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.