Accuracy of Mid-Upper Arm Circumference for Detecting Acute Malnutrition in Children Aged 6-59 Months in an Urban Slum in Bangladesh: A Cross-Sectional Analysis.

Background The weight-for-height z-score (WHZ) is considered the gold standard for detecting acute malnutrition in children. However, an accurate assessment of WHZ can often be challenging, especially in community settings. Mid-upper arm circumference (MUAC) is a simple and easy-to-perform method to identify children with acute malnutrition. The objective of the study was to evaluate the accuracy of MUAC in detecting acute malnutrition compared to WHZ among children aged 6-59 months in Bangladesh. Methods We used anthropometric data for 239 children aged 6-59 months from a cross-sectional study conducted in 2013 in an urban slum in Dhaka, Bangladesh. The sensitivity and specificity of MUAC to detect acute malnutrition were calculated, considering WHZ as the gold standard. Results The mean age of the children was 29.4 ± 12.7 months, with a male-to-female ratio of 1:1.2. The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively. The total area under the receiver operating characteristic curve was 0.816. For detecting acute malnutrition, the sensitivity of MUAC was 61.0% and the specificity was 85.4% for the World Health Organization (WHO) recommended cutoff of <125 mm. Using the Youden index, the best MUAC cutoff point to detect acute malnutrition was <128 mm with a sensitivity of 75.6% and a specificity of 74.7%. Conclusions Our study demonstrated a low sensitivity of MUAC to identify acute malnutrition at the WHO cutoff of <125 mm. The cutoff could be increased to <128 mm to capture more children with acute malnutrition.