The Use of Arm Circumference in Simplified Screening for Acute Malnutrition by Minimally Trained Health Workers

Abstract

The most commonly used measures for detecting protein energy malnutrition (PEM) in children are difficult for functionally illiterate personnel to make on a routine basis in poor rural households. Consequently arm circumference (AC) has been suggested as a simplified tool for field screening of PEM by minimally trained health workers. This study was designed to investigate the observer reliability of AC with respect to conventionally used indices of weight for height and weight for age. The project was set in 4 Indian villages in Guatemala where public health conditions are similar to those found in poor rural areas in many developing countries; 127 children ages 12 to 60 months were screened. A plastic measuring tape was used to obtain AC in centimeters and all measurements were taken on the same day. The principal implication is that under field conditions minimally trained workers make fewer and smaller errors in screening children with AC than with either weight for age or for height. The difference between community workers (promoter) and trained anthropometrists measurements as well as the variability between promoters suggest that training and follow-up of promoters are necessary for AC to be used effectively. In addition the analysis presented in this paper indicates that for this population AC was as reliable as weight for age and more reliable than the compounded weight for height measures. It is recommended that AC be used in nutrition surveillance and in programs of extension of coverage of public health services.