Arm Circumference v. Weight-for-Height in Nutritional Assessment: Are the Findings Comparable?

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Abstract
Arm circumference (AC) has been proposed as an alternative to weight-for-height (W/H) as a measure of acute malnutrition because of its low cost and ease of performance, particularly for rapid field assessments of nutritional status in circumstances where resources and trained personnel are limited. Few studies, however, have evaluated the performance of AC as compared to W/H as a measure of acute malnutrition. We used data from rapid nutrition assessments conducted during 1984–85 in Burkina Faso, Guinea, and Niger to compare the prevalence of malnutrition as measured by these two indices employing commonly used cut-offs for severe and moderate malnutrition. We further evaluated the sensitivity and specificity of AC compared with W/H for severe and moderate malnutrition. The prevalence of severe malnutrition was 5 per cent using the cut-off of AC < 12.5cm and 1 per cent using the cut-off of W/H < 70 per cent of median; for moderate malnutrition (AC < 13.5cm and w/h <80 per cent of median) the corresponding prevalences were 20 and 8 per cent. For severe malnutrition, the sensitivity of AC compared with w/h was 54 per cent, with a specificity of 95 per cent. For moderate malnutrition sensitivity and specificity were 75 and 85 per cent, respectively. Raising the AC cut-offs used to define severe and moderate malnutrition resulted in higher sensitivity, but yielded lower specificity. Our results indicate that considerable different prevalence rates were obtained with the two measures at the cut-offs used, and that despite substantial overlap, AC and w/h identify somewhat different children as malnourished. Further work needs to focus on functional outcomes such as morbidity and mortality, comparing children with low AC to those with low w/h to better evaluate the relative usefulness of these two measuring techniques in identifying children at nutritional risk.