First Field Test of an Innovative, Wider Tape to Measure Mid-Upper Arm Circumference in Young Laotian Children

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mid-upper arm circumference, MUAC, young children, Lao PDR


Background: Measurements of mid-upper arm circumference (MUAC) may result in measurement error due to incorrect placement along the arm or tight pulling of tape. To reduce the risk of these measurement errors, a new wider tape was developed.

Objective: To compare the measurement agreement and precision and the ease of use of the standard and wide MUAC tapes.

Methods: Mid-upper arm circumference was measured in 814 children aged 9 to 32 months with both tapes. The midpoint of the upper arm was measured with the standard tape and estimated with the wide tape. Standardization sessions were implemented to assess intra- and interobserver precision.

Results: Mid-upper arm circumference with the wide MUAC tape was significantly larger than the standard tape (mean [standard deviation]: 14.3 [1.0] cm vs 13.9 [1.0] cm; P < .001), resulting in a consistent bias of +0.41 cm. Forty-six (5.7%) children were identified with low MUAC <12.5 cm by standard tape compared with 10 (1.2%) by the wide tape (P <.001). Because a new tape could be reproduced by correcting for this bias, we corrected measured results by subtracting 0.41 cm and mean MUAC by tape type was no longer significantly different. Intra- and interobserver technical error of measurement suggested a better precision with the wide MUAC tape.

Conclusions: Despite simplifying the measurement by approximating the midpoint of the upper arm, the wide MUAC tape tended to have better precision than the standard MUAC tape. However, there was a consistent measurement bias of +0.41 cm in mean MUAC. This first field test yielded promising results and led to further product adjustments.

Recommended Citation

Hess, Sonja Y., Guy-Marino Hinnouho, Maxwell A. Barffour, Bangone Bounheuang, Charles D. Arnold, David Bell, Tola H. Marts, and Sengchanh Kounnavong. "First field test of an innovative, wider tape to measure mid-upper arm circumference in young Laotian children." Food and nutrition bulletin 39, no. 1 (2018): 28-38.

DOI for the article



Master of Public Health