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Arch Public Health. 2018 Feb 22;76:11. doi: 10.1186/s13690-018-0260-x. eCollection 2018.

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

Author information

Action Against Hunger, One Whitehall St, New York, NY 10004 USA.
Action Against Hunger, Nyangumi Road, PO Box, Nairobi, 39900-00623 Kenya.
3Department of International Health, University of Tampere School of Medicine, PB 100 Tampere, Finland.
4Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, DK-1958 Frederiksberg, Denmark.
National Ministry of Health Unit of Nutrition, Monitoring and Evaluation Department, Old Mbagathi Road, PO Box 43319-01000, Nairobi, Kenya.
Isiolo County Health Management Team, Hospital Road, PO Box 36-30600, Isiolo, Kenya.
Brixton Health, Alltgoch Uchaf, Llawryglyn, Caersws, Powys SY17 5RJ UK.



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.


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).


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.


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.


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 (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.

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