Screening for ânutritionally at-risk’ women by field health workers during monthly village health days (VHD) is missing in most Indian States. We tested feasibility and diagnostic accuracy of wall marking <145 cms and MUAC <23 cms for inclusion during VHDs in Bihar, India.
Using standard methods, weight, height and MUAC measurements was taken for 99 adult women (out of which 19 were pregnant) by trained health workers during the January 2016 VHNDs in Sabalpur village, Purnia district, Bihar. Measurement time using key MUACand height assessment tools were compared. MUAC diagnostic accuracy was tested against Body Mass Index <18.5 kg/m2.
Median screening time per person per tool was as follows: MUAC via non-stretchable adult tape (54 seconds), Armband (8 seconds), adult height via stadiometer (61 seconds) and wall marking (8 seconds). Proportion of women with height <145 cms, MUAC <23 cms and MUAC <21 cms was 21%, 29% and 69%, respectively. MUAC <23 cm in women (AUC 0.75) had highest Youden's index (0.64) corresponding to BMI <18.5kg/m2. Determining correct age was time consuming, reducing health workers' efficiency, as VHD activities had to be completed within four hours.
In rural settings, with limited human resource capacity to collect accurate data on women’s age and weight gain, and with poor access to equipment (stadiometer, weighing scale, body-mass index chart), Armband MUAC <23 cms for adult women is the most viable screening tool for identifying nutritionally at-risk women. Additional research is required involving representative population for generalizing the results.