Is mid-upper-arm circumference a useful tool for screening in emergency settings?

Area of Science:

• Public Health
• Nutrition Science
• Humanitarian Aid

Background:

• Rapid nutritional data collection is crucial for public health planning in refugee emergencies.
• A two-step screening procedure using mid-upper-arm circumference (MUAC) followed by weight-for-height was implemented in Rwandan refugee camps.

Purpose of the Study:

• To assess the effectiveness and efficiency of a two-step screening procedure (MUAC followed by weight-for-height) for identifying malnutrition in refugee children.
• To evaluate the overlap and performance of MUAC as a standalone screening tool compared to weight-for-height.

Main Methods:

• Analysis of screening data from 3681 children in three Rwandan refugee camps in eastern Zaire.
• Evaluation of MUAC performance with different cut-off points (e.g., <12 cm, 14 cm).
• Comparison of children identified by MUAC versus those identified by low weight-for-height.

Main Results:

• MUAC performance varied significantly with the chosen cut-off; a 14 cm cut-off detected 88% of children with low weight-for-height but required a second step for over 40% of children.
• MUAC screening preferentially identified younger children as malnourished, while missing older children with low weight-for-height.
• The overlap between children identified by low MUAC and low weight-for-height was poor, ranging from 20% to 39% depending on age.

Conclusions:

• The two-step screening procedure using MUAC followed by weight-for-height did not yield expected time savings.
• Low MUAC cannot reliably substitute for low weight-for-height in assessing nutritional status in refugee children.
• Weight-for-height surveys or screening are likely more efficient strategies for nutritional data collection in refugee settings.