Early Detection and Referral of Children with Malnutrition
Detection and Referral of Children with Acute Malnutrition
MUAC Resources - Sources for MUAC straps
Interpretation of Mid-Upper Arm Circumference MUAC indicators
- MUAC less than 110mm (11.0cm), RED COLOUR, indicates Severe Acute Malnutrition (SAM). The child should be immediately referred for treatment.
- MUAC of between 110mm (11.0cm) and 125mm (12.5cm), RED COLOUR (3-colour Tape) or ORANGE COLOUR (4-colour Tape), indicates Moderate Acute Malnutrition (MAM). The child should be immediately referred for supplementation.
- MUAC of between 125mm (12.5cm) and 135mm (13.5cm), YELLOW COLOUR, indicates that the child is at risk for acute malnutrition and should be counselled and followed-up for Growth Promotion and Monitoring (GPM).
- MUAC over 135mm (13.5cm), GREEN COLOUR, indicates that the child is well nourished.
4-colour Mid-Upper Arm Circumference (MUAC) tape
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MSF has developed a new universal MUAC strip which is awaiting field validation
- The tape is 25 mm wide. This increases the probability of the table covering the mid point of the upper arm and reduces the effect of over-pulling.
- The tape is double sided. One side is for use with children with thresholds marked for moderate and severe wasting and low chest-circumference in neonates). The other side is for adults with thresholds marked for moderate and severe wasting and for pregnant / lactating women.
- The tape is numbered and colour-coded allowing use by community-based volunteers.
- The tape can measure MUACs up to about 500 mm. This enables the use of PROBIT estimators for GAM, MAM, and SAM in surveys of nutritional status in adults.
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Advantages of Mid-Upper Arm Circumference (MUAC) screening
- It is simple and cheap. It can be used by service providers at different contact points without greatly increasing their workload and it can be effectively used by community-based people for active case finding.
- It is more sensitive. MUAC is a better indicator of mortality risk associated with malnutrition than Weight-for-Height. It is therefore a better measure to identify children most in need of treatment.
- It is less prone to mistakes. Comparative studies have shown that MUAC is subject to fewer errors than Weight-for-Height (Myatt et al, 2006).
- It increases the link with the beneficiary community. MUAC screening allows service providers from peripheral health units and from the community to refer children with acute malnutrition to therapeutic or supplementary feeding programs. The MUAC colour coding is easy to understand for the child's care-taker.
- It is common practice to have the child's Weight-for-Height measurement taken to confirm admission into a therapeutic or supplementary feeding program. Particularly for supplementary feeding programs, this may lead to children being referred from the community or peripheral units but not admitted. In these cases, counselling and compensation (e.g. a
"protection ration" or soap) should be offered to care-givers turned away so that the visit to the site is still worthwhile.
- Using a MUAC cut-off of less than 125 mm for referral and admission in supplementary feeding programs can have implications for the size. Cut-offs for supplementary feeding programs can be adjusted (e.g. reduced to 120mm) based on capacity and resources so that priority is given to identifying children most at risk of death and therefore most in need of treatment.
14 September, 2019