutrition in children aged 6-59 months. Pak J Med Sci 35, 337–341 (2019).
Lambebo, A., Mezemir, Y., Tamiru, D. & Belachew, T. Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children ages 6 to 59 months: Systematic review and meta-analysis. Nutrition vol. 107 Preprint at https://doi.org/10.1016/j.nut.2022.111918 (2023).
Abitew, D. B., Yalew, A. W., Bezabih, A. M. & Bazzano, A. N. Comparison of Mid-Upper-Arm Circumference and Weight-For-Height Z-Score in Identifying Severe Acute Malnutrition among Children Aged 6-59 Months in South Gondar Zone, Ethiopia. J Nutr Metab 2021, (2021).
Habib Hanga, A. et al. Brief review on Sensitivity, Specificity and Predictivities Brief review on Sensitivity, Specificity and Predictivities 1. Article in IOSR Journal of Dental and Medical Sciences 14, 64–68 (2015).
Rana, R., Barthorp, H., Mcgrath, M., Kerac, M. & Myatt, M. Mid-Upper Arm Circumference Tapes and Measurement Discrepancies: Time to Standardize Product Specifications and Reporting. Glob Health Sci Pract 9, 1011–1014 (2021).
Laillou, A. et al. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups. PLoS One 9, (2014).
Roberfroid, D. et al. Management of oedematous malnutrition in infants and children aged >6 months: a systematic review of the evidence. World Health Organization. Nutrition and Development Health (2013).
Dipasquale, V., Cucinotta, U. & Romano, C. Acute malnutrition in children: Pathophysiology, clinical effects and treatment. Nutrients vol. 12 1–9 Preprint at https://doi.org/10.3390/nu12082413 (2020).
Grellety, E. & Golden, M. H. Severely malnourished children with a low weight-for-height have similar mortality to those with a low mid-upper-arm-circumference: II. Systematic literature review and meta-analysis. Nutr J 17, (2018).
Christijani, R. Pengukuran Weight for Height Z-Score (WHZ) dan Mid Upper Arm Circumstance (MUAC) di Berbagai Tempat di Dunia untuk Menentukan Status Gizi Balita dan Risiko Kematian – Sebuah Tinjauan Sistematis. Majalah Kedokteran UKI 35, 174–186 (2019).
Barro, M. et al. Upper arm length along with mid-upper arm circumference to enhance wasting prevalence estimation and diagnosis: Sensitivity and specificity in 6-59-months-old children. Fam Med Community Health 9, (2021).
Sougaijam, R., Gupta, S. S., Raut, A. V, And, B. & Garg, B. S. Validating the MUAC (Mid-upper arm circumference) Cut-off for Detection of Severe Acute Malnutrition in Children Aged 6-59 Months in Rural Maharashtra. INDIAN PEDIATRICS vol. 209 (2019).
Thi Hai, T. et al. The optimal mid-upper-arm circumference cutoffs to screen severe acute malnutrition in Vietnamese children. AIMS Public Health 7, 188–196 (2020).
Chand, S. & Shah, D. Management of Acute Malnutrition in Infants (MAMI) project. Emergency Nutrition Network, UCL Centre for International Health & Development, Action Contre la Faim. INDIAN PEDIATRICS vol. 529 (2015).
Khan, A. M., Sharmin, R. & Ahasan, Md. F. Accuracy of Mid-Upper Arm Circumference for Detecting Acute Malnutrition in Children Aged 6–59 Months in an Urban Slum in Bangladesh: A Cross-Sectional Analysis. Cureus (2022) doi:10.7759/cureus.33137.
Hossain, I. et al. Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6-60 mo: an analytical study. Am J Clin Nutr 106, 1232–1239 (2017).
Bai, P., Rais, H., Fawad, B. & Kumari, S. Concordance Between Indices of Malnutrition: Mid-Upper Arm Circumference V/S Weight for the Height Z Score in Different Age Groups in Karachi, Pakistan. Cureus (2022) doi:10.7759/cureus.27387.
Marshall, S. K., Monárrez-Espino, J. & Eriksson, A. Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6-24 months in niger. Nutr Res Pract 13, 247–255 (2019).
Sachdeva, S., Dewan, P., Shah, D., Malhotra, R. K. & Gupta, P. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public Health Nutr 19, 2513–2520 (2016).
Grellety, E. & Golden, M. H. Severely malnourished children with a low weight-for-height have similar mortality to those with a low mid-upper-arm-circumference: II. Systematic literature review and meta-analysis. Nutr J 17, (2018).
Lambebo, A., Mezemir, Y., Tamiru, D. & Belachew, T. Validating the diagnostic performance of MUAC in screening moderate acute malnutrition and developing an optimal cutoff for under five children of different regions in Ethiopia. PLoS One 17, (2022).
Zaba, T., Nyawo, M. & Álvarez Morán, J. L. Does weight-for-height and mid upper-arm circumference diagnose the same children as wasted? An analysis using survey data from 2017 to 2019 in Mozambique. Archives of Public Health 78, (2020).
Kumar, P. et al. Comparison between weight-for-height Z-Score and mid upper arm circumference to diagnose children with acute malnutrition in five Districts in India. Indian Journal of Community Medicine 43, 190–194 (2018).
Blackwell, N. et al. Mothers Understand and Can do it (MUAC): A comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years. Archives of Public Health 73, (2015).
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