Validity of random upper arm circumference for screening wasting among under five children in hadero tunto zuria woreda, kembata tembaro zone, southern Ethiopia, 2019.

Abstract

Background: Undernutrition is widely recognized as a major health problem in developing countries. For practical purposes, anthropometric measurements are the most useful tool for assessing the nutritional status of children. Random upper arm circumference has been proposed as an alternative to mid upper arm circumference as a measurement of wasting because of its ease of performance particularly for rapid field assessments of nutritional status in circumstances where resources and trained personnel were limited. Although mid upper arm circumference (MUAC) has been widely used for screening wasting, finding the mid-point is a cumbersome procedure that needs intensive training and educated and skilled personnel. To identify these cases early, simple and valid tool is needed. No research was done to validate whether random upper arm circumference(RUAC) measurement is a useful tool for rapid screening of children as compared to mid upper arm circumference measurement. Objective: The objective of this study was to validate random upper arm circumference against mid-upper arm circumference in screening wasting among under-five children. Methods and Materials: A community based cross sectional study was conducted from March 1st to 15, 2019 in Hadero Tunto Zuria woreda, Southern Ethiopia, among in a total of 412 under-five children. Study participants were selected using systematic sampling technique. Intervieweradministered questionnaire was used to collect the data and a tape meter was used for anthropometric measurement. The data were analyzed using SPSS windows version 20. Receiver operating characteristic curve analysis was used to calculate sensitivity and specificity of random upper arm circumference and mid upper arm circumference. Pearson Correlation coefficient(r) was used to evaluate the correlation between random upper arm circumference and mid upper arm circumference. Kappa coefficient statistic (K) and Bland-Altman plot was used to compare the agreement between random upper arm circumference versus mid upper arm circumference. Multivariable Linear regression model was used to generate coefficients of RUAC in predicting MUAC. A p-value of < 0.05 was considered statistically significant. Results and discussion: The sensitivity of RUAC in detecting wasting was found to be around 89% in our study whereas the specificity was 94.8%, the positive predictive value and negative predictive value was 68% and 98.6% respectively. Area under the curve in this study using receiver operating characteristic curve analysis was high (0.919[95% CI: 0.864, 0.973]). The agreement of the two measurements by using the Kappa coefficient was substantial (K=0.739) agreement for moderate wasting. The correlation between random upper arm circumference and mid upper arm circumference in this study was strong (r=0.972).Bland-Altman plot also showed strong agreement between the two measurements. Conclusion and recommendation: RUAC has excellent sensitivity and specificity compared to MUAC. The findings imply that random upper arm circumference could be used for screening wasting among 6-59 month aged children as it identifies more children with wasting.