Validity of mid-upper arm circumference in assessing thinness among children aged 5-9 years with and without HIV: A multi center study

Abstract

Background: Malnutrition is prevalent in children 5-9 years especially among those co-infected with HIV/AIDS yet it negatively impacts their growth, development and cognition. Although body mass index for age and sex z score (BAZ) is the recommended assessment method in this age group, it is cumbersome in the field and busy hospital settings. Uganda adopted mid-upper arm circumference (MUAC) use even for those 5-9 years because of its relative convenience compared to BAZ. MUAC use in children above 5 years has not been extensively studied and available studies show mixed results. This study therefore assessed validity of MUAC in assessing thinness among children aged 5-9 years. Objective: The objective of this study was to determine the validity of MUAC in assessing thinness among children aged 5 to 9 years. Methodology: We obtained cross-sectional anthropometric and demographic data from children 5-9 years who visited Kampala Capital City (KCCA) health centers and Baylor between October and December 2021. The sensitivity, specificity, negative and positive predictive values of MUAC were determined using BAZ as the gold standard. Receiver operating Characteristic (ROC) curves were plotted to determine the validity of MUAC. Logistic regression was used to determine the factors influencing the validity of MUAC in assessing thinness. Results: A total 767 children were enrolled into the study, half (52%) were female with a mean age of 7.2 +/-1.6 years. Prevalence of thinness was 5.7%, 95% C.I(4.2-7.6). The sensitivity and specificity of MUAC were 22.7%, 95% CI (11.5-37.8) and 97.3%, 95% CI (95.9-98.4) respectively. The positive and negative predictive values were34.5%, 95% CI (17.9-54.3) and 95.4%, 95% CI (93.6-96.8) respectively. The area under the ROC curve was 0.30, 95%CI (0.206-0.394). This showed MUAC was a poor assessment tool for thinness even after stratifying for age and Human Immune-deficiency Virus (HIV) status Conclusion: Despite MUAC being convenient, this study revealed that it has no role in assessing thinness among children 5-9 years. The low sensitivities show the tool can hardly identify thin individuals. A community study involving children from different areas of the country would help concretize the decision for Ministry of Health (MOH) on its use among children 5-9 years.