The Use of Arm Circumference in Simplified Screening for Acute Malnutrition by Minimally Trained Health Workers

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Abstract
This study investigated the observer reliability of arm circumference measures (AC) with respect to the conventionally used indices of weight for height and weight for age when all these measures are obtained under field conditions of door-to-door screening by minimally trained health personnel. Data were collected in a Guatemalan village from 127 children aged 12 to 60 months. Five health promoters were selected by the community and were trained to measure height, weight and AC. A trained anthropometrist measured the children under ideal conditions and the promoters measured children in the community. Remeasurement was made on a sample of children to establish intra-observer variability. The AC measures of promoters had the highest correlation with anthropometrist measures (0.8881) compared to weight for age (0.8756) and weight for height (0.7588). Field reliability of AC and weight for age measures varied little between promoters, but weight for height exhibited a large range of reliability. The principal implication of this study is that, under field conditions, minimally trained workers make fewer and smaller errors in screening children 12 to 60 months of age with AC than with either weight for age and weight for height.

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