Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children ages 6 to 59 months: Systematic review and meta-analysis

Abstract

OBJECTIVES: Sensitivity is the proportion of people classified as diseased (i.e., no false negatives). A test with low sensitivity can be thought of as being too cautious in finding a positive result. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed for this systematic review and meta-analysis. The databases used were PubMed, Google Scholar, Jane, and African Journals Online. The search terms used were "sensitivity" and "specificity of and mid-upper arm circumference" (MUAC). A Joanna Briggs Institute meta-analysis and checklist for diagnostic test accuracy studies was used for the critical appraisal of the studies. The meta-analysis was conducted using STATA, version 14, software. The pooled sensitivity was computed to present the pooled sensitivity at a 95% confidence interval (CI). RESULTS: A total of 11 individual studies were included in the meta-analysis. The lowest sensitivity of MUAC with the detection of severe acute malnutrition (SAM) was 5% in Vietnam, and the highest sensitivity was at 43.2% in India. The pooled sensitivity of MUAC among children aged <5 y to determine SAM was 20.7% (range, 13.24%-28.25%; P = 0.001). Based on the pooled specificity of MUAC, the detection of SAM was 97.636% (95% CI, 96.339%-98.932%; P = 0.001), and the pooled optimal cutoff point to diagnose SAM was 13.23 cm (95% CI, 12.692-13.763 cm; P = 0.001). CONCLUSIONS: The sensitivity of MUAC is lower compared with the specificity to detect SAM, and varies from area to area.