Mid-upper arm circumference (MUAC) performance versus weight for height in South African children (0–59 months) with acute malnutrition

Objectives: The objective of this study was to compare mid upper arm circumference (MUAC) and weight for height (W/H) as indices of acute malnutrition in children aged 0-59 months in South Africa. Design: A cross-sectional weighted survey of households was performed. Subjects and setting: Children aged 0-59 months and their mothers/caregivers were included in the study in iLembe district conducted between April and September 2014. Outcome measures: W/H and MUAC were measured and z-scores were calculated using the 2006 World Health Organisation (WHO) child growth standards. Results: Of the 572 child participants, 44 were malnourished (7.7%) using W/H measurements in comparison to 38 children (6.6%) using MUAC. There was ~54.0% agreement between the two indices when categorised in standard deviation (SD) bands and the significant Kappa statistic value of 0.27 constituted fair agreement. Similar percentages of male (1.1%) and female (1.1%) children under five years of age were detected with severe acute malnutrition (SAM) using W/H. In children aged 0-6 months W/H identified ten children as malnourished compared to only one child identified as malnourished using MUAC. Conclusions: The study found W/H to be a more sensitive measure. At a facility level W/H is considered the anthropometric measure of choice in children aged 0-59 months as nurses are trained in obtaining this measure. At the household level MUAC is preferred as a quick and easy measuring tool. In South Africa, the Road to Health Card, given at the clinics, records the W/H of children up to five years of age to assist in the prevention of childhood malnutrition. Future studies are recommended using both indicators in community settings in children particularly during 0-6 months as it is during this critical age period that moderate acute malnutrition (MAM) and SAM can be detected for timeous treatment and management of malnutrition.