Comparing performance of mothers using simplified mid-upper arm circumference (MUAC) classification devices with an improved MUAC insertion tape in Isiolo County, Kenya

Angeline Grant, James Njiru, Edgar Okoth, Imelda Awino, André Briend, Samuel Murage, Saida Abdirahman, Mark Myatt, Angeline Grant, James Njiru, Edgar Okoth, Imelda Awino, André Briend, Samuel Murage, Saida Abdirahman, Mark Myatt

Abstract

Background: A novel approach for improving community case-detection of acute malnutrition involves mothers/caregivers screening their children for acute malnutrition using a mid-upper arm circumference (MUAC) insertion tape. The objective of this study was to test three simple MUAC classification devices to determine whether they improved the sensitivity of mothers/caregivers at detecting acute malnutrition.

Methods: Prospective, non-randomised, partially-blinded, clinical diagnostic trial describing and comparing the performance of three "Click-MUAC" devices and a MUAC insertion tape. The study took place in twenty-one health facilities providing integrated management of acute malnutrition (IMAM) services in Isiolo County, Kenya. Mothers/caregivers classified their child (n=1040), aged 6-59 months, using the "Click-MUAC" devices and a MUAC insertion tape. These classifications were compared to a "gold standard" classification (the mean of three measurements taken by a research assistant using the MUAC insertion tape).

Results: The sensitivity of mother/caregiver classifications was high for all devices (>93% for severe acute malnutrition (SAM), defined by MUAC < 115 mm, and > 90% for global acute malnutrition (GAM), defined by MUAC < 125 mm). Mother/caregiver sensitivity for SAM and GAM classification was higher using the MUAC insertion tape (100% sensitivity for SAM and 99% sensitivity for GAM) than using "Click-MUAC" devices. Younden's J for SAM classification, and sensitivity for GAM classification, were significantly higher for the MUAC insertion tape (99% and 99% respectively). Specificity was high for all devices (>96%) with no significant difference between the "Click-MUAC" devices and the MUAC insertion tape.

Conclusions: The results of this study indicate that, although the "Click-MUAC" devices performed well, the MUAC insertion tape performed best. The results for sensitivity are higher than found in previous studies. The high sensitivity for both SAM and GAM classification by mothers/caregivers with the MUAC insertion tape could be due to the use of an improved MUAC tape design which has a number of new design features. The one-on-one demonstration provided to mothers/caregivers on the use of the devices may also have helped improve sensitivity. The results of this study provide evidence that mothers/caregivers can perform sensitive and specific classifications of their child's nutritional status using MUAC.

Trial registrations: Clinical trials registration number: NCT02833740.

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

Conflict of interest statement

The study protocol was granted ethical approval by the African Medical and Research Foundation (AMREF) Ethics and Scientific Review Committee, Kenya (ESRC number P249/2016). The study is registered at clinicaltrials.gov (Trial number: NCT02833740). Consent was obtained by the data collection team in either written or verbal form and was recorded through signature or thumb prints on individual consent forms.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The three “Click-MUAC” prototypes used in the study. Devices 1 and 2 have an internal circumference of 115 mm. Device 3 has an internal circumference of either 115 mm or 125 mm depending on how the device is latched
Fig. 2
Fig. 2
Features of the universal design MUAC insertion tape used in the study
Fig. 3
Fig. 3
Age and sex distribution of the study sample. Ranges are expressed in ISO 31–11 form [A] The form (a,b] expresses the interval a

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