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Objectives <p>To identify suitable mid-upper arm circumference (MUAC) thresholds for screening wasting and severe wasting among children in India.</p> Methods <p>Community-based cross-sectional studies were conducted in five districts from four Indian states- Jharkhand, Odisha, Uttar Pradesh, and Madhya Pradesh. Anthropometric measurements of 2,335 children aged 6–59 mo were taken.</p> Results <p>Wasting [Weight-for-height Z-score (WHZ) &lt;–2] and severe wasting (WHZ &lt;–3) prevalence were found to be 30.9% and 5.5%, respectively. A strong correlation [0.72 (95% CI: 0.69, 0.74; <i>P</i> &lt; 0.001)] between MUAC and WHZ was observed. However, Cohen’s Kappa coefficients of 0.28 (<i>P</i> &lt; 0.001) and 0.36 (<i>P</i> &lt; 0.001) suggested a lack of strong agreement between the current WHZ and MUAC thresholds for detecting wasting and severe wasting. ROC analyses for identifying severe wasting indicated that MUAC of 12.8&#xa0;cm was appropriate for children aged 6–59 mo (sensitivity: 0.80, specificity: 0.87, AUC: 0.91; 95% CI: 0.89, 0.93). For children 6–23 mo and 24–59 mo, MUAC of 12.7&#xa0;cm and 13.3&#xa0;cm respectively were suitable. For identifying wasting, the appropriate MUAC cut-offs were 13.8&#xa0;cm for children 6–59 mo (sensitivity: 0.82, specificity: 0.69, AUC: 0.84; 95% CI: 0.82, 0.86), 13.1&#xa0;cm for children 6–23 mo, and 13.8&#xa0;cm for children 24–59 mo.</p> Conclusions <p>MUAC is a reliable indicator of WHZ for children 6–59 mo in India. In under-resourced areas where measuring WHZ may be challenging, MUAC cut-offs of &lt; 14.0&#xa0;cm for wasting and &lt; 13.0&#xa0;cm for severe wasting can be used for initial screening. Further assessment using WHZ can follow MUAC screening.</p>

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Optimizing Mid-Upper Arm Circumference (MUAC) Thresholds for Screening Wasting and Severe Wasting in Children Aged 6–59 Months in Community Settings in India

  • 期刊论文

  • 发表日期：

    2025年12月10日

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  • Rajesh Kumar Sinha,
  • Praveen Kumar,
  • Anju Seth

摘要

Objectives

To identify suitable mid-upper arm circumference (MUAC) thresholds for screening wasting and severe wasting among children in India.

Methods

Community-based cross-sectional studies were conducted in five districts from four Indian states- Jharkhand, Odisha, Uttar Pradesh, and Madhya Pradesh. Anthropometric measurements of 2,335 children aged 6–59 mo were taken.

Results

Wasting [Weight-for-height Z-score (WHZ) <–2] and severe wasting (WHZ <–3) prevalence were found to be 30.9% and 5.5%, respectively. A strong correlation [0.72 (95% CI: 0.69, 0.74; P < 0.001)] between MUAC and WHZ was observed. However, Cohen’s Kappa coefficients of 0.28 (P < 0.001) and 0.36 (P < 0.001) suggested a lack of strong agreement between the current WHZ and MUAC thresholds for detecting wasting and severe wasting. ROC analyses for identifying severe wasting indicated that MUAC of 12.8 cm was appropriate for children aged 6–59 mo (sensitivity: 0.80, specificity: 0.87, AUC: 0.91; 95% CI: 0.89, 0.93). For children 6–23 mo and 24–59 mo, MUAC of 12.7 cm and 13.3 cm respectively were suitable. For identifying wasting, the appropriate MUAC cut-offs were 13.8 cm for children 6–59 mo (sensitivity: 0.82, specificity: 0.69, AUC: 0.84; 95% CI: 0.82, 0.86), 13.1 cm for children 6–23 mo, and 13.8 cm for children 24–59 mo.

Conclusions

MUAC is a reliable indicator of WHZ for children 6–59 mo in India. In under-resourced areas where measuring WHZ may be challenging, MUAC cut-offs of < 14.0 cm for wasting and < 13.0 cm for severe wasting can be used for initial screening. Further assessment using WHZ can follow MUAC screening.