In India, as a part of School Health Programme, assessment of height, weight and clinical signs of nutritional deficiencies are to be conducted biannually by trained paramedics. We tested feasibility and diagnostic accuracy of using Mid-upper-arm-circumference (MUAC) during these biannual assessments.
Using PPS methodology, in May-July 2013, 30 government schools each in two Indian States (Delhi and Haryana) were selected; sampled 4,183 adolescents 10-19 years (1,980 boys and 2,203 girls) were assessed for height, weight and MUAC by trained nutrition researchers during school health programme using standard anthropometric methods and equipment. BMI-for-age z scores were calculated using WHO anthro-plus and tests of diagnostic accuracy helped assess sensitivity and specificity of MUAC compared to BMI-for-age.
Power of association (r) between MUAC (cms) and BMI-for-age z score was 0.68 (p<0.001). In 3,246 (78%) observations, MUAC < 18.5 cm was in agreement, with BMI-for-age z score <-2SD (Kappa value: 0.34 95% C.I.0.31-0.38). With BMI-for-age z-score <-2SD as a gold standard, sensitivity and specificity of MUAC <18.5 cms was 73% and 79%, respectively. When MUAC <16 cms was compared with BMI-for-age <-3SD as gold standard, there was agreement in 3,959 observations (95%) (Kappa value: 0.38 95% C.I.0.31-0.38) and sensitivity and specificity of MUAC <16 cms method was 62.6% and 97.3%, respectively.
In settings where weighing scales, height meters and BMI-for-age charts are not available, MUAC is a reasonable alternative. Additional diagnostic accuracy studies in other Indian settings are needed to establish MUAC cutoffs to classify acute malnutrition among adolescents.