Mid-upper arm circumference is one of the quickest and most useful screens for acute malnutrition in children aged 6 to 59 months, and a reading below 11.5 cm identifies severe acute malnutrition. Its value depends on technique.
The midpoint is found between the tip of the shoulder (acromion) and the tip of the elbow (olecranon) with the arm bent at a right angle. The measurement is then taken with the arm hanging loosely, the tape snug against the skin but not compressing it. A tape pulled too tight can move a child across the cut-off. Bilateral pitting oedema of the feet indicates severe acute malnutrition whatever the MUAC.
- Use the left arm and find the midpoint between shoulder tip and elbow tip with the elbow bent at 90 degrees.
- Measure with the arm relaxed and hanging, the tape touching the skin without compressing it.
- Read to the nearest millimetre and repeat if the value is close to 11.5 or 12.5 cm.
- Check both feet for pitting oedema, which signals severe acute malnutrition regardless of MUAC.
Why it matters
A few millimetres of technique decide which side of the referral cut-off a child falls.
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