Reliability of Mid-Upper Arm Circumference Measurements taken by Community Health Nurses

Mid upper arm circumference-based diagnosis of severe acute malnutrition is seen as very attractive because it is assumed to be simple to use in measuring the arm and also requires a single cut-off without having to compute an index or compare to a reference population. The circumference of the left upper arm measured at the mid-point between the tip of the shoulder and the tip of the elbow is referred to as mid upper arm circumference (MUAC). MUAC was originally used in emergency settings where huge populations had to be screened within a short time. However, in the past few years the development of community therapeutic care of acute malnutrition implied a need for a diagnostic tool. The general objective of the study was to assess the inter-and intra-observer variability in MUAC measurements of under-five children by community health nurses in selected communities of the Northern Region in Ghana. A community-based cohort study was conducted on a convenience sample of 120 community health nurses and nursing students from selected communities in the Northern region of Ghana. Each CHN measured MUAC for four unique children on three consecutive days to assess intra-observer variability. To assess inter-observer variability, 50 independent nursing students took MUAC measures of four children on the same day. Bland Altman plots showed a high degree of agreement of MUAC measures taken repeatedly for three days by the same observers and ICC = 0.993. MUAC measures among observers (inter-observer) and ICC = 0.042 showed a considerable level of variability among different observers. This study showed that MUAC is reliable when repeated measures are taken on children by the same observers, but using different observers for the same children showed a high level of variability.