Prompt detection of malnutrition among children is possible, especially during times of emergencies with the use of mid-upper arm circumference (MUAC) tape and checking of bilateral pitting edema. These techniques help in the initial assessment of nutritional status to identify the appropriate intervention to address the nutritional problem.

The Mid Upper Arm Circumference (MUAC) tape is a simple plastic tape used in determining the thinness to weight-for-height of a child through measuring of the circumference of an individual’s left upper arm between the tip of the shoulder and the tip of the elbow. Advantages of using this includes it is cost-effective, simple, lightweight, easy to handle, effortless to manipulate, less susceptible to errors, can used for active case finding in community-based and a preferable indicator of mortality risk. 

To use the MUAC properly, follow these steps when measuring children 6-59 months old:

Step 1: Request the mother or guardian to remove the clothing that covers the child’s left arm.

Step 2: Measure the midpoint of the relaxed left arm by placing your fingertip on the tip of child’s shoulder. Arc the child’s elbow creating L-shape or right angle.

Step 3: Identify the left arm’s midpoint with any of these two strategies:

• Place the tape at zero on the tip of the shoulder straight down to the tip of the elbow. Read the number the resulted at the tip of the elbow and divide the number into two to get the midpoint.
• Instead of using MUAC tape, a piece of any kind of string can be used to bend up to the medial length and mark the midpoint using a pen. This technique is said to be more suitable and will lessen the chance of damaging the MUAC tape.

Step 4: Unbend or straighten the left arm of the child and wrap the tape around where midpoint was identified. To be accurate, read the numbers at right side up. The tape should touch the skin flatly.

Step 5: Ensure that the tape is neither too tight nor too loose. Tension of the tape should fit just right in the circumference.

Step 6: Inspect if the tape is placed correctly with the proper tension. If yes, you are now ready to read the measurement to the nearest 0.1 cm or 1 mm.

Step 7: Write down and record immediately to avoid forgetting the measurement.

After the MUAC is taken, the result is then interpreted with the help of the color zones.

Source: UNICEF

Alongside the measurement of MUAC, examining the bilateral pitting edema of the infant or child is needed for screening malnutrition. Nutritional edema is defined as abnormal water retention in the tissues of the body. This begins on the feet extending to the upper parts of the body. To determine the presence of edema, follow these simple steps:

• Press the child’s both feet with a normal thumb pressure.
• Count up to three seconds (preferably one thousand one, one thousand two, one thousand three).
• Gently release your thumb. If a shallow print was left on the feet, the child is therefore diagnosed with edema.

Once edema is seen, determine the severity of edema with the table below:

*Immediately refer the infant or child to the nearest health facility if edema is present.

The National Nutrition Council MIMAROPA Region will be disseminating MUAC tapes to all local government units in MIMAROPA Region for use in the 2021 Operation Timbang Plus. (NKSLoyola)

Sources:

United Nations Children's Fund (UNICEF)

National Nutrition Council MUAC Flyer
Mother Child and Health Education Trust. Early Detection and Referral of Children with Malnutrition. Accessed from https://motherchildnutrition.org/