Related Experiment Video
Updated: Mar 16, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings
Mark E Ralston1, Mark A Myatt2
1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
Insights
Height and mid-upper arm circumference (MUAC) provide accurate weight estimations for children under five in low-resource settings. This anthropometric tool is more precise than previous methods, aiding in malnutrition assessment where scales are unavailable.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Global Health
Background:
- Accurate weight estimation is critical for children in low-resource settings, especially for managing severe acute malnutrition.
- Existing weight estimation tools may lack uniform reliability, and scales are often unavailable in emergencies.
Purpose of the Study:
- To evaluate the accuracy and precision of mid-upper arm circumference (MUAC) and height for estimating weight in children under five in low-to-middle income countries.
- To identify reliable anthropometric tools for rapid weight estimation in resource-limited environments.
Main Methods:
- Retrospective observational study utilizing data from 560 nutritional surveys (1992-2006).
- Included 453,990 children aged 6-59 months, excluding those with edema or implausible anthropometric z-scores.
- Weight was estimated using Broselow Tape, Hong Kong formula, MUAC alone, height alone, and combined height and MUAC.
Main Results:
- Height alone proved to be a more accurate and precise predictor of weight than Broselow Tape or MUAC alone.
- Height-based models, particularly when stratified by MUAC classes, demonstrated high accuracy (e.g., 97.36% within ±25% of true weight).
- Specific MUAC strata (e.g., 115-125 mm) showed excellent precision with minimal Bland-Altman bias.
Conclusions:
- Weight estimation models using height alone or height combined with MUAC classes are superior to previous tools for children aged 6-59 months in low-to-middle income countries.
- A proposed height-based weight estimation tape, stratified by MUAC classes, offers a practical solution for limited-resource settings.
- This anthropometric approach can significantly improve nutritional assessment and management in vulnerable populations.
Importance:
A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers.
Objective:
To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries.
Design:
This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design.
Setting:
Locations with high prevalence of acute and chronic malnutrition.
Participants:
A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values).
Exposures:
Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined.
Main Outcomes And Measures:
Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision.
Results:
Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.15 kg; 2.24 kg). The height model fitted for MUAC classes was accurate and precise. For MUAC < 115 mm, the proportion of estimates accurate to within ± 25% of true weight was 97.15% (95% CI 96.90%, 97.42%) and the Bland-Altman bias and 95% limits of agreement were 0.08 kg and (-1.21 kg; 1.37 kg). For MUAC between 115 and 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.93% (95% CI 98.82%, 99.03%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-1.15 kg; 1.24 kg). For MUAC > 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.33% (95% CI 98.29%, 98.37%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.08 kg; 2.19 kg).
Conclusions And Relevance:
Models estimating weight from height alone and height with MUAC class in children aged 6-59 months in a database from low-to-middle income countries were more accurate and precise than previous weight estimation tools. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6-59 months in limited-resource settings.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:06What are Estimates?
The estimate for the mean of a sample is denoted by ͞x, whereas the mean of the population is designated as μ. Further, parameters such...
01:29Drug Dosing: Infants and Children