All India Institute of Medical Sciences, Rajkot, Gujarat, India.
Department of Community Medicine, PDU Government Medical College, Rajkot, India.
J Res Health Sci. 2024 Jun 1;24(2):e00612. doi: 10.34172/jrhs.2024.147.
Timely and accurate screening of malnutrition at the community level is essential to identifying malnourished children. The World Health Organization (WHO) guidelines classify non-oedematous acute malnutrition among children using mid-upper arm circumference (MUAC) or weight-for-height Z-score (WHZ). A cross-sectional study.
This study was conducted among children aged 6‒60 months. After necessary exclusions, 433 participants were selected using a multi-stage simple random sampling method. Using WHO guidelines for global acute malnutrition (GAM) [WHZ<-2, MUAC<12.5 cm], the sensitivity (Se), specificity (Sp), predictive values, likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve were calculated for MUAC using WHZ as the criterion.
Out of 433 participants, 30% were diagnosed with GAM using WHZ, while 17.6% were found malnourished using MUAC measurements. As per WHO cut-offs, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of MUAC were 48%, 96%, 83%, 81%, 0.44, 12, and 0.54, respectively. The ROC curve displayed an area under the curve of 0.86 (95% confidence interval=0.83, 0.90) for MUAC<12.5 cm. Bivariate Pearson correlation also demonstrated a positive linear relationship (R2=0.302) between the WHZ and MUAC variables.
Based on the findings, 48% of the children were correctly identified by the MUAC with an 83% probability of GAM (PPV=0.83). Moreover, there was 96% Sp in non-malnourished children, with only 4% false positives. Therefore, personnel at the grassroots level can use MUAC for timely and accurate screening of children in Anganwadi centers (AWCs) due to its ease of use and simplicity.
及时准确地在社区层面筛查营养不良对识别营养不良儿童至关重要。世界卫生组织（WHO）指南使用上臂中部周长（MUAC）或体重与身高 Z 分数（WHZ）对儿童进行非水肿性急性营养不良分类。这是一项横断面研究。
本研究在 6-60 个月大的儿童中进行。经过必要的排除后，采用多阶段简单随机抽样法选择了 433 名参与者。使用全球急性营养不良（GAM）的 WHO 指南[WHZ<-2，MUAC<12.5cm]，根据 WHZ 计算 MUAC 的灵敏度（Se）、特异性（Sp）、预测值、似然比、Youden 指数和受试者工作特征（ROC）曲线。
在 433 名参与者中，30%的人根据 WHZ 被诊断为 GAM，而 17.6%的人根据 MUAC 测量结果被诊断为营养不良。根据 WHO 切点，MUAC 的 Se、Sp、阳性预测值（PPV）、阴性预测值（NPV）、Youden 指数、阳性似然比（LR+）和阴性似然比（LR-）分别为 48%、96%、83%、81%、0.44、12 和 0.54。ROC 曲线显示 MUAC<12.5cm 的曲线下面积为 0.86（95%置信区间=0.83，0.90）。双变量 Pearson 相关也显示 WHZ 和 MUAC 变量之间存在正线性关系（R2=0.302）。
根据研究结果，48%的儿童通过 MUAC 正确识别，GAM 的概率为 83%（PPV=0.83）。此外，非营养不良儿童的 Sp 为 96%，仅有 4%的假阳性。因此，基层工作人员可以使用 MUAC 对安格安瓦迪中心（AWCs）的儿童进行及时、准确的筛查，因为它使用方便、简单。
