Indian Journal of Community Medicine

LETTER TO EDITOR
Year
: 2018  |  Volume : 43  |  Issue : 4  |  Page : 325--326

Utility of mid-upper arm circumference in detection of maternal acute malnutrition


Umesh Kapil1, Ajeet Singh Bhadoria2,  
1 Department of Public Health Nutrition, Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Correspondence Address:
Dr. Umesh Kapil
Department of Public Health Nutrition, Human Nutrition Unit, All India Institute of Medical Sciences, Old OT Block, New Delhi - 110 029
India




How to cite this article:
Kapil U, Bhadoria AS. Utility of mid-upper arm circumference in detection of maternal acute malnutrition.Indian J Community Med 2018;43:325-326


How to cite this URL:
Kapil U, Bhadoria AS. Utility of mid-upper arm circumference in detection of maternal acute malnutrition. Indian J Community Med [serial online] 2018 [cited 2019 Dec 7 ];43:325-326
Available from: http://www.ijcm.org.in/text.asp?2018/43/4/325/248195


Full Text



Sir,

The recent publication entitled “Screening Maternal Acute Malnutrition Using Adult Mid-Upper Arm Circumference (MUAC) in Resource-Poor Settings”[1] supported by the UNICEF in your journal was informative and useful. However, few scientific issues need clarification for the benefits of public health practitioners, research scientists, program implementers, and health administrators.

The researchers have justified measuring MUAC instead of height to assess acute maternal malnutrition, as the former takes comparatively less time than the latter. According to them, using nonstretchable adult MUAC tape “an average measuring time taken per person for MUAC was 54 s whereas for height using stadiometer was 59 s.” Authors have referred their earlier study in support of this justification. This is an important issue as it raises concern about validity of results obtained in both present and earlier study. Real time consumed in measuring height and MUAC at community-level research study should be much more as it involves many additional steps that need to be addressed. These steps include visiting a house, identifying an indexed subject, self-introduction, obtaining informed consent, taking tools out for measurements and taking measurements, adjustment of clothes/footwear, and recording it in duplicate or triplicateResearchers identified 84% specificity in mothers screened with MUAC <23 cm. This cutoff could detect high proportion of “false-positive” women with acute malnutrition that may pose additional high burden on treatment/interventions for managing malnourished mothersAuthors have referred nine studies in to support their results. Out of them, five are unpublished concerning validity of recommendations made in the present studyAuthors recommended “Care packages for those mothers who have very low MUAC on their nutrition as well as fetal stunting.” Does the study suggest provision of nutrition supplements/therapeutic foods for mothers screened positive for acute malnutrition? If yes, what specific interventions can be given to these identified mothers? If no, then why should mothers screened for acute malnourishmentThe present study revealed “those with MUAC <23 and <21 cm were 48% and 14%, respectively.” Diagnostic accuracy between MUAC cutoff of <23 cm and body mass index (BMI) of <18.5 kg/m2 as the gold standard. It would be more meaningful if BMI <16 kg/m2 would be taken as the gold standard as suggested in a previously published data.[2] It recommended BMI <16 kg/m2 to assess severe acute malnutrition in adults (nonpregnant and nonpostpartum). It further added that if BMI cannot be assessed, then MUAC <19 cm should be identified[2]A recently completed seven countries study on pregnant women, four from Africa (Democratic Republic of Congo, Ethiopia, Malawi, and South Africa) and three from South Asia (Bangladesh, Nepal, and Pakistan) concluded that based on the wide variability of sensitivity and specificity between studies, it may be difficult to recommend a MUAC cutoff that would be suitable in all settings.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kumar P, Sareen N, Agrawal S, Kathuria N, Yadav S, Sethi V, et al. Screening maternal acute malnutrition using adult mid‑upper arm circumference in resource‑poor settings. Indian J Community Med 2018;43:132‑4.
2Nutrition Care Plan C2: Outpatient Care of Adults with SAM. Algorithm for Managing Malnutrition in Adults. p. 3. Available from: http://www.fantaproject.org/sites/default/files/resources/Namibia%20flipchart%20algorithm%20adults_Sept2010.pdf. [Last accessed on 2018 Jul 16].
3Tang AM, Chung M, Dong K, Wanke C, Bahwere P, Bose K, et al. Determining a Global Mid‑Upper Arm Circumference Cutoff to Assess Underweight in Adults (Men and Nonpregnant Women). FHI 360/FANTA. Washington, DC; 2017. Available from: https://www.fantaproject. org/sites/default/files/resources/Global‑MUAC‑Cutoffs‑non Pregnant‑Adults‑Jun2017.pdf. [Last accessed on 2018 Jul 16].