Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years

Arch Public Health. 2015 May 18;73(1):26. doi: 10.1186/s13690-015-0074-z. eCollection 2015.


Background: Mid-upper arm circumference (MUAC) was recently endorsed and recommended for screening for acute malnutrition in the community. The objective of this study was to determine whether a colour-banded MUAC strap would allow minimally trained mothers to screen their own children for malnutrition, without locating the mid-point of the left upper arm by measurement, as currently recommended.

Methods: A non-randomised non-blinded evaluation of mothers' performance when measuring MUAC after minimal training, compared with trained Community Health Workers (CHW) following current MUAC protocols. The study was conducted in 2 villages in Mirriah, Zinder region, Niger where mothers classified one of their children (n = 103) aged 6-59 months (the current age range for admission into community malnutrition programs) using the MUAC tape.

Results: Mothers' had a sensitivity and specificity for classification of their child's nutritional status of > 90% and > 80% respectively for global acute malnutrition (GAM, defined by a MUAC < 125 mm) and > 73% and > 98% for severe acute malnutrition (SAM, defined by a MUAC < 115 mm). The few children misclassified as not having SAM, were classified as having moderate acute malnutrition (MAM). The choice of arm did not influence the classification results; weighted Kappa of 0.88 for mothers and 0.91 for CHW represent almost perfect agreement. Errors occurred at the class boundaries and no gross errors were made.

Conclusions: Advanced SAM is associated with severe complications, which often require hospital admission or cause death. Mothers (with MUAC tapes costing $0.06) can screen their children frequently allowing early diagnosis and treatment thereby becoming the focal point in scaling-up community management of acute malnutrition.

Trial registration: The trial is registered with (Trial number NCT01790815).

Keywords: Community management of acute malnutrition; Mid-upper arm circumference; Screening by mothers; Severe acute malnutrition.

Associated data