Comparing performance of mothers using simplified mid-upper arm circumference (MUAC) classification devices with an improved MUAC insertion tape in Isiolo County, Kenya

Abstract

Abstract Background A novel approach for improving community case-detection of acute malnutrition involves mothers/caregivers screening their children for acute malnutrition using a mid-upper arm circumference (MUAC) insertion tape. The objective of this study was to test three simple MUAC classification devices to determine whether they improved the sensitivity of mothers/caregivers at detecting acute malnutrition. Methods Prospective, non-randomised, partially-blinded, clinical diagnostic trial describing and comparing the performance of three “Click-MUAC” devices and a MUAC insertion tape. The study took place in twenty-one health facilities providing integrated management of acute malnutrition (IMAM) services in Isiolo County, Kenya. Mothers/caregivers classified their child (n=1040), aged 6–59 months, using the “Click-MUAC” devices and a MUAC insertion tape. These classifications were compared to a “gold standard” classification (the mean of three measurements taken by a research assistant using the MUAC insertion tape). Results The sensitivity of mother/caregiver classifications was high for all devices (>93% for severe acute malnutrition (SAM), defined by MUAC 90% for global acute malnutrition (GAM), defined by MUAC 96%) with no significant difference between the “Click-MUAC” devices and the MUAC insertion tape. Conclusions The results of this study indicate that, although the “Click-MUAC” devices performed well, the MUAC insertion tape performed best. The results for sensitivity are higher than found in previous studies. The high sensitivity for both SAM and GAM classification by mothers/caregivers with the MUAC insertion tape could be due to the use of an improved MUAC tape design which has a number of new design features. The one-on-one demonstration provided to mothers/caregivers on the use of the devices may also have helped improve sensitivity. The results of this study provide evidence that mothers/caregivers can perform sensitive and specific classifications of their child’s nutritional status using MUAC. Trial registrations Clinical trials registration number: NCT02833740

Keywords

• Screening by mothers
• Severe acute malnutrition
• Community management of acute malnutrition
• Mid-upper arm circumference