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Journal of Tropical Pediatrics 1993 39(5):298-302; doi:10.1093/tropej/39.5.298
© 1993 by Oxford University Press
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Arm Circumference {nu}. Arm Circumference/Head Circumference Ratio in the Assessment of Malnutrition in Rural Malawian Children

T. M. Ball, MD* {dagger} and R. E. Pust, MD**

*Blantyre Adventist HospitalBlantyre, Malawi
**Department of Family and Community Medicine, University of Arizona School of Medicine Tucson, Arizona 85724, USA

The arm circumference/head circumference ratio (AC/HC) was compared with arm circumference (AC) alone in the diagnosis of protein-energy malnutrition (PEM) in 685 Malawian children between the ages of 3 and 48 months. The AC/HC ratio correlates well, r=0.6863 (P< 0.001), with weight-for-age (WA).

The sensitivity and specificity were calculated for both indicators compared to the NCHS reference standard of WA. Compared to 80 per cent WA, the 0.310 AC/HC cut-off was 92 per cent sensitive and 41 per cent specific, while the 0.290 AC/HC cut-off was 75 per cent sensitive and 74 per cent specific. AC alone in the 6–12-month-old children was 75 per cent sensitive and 89 per cent specific at a cut-off of 12.5 cm. In the children from 12 to 48 months with a cut-off of 13.5 cm the AC was 82 per cent sensitive and 70 per cent specific. The AC alone was more sensitive than AC/HC at all levels of specificity.

Adding the HC to AC offered no advantage in screening for PEM in these children. In fact, if one were to use the standard 0310 cut-off for AC/HC, the resulting low (41 per cent) specificity would identify such a large proportion of false positives as to make this ratio impractical for field use where it is most needed—in primary health care programmes with low resources which serve populations with high prevalences of PEM.


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