Mid-Upper Arm Circumference Tapes and Measurement Discrepancies: Time to Standardize Product Specifications and Reporting.

Ritu Rana,Marko Kerac,Hatty Barthorp,Mark Myatt,Marie Mcgrath

doi:10.9745/ghsp-d-21-00273

Abstract

In recent years, community-based management of acute malnutrition (CMAM) has revolutionized the care for children by increasing treatment coverage. Critical to the success of CMAM is early case identification. Mid-upper arm circumference (MUAC) measurement is a widely used, practical anthropometric measure used at the community level for the identification and admission of cases to appropriate treatment services. Globally, many organizations and government services use MUAC tapes for early case detection. However, there is no one universal MUAC tape specification, and it has been observed that using different MUAC tapes results in different measurements. In this article, we aim to: (1) present the measurement discrepancies; (2) discuss design specifications and their effect on case identification and admissions; (3) present a call to action to agree on common design specifications and standardized reporting. We hope this article will catalyze discussion and practical actions among nutrition and health stakeholders to ensure we have common MUAC tape design specifications so that all eligible at-risk children will get an equal chance to be identified early for critical treatment.

Highlights

An estimated 47 million children under age 5 years are wasted and are at increased risk of mortality, morbidity, poor development, and long-term adverse effects.[1,2,3] In recent years, community-based management of acute malnutrition (CMAM) has revolutionized the care for children by increasing treatment program coverage.[4]
There is not one mid-upper arm circumference (MUAC) tape specification, and it has been observed that using different MUAC tapes results in different measurements
We aim to: (1) present the measurement discrepancies; (2) discuss design specifications and their effect on case identification and admissions; (3) present a call to action to agree on common design specifications and standardized reporting

Summary

BACKGROUND

An estimated 47 million children under age 5 years are wasted and are at increased risk of mortality, morbidity, poor development, and long-term adverse effects (noncommunicable diseases).[1,2,3] In recent years, community-based management of acute malnutrition (CMAM) has revolutionized the care for children (aged 6–59 months) by increasing treatment program coverage.[4]. Mid-Upper Arm Circumference Tapes and Measurement Discrepancies www.ghspjournal.org. The MUAC measurement is taken around the upper arm and tapes made of thicker material add to the circumference This leads to systematic bias/differences in MUAC measurements taken using different tapes (Table), unless this is corrected for in tape design—which currently is not the case. Applying an error-free tape to a population of 10,000 children with a mean MUAC of 142 mm with a standard deviation of 14.5 mm, we would expect (using the PROBIT approach to estimating prevalence)[10] to identify: PROBIT (115, 142, 14.5) Â 10000 = 313 cases. 2. If organizations choose to use different tape thicknesses than the common recommendation, they should shift the ruler to account for this, ensuring measurement of the true MUAC. Since it is not reported which tapes many original MUAC validation studies used, www.ghspjournal.org we note a need for broader examination of implications for current MUAC thresholds

Limitations

CONCLUSION