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Trouver la médiane pour le dépistage de la malnutritoin par le périmètre brachial (PB)

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 5 replies.

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Alison Donnelly

Normal user

16 Nov 2017, 02:57

Is there any evidence or finalised guidance on the need to measure the arm and find the mid-point when taking MUAC? I remember some earlier posts from Mark Myatt indicating that this was unnecessary, but I haven't been able locate these on this forum.
In Rohingya refugee response in Bangladesh, we are facing a huge caseload of malnourished children and carefully taking the mid point of the arm is is adding significant time (and complication for those new to MUAC screening). If we were able to skip this part of the process, it would save quite a lot of time and make it easier to scale-up screening by health actors. However, many partners feel that it is unacceptable to just guess the mid point of the arm when taking the measurement.



Normal user

16 Nov 2017, 15:02

Dear you can check this link for this



Normal user

16 Nov 2017, 15:07

Colleen Emary

Technical Advisor, Nutrition

Normal user

16 Nov 2017, 15:08

Alima guidelines on MotherLed MUAC reference the research which showed that estimating the mid point by eye did not affect the accuracy of the measurement. Their studies are available here:
Their guidelines are available here:

hope this helps.


Frequent user

18 Nov 2017, 08:28

Dear Alison,

You say :

“However, many partners feel that it is unacceptable to just guess the mid point of the arm when taking the measurement.”

I suggest you ask these partners what is the evidence in favour of the tradition of using the left arm only and exactly measure the mid point. My perception is that this has been uncritically repeated for years from article to article and from books to guidelines following a WHO document published in the 60’s. See:

Jelliffe Assessment nutritional status community

Technique mesure MUAC : section 2 p 77

This made some sense in this document which dealt with overall assessment of the community, including adults. Among adults choosing the left arm may be warranted as the right arm may be bigger as a result of intensive physical activity. And it is important to get the mid point to get the biceps which may bulge at that place especially again among those engaged in heavy physical activity.

I am not aware this has been ever validated in children who are not engaged in heavy physical activity and have a rather tubular upper arm.

To my knowledge, the most extensive study using MUAC to detect high risk children was done in Bangladesh. It showed (and many other studies) that MUAC was very good at that. And in this study MUAC was measured by CHWs not checking mid-point. See:

I think the burden of proof is on the side of those who want the middle upper arm precisely checked. And until there is evidence supporting this approach, please do simplify screening by avoiding the ritual of measuring the upper arm mid-point.

I hope this helps

Alison Donnelly

Normal user

22 Nov 2017, 02:37

Thanks all. This is very helpful!

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