New Reference Data for MUAC for Height Measurements

A published paper

MUAC measurements have traditionally been used in emergency situations as a rapid means of assessing population levels of wasting and screening for selective feeding programmes when the collection of height and weight measurements are difficult. Over the years a single MUAC cut-off point (generally 12.5 cm or 13cm) has been used to identify malnourished children under five. These cut-off points were based on data sets from normal, well fed Polish children in the 1960s. However, there has been a lot of controversy over the years as to whether MUAC is age and sex-independent in the under fives and therefore whether it is appropriate to have single cut-off point based on a combined MUAC for boys and girls or whether a MUAC for age indicator should be used instead.

A WHO Expert Committee has recently recommended a new MUAC-for Age set of reference data for children aged 6-60 months (Bulletin of World Health Organisation 1997, Vol. 75, 4). It is nevertheless widely acknowledged that any nutritional indices which involve the collection of age data can be problematic, especially in emergency settings, as age data may be imprecisely given by parents.

During the 1960s a method was developed to relate the measured MUAC to the child's height using a special measuring stick - the QUAC stick (Quaker Arm Circumference measuring stick). The method was independent of correct age, inexpensive, easy to use and fairly reliable. It became the main anthropometric assessment tool of a few agencies. e.g. ICRC. However, most agencies stuck with weight for height measurements when conducting nutritional surveys as measurements involving MUAC were believed to be prone to greater inaccuracies for a number of reasons, e.g. difficulties in identifying the mid point of the arm, the arm may be kept too flaccid, or the tape may be pulled too tightly or not tightly enough. A recent article has provided a MUAC for height reference data suitable for international use based on the same set of data recommended by the WHO expert Committee for use as a MUAC for age reference (a representative sample of children aged 659 months in the USA). The previous QUAC stick reference data were derived from separate sets of MUAC data based on well-nourished Polish children and from height data based on healthy West Nigerian village children or on country-specific data. The article also proposes use of a standard QUAC stick, which facilitates comparison of data between countries. The authors of the article show that MUAC for height Z scores (and MUAC for age Z scores) are better predictors of weight for height than MUAC measurements based on a fixed cut-off point of 12.5 or 13 cms. The authors point out that MUAC for height measurements have certain advantages over weight for height measurements in emergency or refugee situations; first they do not require the use of cumbersome scales and second they are less influenced by errors in measuring height. In other words an inaccuracy in height measurement will have a far greater influence on the final Z score for weight for height than it would in MUAC for height measurements. Height measurements are likely to be problematic where a completely flat platform with a vertical wall behind cannot be found. However, the authors recognise that in most situations it is more likely that the MUAC measurement will be inaccurate. They therefore conclude that the QUAC stick technique should only be used as a rapid method for determining levels of nutrition in large populations and as a screening tool for malnourished children.

A WHO modified QUAC stick is described in the annex to the article including details of its construction and use. The reference data in the article are meant to be used with the modified QUAC stick.

The full paper can be found in Bullet in of the World Health Organisation, 1997, vol. 7S, (4) pp333-341

More like this

FEX: Finding the right MUAC cut-off to improve screening efficiency

Author Koert Ritmeijer, MSF Holland In Hlaing Thayer township, Yangon, Burma, ORWs were spending a considerable amount of time doing weight and height measurements on all...

FEX: Can height-adjusted cut-offs improve MUAC’s utility as an assessment tool?

By Michel Van Herp, An Verwulgen, Bérengère Leurquin, and Pascale Delchevalerie Michael Ven Herp, Bérengère Leurquin, An Verwulgen & Pascale Delchevalerie Michael Ven Herp is...

FEX: Implications of 65 cm height cut-off as age proxy in Bangladesh

Summary of published research1 Location: Bangladesh What we know: Age data for children aged 6 to 59 months is often not available in poor, migrant or conflict affected...

en-net: Admission of children 5 to 10 years - criteria to use in famine situation

We're currently looking to expand admission criteria in Somalia to include children 5 to 10 years of age. Some partners are already doing this and using a variety of admission...

en-net: MUAC tapes

When was the MUAC tape invented? The circumferential measure most used as an alternative birthweight or birthweight for gestational age is neonatal chest circumference using...

FEX: MUAC versus weight-for-height debate in the Philippines

By Bernardette Cichon Bernardette is a Public Health Nutritionist who at the time of the work described in this article, worked with Action Contre la Faim (ACF). She is...

FEX: Anthropometric indicators to identify a pregnant woman as acutely malnourished and predict adverse birth outcomes

Summary of published research1 Location: Global What we know: There is no consensus on how to identify pregnant women as acutely malnourished and when to enrol them in...

FEX: Adults and adolescents: assessment of nutritional status in emergency-affected populations

New publications1,2 In July last year the ACC/Sub-committee on nutrition published two reports on the assessment of nutritional status in emergencies. One report deals with...

FEX: International Committee of the Red Cross

Name International Committee of the Red Cross Address 19, Avenue de la Paix, 1202 Geneva, Switzerland President Mr Jakob Kellenberger Telephone 00 41 22 734 60...

FEX: Evaluation of the Supplementary Feeding Programme carried out in Marsabit District, Kenya, April-November 1997

Vincent Brown (Epicentre), Sylvia Carbonell (Médecins Sans Frontières) MSF implemented a nutrition rehabilitation programme in Marsabit District between April...

FEX: Older people, nutrition and emergencies in Ethiopia

By Vanessa Tilstone Vanessa Tilstone has worked for HelpAge International in Ethiopia for the last 3 years as the Country Programme Director and has worked previously in...

FEX: MUAC and weight-for-height in identifying high risk children

Summary of research1 The World Health Organisation (WHO) and UNICEF propose to use two independent criteria for diagnosing non-oedematous severe acute malnutrition (SAM) in...

FEX: Letter on WHO 2006 Growth Standards, by Marko Kerac and Andrew Seal

This new 2006 WHO Growth standards: What will they mean for emergency nutrition programmes? Dear Editor Whilst welcoming the principles which have driven the development of...

FEX: CMAM in Cambodia – indicators of acute malnutrition for screening

By Jennifer Carter and Joel Conkle Jennifer Carter is a second year MPH student at the Tulane University School of Public Health and Tropical Medicine in the Department of...

en-net: Discharge Criteria in OTP: 15% GoW vs. W/H>-1.5SD

Dear all, Id like to know if there was a study comparing the efficiency of discharge criteria with 15% GoW only vs. W/H>-1.5SD, especially regarding the risk of relapse and...

en-net: Is it valid to use similar cut-off points for prevalence of wasting using z scores for different countries and contexts?

Hi there, II faced this situation and want to to hear your ideas. We have a programme running for long, but the GAM rates during the hunger gap based on WHO standards 2006 is...

FEX: Integration of CMAM into routine health services in Nepal

By Regine Kopplow Regine is a former CMAM Advisor with Concern Nepal. She is a nutritionist with a background in rural development. She has worked in the field of nutrition...

FEX: Comment on: Including infants in nutrition surveys

Experiences of ACF in Kabul city By Michael Golden, Department of Medicine and Therapeutics, University of Aberdeen, AB25 2ZD, Scotland. Perinatal mortality and birth-weight...

FEX: Letter on Field Exchange quality control, by André Renzaho

Dear Field Exchange A need for quality control, consistency and diligence for articles published in Field Exchange. As an experienced practitioner and trainer in refugee...

en-net: Using length/height to estimate Age of 6-59 month old children in high Stunting level countries

WHO recommended to use 60 cm as an estimate for 6 month old infants and 100 cm for the 59-60 month old children in countries with high stunting rates in 1995 Nutrition...

Close

Reference this page

New Reference Data for MUAC for Height Measurements. Field Exchange 3, January 1998. p8. www.ennonline.net/fex/3/new