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Nutritional status of children: validity of mid-upper arm circumference for screening undernutrition.

OBJECTIVES
To determine the nutritional status and validity of mid upper arm circumference (MAC) in diagnosing malnutrition among preschool children.


DESIGN
Cross-sectional household survey.


SETTING
47 villages in District Ambala, Haryana.


SUBJECTS
3747 children aged less than six years.


METHODOLOGY
Trained field workers recorded age, weight, length/ height and MAC of children. Prevalence of underweight, stunting, and wasting were calculated in reference to National Centre for Health Statistics (NCHS) standards. Sensitivity and specificity of MAC for detecting underweight, wasting and stunting among children aged 1 to 4 years were determined.


RESULTS
At the cut-off level of < -2.00 SD of Z-scores, 48.8% children were stunted, 49.6% were underweight and 9.1% were wasted whereas 47.6% children had neither wasting nor stunting. Prevalence of severe stunting, underweight, and wasting (Z-score < -3 SD) was 18.1%, 11.5% and 0.6%, respectively. Undernutrition showed a significant rise after 12 months of age (p < 0.0001). Stunting and underweight were significantly more among girls compared to boys (p < 0.01) but wasting was not significantly different in them. Compared to the conventional MAC cut off levels of < 13.5 cm and < 12.5 cm, sensitivity and specificity in our setting were optimum at < 13.5 cm for detection of wasting and < 14.0 cm for diagnosis of underweight and stunting, and < 13.0 cm for detection of severe wasting and < 13.5 cm for diagnosis of severe underweight and severe stunting.


CONCLUSIONS
Almost every second child was undernourished. Optimum cut off level of MAC in our setting were higher than the conventional cut off points for detection of undernutrition among children.