The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia

Tesfaye Abrhame; Jemal Haidar

doi:doi:10.11648/j.sjph.20150301.14

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The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia

Tesfaye Abrhame, Jemal Haidar

Published in Science Journal of Public Health (Volume 3, Issue 1)

Received: 29 May 2014 Accepted: 12 August 2014 Published: 29 December 2014

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Abstract

Introduction: For nutritional assessment of HIV-positive adults and adolescents, it is recommended to take Weight, Height and MUAC (for pregnant and lactating women and/or adults who cannot stand straight) in every contact, such measurements increase the waiting time and inconvenience(1). So that a simple and yet useful anthropometric measurement is needed to screen malnutrition for an immediate nutrition support in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic. Methods: A cross-sectional study was conducted from January to July 2013 among adults with HIV (PLHIV), who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. A total of 594 study subjects were selected using a multi stage cluster sampling technique. MUAC, Height and weight were measured for all subjects and BMI was calculated as Wt/Ht2. Receivers operating characteristic curve analyses were undertaken to discover the most suitable cut-off values of MUAC for both Men and Women. Results: The prevalence of chronic energy deficiency (CED) based on BMI (BMI <18.5) was 39.4% for males and 24.21% for females, while based on MUAC <230 mm for male was 48.4% and < 220 mm for female was 35.7%. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224 for females were 92.86 and 87.07, whereas for Males MUAC with optimal criteria of ≤234 were 94.85 and 68.46, respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6(95%CI=89.9 to 99.3) with the highest NPV 98.2 (95%CI=66.8 to 77.9), thus having the highest Youden Index of 0.21. A MUAC value of ≤242mm was identified as the best cut off point to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3(95%CI=91.2 to 99.4) with the highest NPV 98.1 (95%CI=50.0 to 66.4), thus having the highest Youden Index of 0.32. Conclusion: a MUAC value of close to 242 mm for male and 239mm for female seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLHIV.

Published in	Science Journal of Public Health (Volume 3, Issue 1)
DOI	10.11648/j.sjph.20150301.14
Page(s)	19-24
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Sensitivity, Specificity, BMI, CED, Mid-Upper Arm Circumference, Nutritional Status, ROC Curve

References

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[2]	WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Technical Report Series. 1995.
[3]	James WP M-TG, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. European Journal of Clinical Nutrition 1994;48:883-94.
[4]	Bisai S BK. Undernutrition in the Kora Mudi tribal population, West Bengal, India: a comparison of body mass index and mid-upper-arm circumference. Food Nutr Bull2009;30(1):63-7.
[5]	Gustafson VFG, C>S> Vieira, B. Samb, A. Naucler,. Predictors for Death in HIV-positive and HIV-negative Tuberculosis Patients in Guinea-Bissau. 2007;35(2):69-80.
[6]	EFMOH. National Guidelines for HIV/AIDS and Nutrition in Ethiopia. 2000.
[7]	Jelliffe DB JE. The arm circumference as a public health index of protein-calorie malnutrition in early childhood. Journal of tropical pediatrics. 1996;15(177-260.).
[8]	Velzeboer Mea. Evaluation of arm circumference as a public health index of protein-calorie malnutrition in early childhood. Joumal of tropical pediatrics1983;29(135-44).
[9]	Briend A DC, Graven K, Mazumder RN, Wojtyniak B. Usefulness of nutritional indices and classifications in predicting death of malnourished children. BMJ1986;923:373=5.
[10]	Vella V TA, Ndiku J, Marshal T, Cortinovis I Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables. Eur J Clin Nutr 1994;48:189-97.
[11]	Steve Collins M, BS. Using Middle Upper Arm Circumference to Assess Severe Adult Malnutrition During Famine JAMA1996;276(5):391-5.
[12]	WHO. Executive Summary of a scientific review. Consultation on Nutrition and HIV/AIDS in Africa.(Evidence, lessons and recommendations for action. Durban, South Africa); 2005.
[13]	BAPEN. Malnutrition universal screening tool (MUST); British Dietetic Association, 2011.
[14]	Z. Cook SK SLaSS. Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice. 2005;64:313.
[15]	T.Khadivzadeh. Mid-upper arm and calf circumferences as indicators of nutritional status in women of reproductive age. Eastern and Mediterranean Health Journal 2002; 8:612-8.
[16]	Collins.S. Using middle upper arm circumference to assess severe adult malnutrition during famine. JAMA 1996;276:391-5.
[17]	Bose K GS, Mamtaz H, Mukhopadhyay A, Bhadra M. High prevalence of undernutrition among adult Kora Mudi tribals of Bankura District, West Bengal, India. Anthropological Sciences 2006;114:65-8.
[18]	AAO. Identification of underweight women by measurement of the arm circumference. International Journal of Gynecology and Obstetrics 1990;31:231-5.
[19]	Rodrigues VC RR, Lena A. . Utility of arm circumference as a screening instrument to identify women at nutritional risk. Tropical Doctor1994;24:164-6.
[20]	India Go. Census of India. (Online) 2001. http:/wwwcensusindiagovin 2010.
[21]	K. B. Generalised obesity and regional adiposity in adult White and migrant Muslim males from Pakistan in Peterborough. Journal of Royal Society of Health 1996;116:161-7.
[22]	Deurenberg P YM, van Staveren WA. Body mass index and percent body fat: a meta- analysis among different ethnic groups. International Journal of Obesity Related Metabolic Disorder 1998;22(12):1164.
[23]	Calverton M, USA, Central Statistical Agency Ethiopia Ethiopia Demographic and Health Survey 2011. Central Statistical Agency and ICF International2012:152-88.

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Tesfaye Abrhame, Jemal Haidar. (2014). The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Science Journal of Public Health, 3(1), 19-24. https://doi.org/10.11648/j.sjph.20150301.14

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Tesfaye Abrhame; Jemal Haidar. The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Sci. J. Public Health 2014, 3(1), 19-24. doi: 10.11648/j.sjph.20150301.14

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AMA Style

Tesfaye Abrhame, Jemal Haidar. The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Sci J Public Health. 2014;3(1):19-24. doi: 10.11648/j.sjph.20150301.14

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@article{10.11648/j.sjph.20150301.14,
  author = {Tesfaye Abrhame and Jemal Haidar},
  title = {The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia},
  journal = {Science Journal of Public Health},
  volume = {3},
  number = {1},
  pages = {19-24},
  doi = {10.11648/j.sjph.20150301.14},
  url = {https://doi.org/10.11648/j.sjph.20150301.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20150301.14},
  abstract = {Introduction: For nutritional assessment of HIV-positive adults and adolescents, it is recommended to take Weight, Height and MUAC (for pregnant and lactating women and/or adults who cannot stand straight) in every contact, such measurements increase the waiting time and inconvenience(1).  So that a simple and yet useful anthropometric measurement is needed to screen malnutrition for an immediate nutrition support in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic. Methods: A cross-sectional study was conducted from January to July 2013 among adults with HIV (PLHIV), who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. A total of 594 study subjects were selected using a multi stage cluster sampling technique. MUAC, Height and weight were measured for all subjects and BMI was calculated as Wt/Ht2. Receivers operating characteristic curve analyses were undertaken to discover the most suitable cut-off values of MUAC for both Men and Women. Results: The prevalence of chronic energy deficiency (CED) based on BMI (BMI <18.5) was 39.4% for males and 24.21% for females, while based on MUAC <230 mm for male was 48.4% and < 220 mm for female was 35.7%. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224 for females were 92.86 and 87.07, whereas for Males MUAC with optimal criteria of ≤234 were 94.85 and 68.46, respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6(95%CI=89.9 to 99.3) with the highest NPV 98.2 (95%CI=66.8 to 77.9), thus having the highest Youden Index of 0.21. A MUAC value of ≤242mm was identified as the best cut off point to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3(95%CI=91.2 to 99.4) with the highest NPV 98.1 (95%CI=50.0 to 66.4), thus having the highest Youden Index of 0.32.  Conclusion: a MUAC value of close to 242 mm for male and 239mm for female seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLHIV.},
 year = {2014}
}

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TY  - JOUR
T1  - The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia
AU  - Tesfaye Abrhame
AU  - Jemal Haidar
Y1  - 2014/12/29
PY  - 2014
N1  - https://doi.org/10.11648/j.sjph.20150301.14
DO  - 10.11648/j.sjph.20150301.14
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 19
EP  - 24
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20150301.14
AB  - Introduction: For nutritional assessment of HIV-positive adults and adolescents, it is recommended to take Weight, Height and MUAC (for pregnant and lactating women and/or adults who cannot stand straight) in every contact, such measurements increase the waiting time and inconvenience(1).  So that a simple and yet useful anthropometric measurement is needed to screen malnutrition for an immediate nutrition support in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic. Methods: A cross-sectional study was conducted from January to July 2013 among adults with HIV (PLHIV), who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. A total of 594 study subjects were selected using a multi stage cluster sampling technique. MUAC, Height and weight were measured for all subjects and BMI was calculated as Wt/Ht2. Receivers operating characteristic curve analyses were undertaken to discover the most suitable cut-off values of MUAC for both Men and Women. Results: The prevalence of chronic energy deficiency (CED) based on BMI (BMI <18.5) was 39.4% for males and 24.21% for females, while based on MUAC <230 mm for male was 48.4% and < 220 mm for female was 35.7%. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224 for females were 92.86 and 87.07, whereas for Males MUAC with optimal criteria of ≤234 were 94.85 and 68.46, respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6(95%CI=89.9 to 99.3) with the highest NPV 98.2 (95%CI=66.8 to 77.9), thus having the highest Youden Index of 0.21. A MUAC value of ≤242mm was identified as the best cut off point to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3(95%CI=91.2 to 99.4) with the highest NPV 98.1 (95%CI=50.0 to 66.4), thus having the highest Youden Index of 0.32.  Conclusion: a MUAC value of close to 242 mm for male and 239mm for female seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLHIV.
VL  - 3
IS  - 1
ER  -

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Author Information

Tesfaye Abrhame

Addis Ababa University, Medical Faculty, School of Public Health, Addis Ababa, Ethiopia
Jemal Haidar

School of Public Health, Addis Ababa University, P.O. Box 27285/1000

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Tesfaye Abrhame, Jemal Haidar. (2014). The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Science Journal of Public Health, 3(1), 19-24. https://doi.org/10.11648/j.sjph.20150301.14

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ACS Style

Tesfaye Abrhame; Jemal Haidar. The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Sci. J. Public Health 2014, 3(1), 19-24. doi: 10.11648/j.sjph.20150301.14

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AMA Style

Tesfaye Abrhame, Jemal Haidar. The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia. Sci J Public Health. 2014;3(1):19-24. doi: 10.11648/j.sjph.20150301.14

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@article{10.11648/j.sjph.20150301.14,
  author = {Tesfaye Abrhame and Jemal Haidar},
  title = {The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia},
  journal = {Science Journal of Public Health},
  volume = {3},
  number = {1},
  pages = {19-24},
  doi = {10.11648/j.sjph.20150301.14},
  url = {https://doi.org/10.11648/j.sjph.20150301.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20150301.14},
  abstract = {Introduction: For nutritional assessment of HIV-positive adults and adolescents, it is recommended to take Weight, Height and MUAC (for pregnant and lactating women and/or adults who cannot stand straight) in every contact, such measurements increase the waiting time and inconvenience(1).  So that a simple and yet useful anthropometric measurement is needed to screen malnutrition for an immediate nutrition support in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic. Methods: A cross-sectional study was conducted from January to July 2013 among adults with HIV (PLHIV), who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. A total of 594 study subjects were selected using a multi stage cluster sampling technique. MUAC, Height and weight were measured for all subjects and BMI was calculated as Wt/Ht2. Receivers operating characteristic curve analyses were undertaken to discover the most suitable cut-off values of MUAC for both Men and Women. Results: The prevalence of chronic energy deficiency (CED) based on BMI (BMI <18.5) was 39.4% for males and 24.21% for females, while based on MUAC <230 mm for male was 48.4% and < 220 mm for female was 35.7%. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224 for females were 92.86 and 87.07, whereas for Males MUAC with optimal criteria of ≤234 were 94.85 and 68.46, respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6(95%CI=89.9 to 99.3) with the highest NPV 98.2 (95%CI=66.8 to 77.9), thus having the highest Youden Index of 0.21. A MUAC value of ≤242mm was identified as the best cut off point to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3(95%CI=91.2 to 99.4) with the highest NPV 98.1 (95%CI=50.0 to 66.4), thus having the highest Youden Index of 0.32.  Conclusion: a MUAC value of close to 242 mm for male and 239mm for female seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLHIV.},
 year = {2014}
}

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TY  - JOUR
T1  - The Sensitivity and Specificity of Mid-Upper Arm Circumference Compared to Body Mass Index in Screening Malnutrition of Adult HIV Patients taking ART; Evidence from Selected Facilities of Addis Ababa, Ethiopia
AU  - Tesfaye Abrhame
AU  - Jemal Haidar
Y1  - 2014/12/29
PY  - 2014
N1  - https://doi.org/10.11648/j.sjph.20150301.14
DO  - 10.11648/j.sjph.20150301.14
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 19
EP  - 24
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20150301.14
AB  - Introduction: For nutritional assessment of HIV-positive adults and adolescents, it is recommended to take Weight, Height and MUAC (for pregnant and lactating women and/or adults who cannot stand straight) in every contact, such measurements increase the waiting time and inconvenience(1).  So that a simple and yet useful anthropometric measurement is needed to screen malnutrition for an immediate nutrition support in developing countries. Objective: To assess the sensitivity (SN) and specificity (SP) of mid-upper arm circumference (MUAC) in detecting under nutrition of adult people with HIV who have a follow up at ART clinic. Methods: A cross-sectional study was conducted from January to July 2013 among adults with HIV (PLHIV), who have follow-up in three selected Governmental Hospitals of Addis Ababa city administration. A total of 594 study subjects were selected using a multi stage cluster sampling technique. MUAC, Height and weight were measured for all subjects and BMI was calculated as Wt/Ht2. Receivers operating characteristic curve analyses were undertaken to discover the most suitable cut-off values of MUAC for both Men and Women. Results: The prevalence of chronic energy deficiency (CED) based on BMI (BMI <18.5) was 39.4% for males and 24.21% for females, while based on MUAC <230 mm for male was 48.4% and < 220 mm for female was 35.7%. The sensitivity and specificity of MUAC for Female with optimal criteria of ≤224 for females were 92.86 and 87.07, whereas for Males MUAC with optimal criteria of ≤234 were 94.85 and 68.46, respectively. The area under curve (AUC) was 0.93 (p<0.001). A MUAC value of ≤239mm was identified as the best cut off-points to identify CED (BMI <18.5) with SN and SP of 96.43% and 72.62%, respectively. The PPV was 56.6(95%CI=89.9 to 99.3) with the highest NPV 98.2 (95%CI=66.8 to 77.9), thus having the highest Youden Index of 0.21. A MUAC value of ≤242mm was identified as the best cut off point to identify CED (BMI <18.5) with SN and SP of 96.91% and 58.39%, respectively. The PPV was 46.3(95%CI=91.2 to 99.4) with the highest NPV 98.1 (95%CI=50.0 to 66.4), thus having the highest Youden Index of 0.32.  Conclusion: a MUAC value of close to 242 mm for male and 239mm for female seemed to be appropriate as a simple and efficient cut-off point for the determination of under nutrition in adult PLHIV.
VL  - 3
IS  - 1
ER  -

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