Performance of MUAC and associated factors in the prediction of acute malnutrition among children 6-59 months at Mulago hospital, Kampala.

Abstract

Background: Malnutrition remains a worldwide challenge and accounts for about 35% of all deaths among children under 5 years in the world. To address the burden of acute malnutrition, weight-for-height (WHZ) and Mid-Upper Arm Circumference (MUAC) have been used for assessment of nutritional status in children. However, both proxies correlate poorly and in some cases differ in application. This study aimed at determining the performance of MUAC and its associated factors in the prediction of acute malnutrition among children aged 6-59 months. Methods: We conducted a cross-sectional study that employed both descriptive and analytical techniques at the paediatric assessment centre of Mulago Hospital between January and March 2018. The study involved 394 children aged 6-59 months from whom demographics and other information were obtained. All eligible participants were selected using systematic random sampling. The data was analyzed using STATA version 12.0. Results: Majority of the study participants were males (60.7%) and (39.3%) were females, most of them belonged to the age group 6-23 months. MUAC sensitivity was 47.5 %, specificity was 96.3 %, the PPV obtained was 92.6% and the NPV was 65.47%. MUAC kappa for intraobserver variability was 0.898 and 0.945with an inter-observer variability of 0.9323. Similarly, WHZ kappa for intraobserver variability was 0.9788 and 0.9626 with an Inter-observer variability of 0.9516. At multivariate analysis, Age (P= 0.019), Anemia (P= 0.037), Down syndrome (P= 0.004) and hair changes (P=0.023) were found to be significant. Conclusion: MUAC at a cutoff of 12.5cm had reasonable performance characteristics despite its low sensitivity, we recommend that it should be used in conjunction with WHZ for effective assessment of malnutrition. Age greater than 24 months is likely to decrease the performance MUAC whilst Anemia, Down syndrome and hair changes are likely to increase the performance of MUAC