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Performance of MUAC and associated factors in the prediction of acute malnutrition among children 6-59 months at Mulago hospital, Kampala

Sendaula Emmanuel

Background: Malnutrition remains a worldwide challenge and accounts for about 35% of all deaths among children under 5 years in the world. To address the burden of acute malnutrition, weight-for-height (WHZ) and Mid-Upper Arm Circumference (MUAC) have been used for acute malnutrition case definition in children. However, these anthropometric indices/indicators correlate poorly and, in some cases, differ in application. We determined the performance of MUAC and its associated factors in the prediction of acute malnutrition among children aged 6-59 months admitted to the pediatric assessment center in Mulago Referral Hospital, Uganda.

Methods: We conducted a cross-sectional study between January and March 2018 among children admitted to the Pediatric Assessment Center of Mulago National Referral Hospital. The study involved 389 children aged 6-59 months from whom demographics and health information were obtained. All eligible participants were selected using systematic random sampling. We conducted descriptive ROC and sensitivity analysis. STATA version 13.0 was used to execute statistical tests for association using the modified poison model.

Conclusion: MUAC had poor performance characteristics at a cutoff of 12.5 cm. MUAC had excellent and similar intra/ inter-observer variability making it a suitable tool for a single user. The optimal cut off-of 13.6 improved the sensitivity. This might be a better cut-off as it has a higher sensitivity and will, therefore, detect a majority of those with malnutrition and yield better results. Age greater than 24 months is associated with a decrease in MUAC performance whilst Anemia, Down syndrome and hair changes are associated with an increase in MUAC performance.