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Review
. 2025 Mar 10:12:1536386.
doi: 10.3389/fnut.2025.1536386. eCollection 2025.

Diagnostic accuracy of MUAC for assessment of acute malnutrition among children aged 6-59 months in Africa: systematic review and meta-analysis

Yonatan Menber  1 , Tefera Belachew  2 , Netsanet Fentahun  1
Affiliations
Review

Diagnostic accuracy of MUAC for assessment of acute malnutrition among children aged 6-59 months in Africa: systematic review and meta-analysis

Yonatan Menber et al. Front Nutr. .

Abstract

Background: Mid-Upper Arm Circumference (MUAC) or Weight-for-Length Z-Score (WHZ) are used to screen for acute malnutrition in children. The relative merits of MUAC and WHZ, as well as whether they ought to be used separately, are still up for debate. Considering the significant impact of acute malnutrition on a large number of children in Africa, along with the constraints on resources, it is crucial to critically assess the validity of simple and widely used tools utilized in both African communities and clinical settings. Therefore, this study aimed to assess the diagnostic test accuracy of MUAC in screening acute malnutrition among children aged 6-59 months in Africa.

Methods: A systematic review and meta-analysis study was conducted to pool evidence on the diagnostic performance of MUAC compared to WHZ among children aged 6 to 59 months across various studies in Africa. The StataMP 17.0 software was utilized for analysis, employing a Bivariate Random-effects Meta-Analysis model. Sensitivity, specificity, the Diagnostic Odds Ratio, and the Area Under the Curve were calculated. Heterogeneity was assessed using Cochrane's Q statistic and the I2 test. Additionally, meta-regression, subgroup analysis, sensitivity analysis, and assessments for publication bias were employed. The overall level of diagnostic test accuracy was estimated using a random-effects meta-analysis model.

Results: Seventeen studies were included in the meta-analysis. The pooled sensitivity and specificity were 38.1% (95% CI: 30.7, 46.1%) and 94.9% (95% CI: 93.2, 96.2%), respectively. The summary receiver operating characteristic curve plot showed that MUAC had good accuracy in detecting acute malnutrition (AUC = 0.85, 95% CI: 0.82, 0.88). The pooled level of diagnostic odds ratio was 13.22 (95% CI: 9.68, 16.77). The rate of misclassification in screening for acute malnutrition using MUAC was observed to be 11.7%.

Conclusion: The MUAC demonstrated low sensitivity but high specificity in diagnosing acute malnutrition in children aged 6 to 59 months across various regions of Africa. Furthermore, it was found that MUAC provides good diagnostic test accuracy when compared to WHZ. To enhance its accuracy, it is suggested to increase the MUAC cutoff thresholds.

Keywords: Africa; MUAC; WHZ; acute malnutrition; children; diagnostic accuracy; validation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of studies included in the systematic review and meta-analysis.
Figure 2
Figure 2
Risk-of-bias and applicability concerns summary.
Figure 3
Figure 3
Risk-of-bias and applicability concerns.
Figure 4
Figure 4
Forest plot—meta-analysis of diagnostic accuracy of MUAC to diagnose acute malnutrition among children aged 6–59 months in Africa.
Figure 5
Figure 5
SROC plots from the midas statistical package.
Figure 6
Figure 6
SROC plots from the metadta statistical package.
Figure 7
Figure 7
Forest plot—meta-analysis of diagnostic accuracy of MUAC based on DOR.
Figure 8
Figure 8
Subgroup analyses by country’s region based on DOR.
Figure 9
Figure 9
Subgroup analyses by country’s region based on sensitivity and specificity.
Figure 10
Figure 10
Sensitivity analysis.
Figure 11
Figure 11
Funnel plot—meta-analysis of diagnostic accuracy of MUAC to diagnose acute malnutrition using DOR among children aged 6–59 months in Africa.
See this image and copyright information in PMC

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