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Simplified MUAC measurement technique - use in surveys?

This question was posted the Assessment and Surveillance forum area and has 3 replies.

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Colleen Emary

World Vision International

Normal user

21 Nov 2019, 15:25

Hi colleagues,

I understand that there is evidence showing that MUAC measurement technique can be simplified - the measurement can be taken on either arm, and mid-point assessed visually.  However, I have noticed that most written guidance on MUAC technique continues to recommend the long-standing method (non-dominant arm, measuring midpoint).  I suspect that these simplified techniques are being used primiarly in community mobilization activities (e.g. Family/Mother MUAC), and have not yet found their way to anthro assessment methods in surveys.  I'm wondering why this is the case?  Are we needing more evidence on the accuracy of the simplified technique? Thanks

Spencer Rivadeneira Danies

pediatra

Normal user

21 Nov 2019, 18:47

Buenas tardes. Excelente comentario. En la práctica, cuando se atiende un número grande de pacientes y con grandes distancias que recorrer entre comunidades, realmente debería simplificarse el método, en aras de optimizar el tiempo y ampliar la cobertura. En nuestras actividades de campo, en La Guajira colombiana, hemos observado que no existe diferencia en las mediciones, cuando se determina el punto braquial medio "al ojo" y luego son comparadas con mediciones en las que se utilizó el método tradicional. 

Por otro lado, teniendo en cuenta las fases del proceso de lateralización y las edades a las que estas suceden, considero que no tiene mayor repercusión clínica que se mida, indistintamente, uno u otro  brazo.

Automatic translation: 

Good afternoon. Excellent comment. In practice, when a large number of patients are being seen and with great distances to travel between communities, the method should really be simplified, in order to optimise time and expand coverage. In our field activities, in La Guajira Colombia, we have observed that there is no difference in the measurements, when the mid brachial point is determined "by eye" when compared with measurements in which the traditional method was used.

On the other hand, taking into account the phases of the lateralization process and the ages at which they occur, I consider that it has no great clinical repercussion that one or the other arm is measured interchangeably.

Carlos Grijalva-Eternod

UCL Institute for Global Health

Normal user

22 Nov 2019, 18:25

Hi Colleen,

I am not up-to-date with the evidence you mentioned, and I would greatly appreciate it if you could share some links or documents to such evidence.

The only reference I am aware that tried to provide an answer to the question of which side to measure was a chapter by Reynaldo Martorell et al, published as part of the 'Anthropometric Standardization Reference Manual' by Timothy Lohman, first published in 1988. Follow this link for a scanned copy of the chapter.

In that chapter, Reynaldo did find differences between arms, although these were small, with the right arm been bigger. Nonetheless, they concluded that the choice of side matters little because the difference between arms is small when compared to measurement error.

In my opinion, standard procedures help to disentangle signal from noise, and different measurers have different levels of noise and different situations require different clarity of signals. I do not think that one should expect that mothers/caregivers at home undertake MUAC measurements with the same degree of standardisation than community health workers collecting MUAC data for research purposes.

I hope the above is useful.

Mark Myatt

Epidemiologist at Brixton Health

Frequent user

23 Nov 2019, 12:42

Colleen has this right ... the work has (mostly) been done by ALIMA as part of their work using mothers to screen their own children for SAM using MUAC. A number of other NGOs have, I think, adopted this approach.

We work in a field that can be slow to innovate. MUAC seems to have become something of a "cause celebre" for reactionaries in our field who spread FUD (fear, uncertainty, doubt) about the use of MUAC which has tended to delay uptake and innovation.

The original work is here.

Follow-up work on operationalising MUAC by mums is here.

I agree with Carlos about signal and noise in measurements. I think that the design of MUAC tapes in common use can contribute to noise and can give us a distorted signal due to systematic bias in measurements. ACF did some work on the design of MUAC classification devices for MUAC by mums and used a MUAC tape design that was designed to reduce noise which performed well. You can read about this work here.

Ther are a number of previous discussions about this issue in these pages. Try seaching for (e.g.) "MUAC left arm" using the search box (should be top-right on this page).

I hope this is of some use.

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