Diagnostic performance of midupper arm circumference for detecting severe wasting among infants aged 1–6 months in Ethiopia

Abstract

Background Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6–59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1–6 mo. Objective The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1–6 mo. Methods We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1–6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of −3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs. Results The median age, MUAC, and WLZ were 100 d (IQR: 69–145 d), 119 mm (IQR: 103–130 mm), and −1.27 (IQR: −2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%). Conclusions A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1–6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…A small but growing number of studies have explored the utility of different anthropometric criteria to identify malnutrition in infants u6m [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The best of these look at the association between anthropometric measures and subsequent mortality.…”

“…We answered a recent call to use aggregate measures to quantify malnutrition and the burden of malnutrition as any manifestation of anthropometric deficit as indexed by CIAF [17]. Published research on malnutrition in infants u6m has focused strongly on severe wasting as denoted by a WLZ < −3 [30,31,34,37], but our data add to growing calls for more inclusive case definitions for identifying infants at risk of malnutrition, mortality, or impaired development. As mentioned above, we are currently developing an intervention trial that will test the benefit of a more inclusive approach and we hope that our data will encourage others to do likewise.…”

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…A small but growing number of studies have explored the utility of different anthropometric criteria to identify malnutrition in infants u6m [28][29][30][31][32][33][34][35][36]. The best of these look at the association between anthropometric measures and subsequent mortality.…”

“…In our study, we sampled infants u6m attending health centres for any reason. Most studies evaluating malnutrition burden in infants u6m focused on community representative samples [28,[31][32][33], on infants hospitalised and receiving in-patient care [30,[34][35][36], or they have followed-up a birth cohort [29].…”

“…We took on the recent call for using aggregate measures to quantify malnutrition and quantify the burden of malnutrition as any manifestation of anthropometric deficit as indexed by CIAF [17]. Published research on malnutrition in infants u6m has focused strongly on severe wasting as denoted by a WLZ <-3 [29,30,33,36], but our data adds to growing calls for more inclusive case definitions for identifying infants at risk of malnutrition, mortality or impaired development. As mentioned above, we are currently developing an intervention trial that will test the benefit of a more inclusive approach and we hope that our data will encourage others to do likewise.…”