{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:40:34Z","timestamp":1789044034118,"version":"build-2803163510"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Valid and reliable anthropometric indicator is useful for early detection and treatment for under nutrition. Although, mid upper arm circumference (MUAC) is used for screening of children with moderate acute malnutrition in Ethiopia, its performance for the different ethnic groups has not been evaluated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To determine the diagnostic performance of MUAC for determination of moderate wasting among children of different ethnic background and develop optimal cut-off.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A community based cross-sectional study was conducted among under five children of the three regions namely: Somalia, Amhara and Gambella Regions. The diagnostic performance of MUAC was validated using weight for height Z-score&lt; -2 as a gold standard binary classifier. Test variable is mid upper arm circumference (MUAC&lt; 12.5cm) and weight for height Z-Score (WHZ) is standard variable. ROC analysis performed based on the assumptions of MUAC value lower the cut-off point indicates the undernutrition. Area under the curve and validity measures (sensitivity and specificity) was generated as parameter estimated. The results were presented using tables and ROC curves.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Except in the Gambella region, there was fair agreement between MUC&lt;12.5cm and Weight for Height Z score&lt;-2 in diagnosing wasting in Somali (Sensitivity = 29.3%, Kappa = 0.325, P&lt;0.001) and in Gambella regions (Sensitivity = 16.7%, Kappa = 0.19, P&lt;0.001). In Amhara region there was fair agreement between the two measures in diagnosing moderate acute malnutrition (MAM) (Sensitivity = 16%, Kappa = 0.216). For the Overall sample, the sensitivity of MUAC&lt;12.5cm was 20.6% (Kappa = 0.245, P&lt;0.001. Based on ROC analysis, the optimal cutoff value of MUAC for diagnosing moderate acute malnutrition for the two regions namely for Gambella and Amhara was 13.85cm with sensitivity of 0.99 and 1.00, respectively. However, for Somali Region the optimal cut was 13.75cm (Sensitivity = 0.98 cm and specificity = 0.71).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Findings revealed that the inter reliability of measurement for MUAC&lt; 12.5cm and WHZ&lt;-2 for diagnosing MAM was low among different ethnic groups with the cut-off varying in each region. The existing cutoff point is less sensitive for diagnosis of MAM. As Ethiopia is home of diverse ethnic groups with different body frame and environmental conditions, the new cut off points developed for each region recommended to be used for screening moderate acute malnutrition to prevent relapse of MAM and reduce chronic malnutrition.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0273634","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T19:02:27Z","timestamp":1664478147000},"page":"e0273634","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Validating the diagnostic performance of MUAC in screening moderate acute malnutrition and developing an optimal cut-off for under five children of different regions in Ethiopia"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1580-0364","authenticated-orcid":true,"given":"Abera","family":"Lambebo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yordanos","family":"Mezemir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dessalegn","family":"Tamiru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tefera","family":"Belachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"issue":"3","key":"pone.0273634.ref001","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-0679","article-title":"Short Malnourished Children and Fat Accumulation With Food Supplementation","volume":"142","author":"Fabiansen","year":"2018","journal-title":"PEDIATRICS"},{"key":"pone.0273634.ref002","article-title":"Morley Undernutrition Disorders of Nutrition MSD Manuals","author":"E. John","year":"2021","journal-title":"Saint Louis University School of Medicine Last full review\/revision"},{"key":"pone.0273634.ref003","author":"WHO","year":"2021","journal-title":"Malnutrition Key facts"},{"key":"pone.0273634.ref004","author":"Global Nutrition Report","year":"2021","journal-title":"A world free from malnutrition: An assessment of progress towards the global nutrition targets"},{"key":"pone.0273634.ref005","author":"Global Nutrition Report","year":"2021","journal-title":"The burden of malnutrition at a glance"},{"key":"pone.0273634.ref006","unstructured":"FANTA, Nutrition Assessment, Counseling, and Support (NACS), in Nutrition Assessment and Classification., A.U.s.G.-M. 2, Editor. 2016, DC: FHI 360\/FANTA: Washington."},{"key":"pone.0273634.ref007","article-title":"Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance Project","author":"C. Bruce","year":"2003","journal-title":"Academy for Educational Development, Washington, D.C."},{"issue":"39","key":"pone.0273634.ref008","article-title":"Anthropometric reference data for children and adults. United States, 2011\u20132014","volume":"3","author":"Fryar","year":"2016","journal-title":"National Center for Health Statistics. Vital Health Stat"},{"key":"pone.0273634.ref009","first-page":"441","author":"WHO","year":"2007","journal-title":"Standard deviation of anthropometric Z -scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis in Bulletin of the World Health Organization"},{"key":"pone.0273634.ref010","unstructured":"Save The Children, Mid Upper Arm Circumference and Weight-for-Height Z-score as indicators of severe acute malnutrition: a consultation of operational agencies and academic specialists to understand the evidence, identify knowledge gaps and to inform operational guidance, ENN, et al., Editors. 2012, Marie McGrath, ENN, marie@ennonline.net: clockwise from le UNICEF, 2008; Nicky Dent, 2004; UNICEFNYHQ2007-2670Pirozzi."},{"issue":"3423","key":"pone.0273634.ref011","first-page":"3423","article-title":"A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study","volume":"358","author":"Lazarus","year":"2017","journal-title":"BMJ"},{"key":"pone.0273634.ref012","author":"Steven McGee","year":"2018","journal-title":"Evidence-Based Physical Diagnosis"},{"key":"pone.0273634.ref013","article-title":"Time to Relapse of Severe Acute Malnutrition and Associated Factors Among Under Five Children in Hadiya Zone, Southern Ethiopia","author":"A.L. 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Manoj","year":"2016","journal-title":"International Journal of Medical Science and Public Health"},{"issue":"3","key":"pone.0273634.ref021","doi-asserted-by":"crossref","first-page":"e0249232","DOI":"10.1371\/journal.pone.0249232","article-title":"Frequency of relapse for severe acute malnutrition and associated factors among under five children admitted to health facilities in Hadiya Zone, South Ethiopia","volume":"16","author":"A Lambebo","year":"2021","journal-title":"PLoS ONE"},{"key":"pone.0273634.ref022","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","article-title":"Sample size estimation in diagnostic test studies of biomedical informatics","volume":"48","author":"K. Hajian-Tilaki","year":"2014","journal-title":"J Biomed Inform"},{"key":"pone.0273634.ref023","volume-title":"ETHIOPIA Demographic and Health Survey Key Indicators Report, in Ethiopia Demographic and Health Survey","author":"CSA and ORC Macro","year":"2017"},{"issue":"4","key":"pone.0273634.ref024","article-title":"The stunting syndrome in developing countries","volume":"34","author":"J. Andrew","year":"2014","journal-title":"Paediatrics and International Child Health"},{"issue":"3","key":"pone.0273634.ref025","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"M.L. McHugh","year":"2012","journal-title":"Biochem Med (Zagreb)"},{"key":"pone.0273634.ref026","author":"WHO and UNICEF","year":"2009","journal-title":"WHO child growth standards and the identification of severe acute malnutrition in infants and children"},{"issue":"1","key":"pone.0273634.ref027","first-page":"302","article-title":"Intergenerational Influences on Child Growth and Undernutrition","volume":"26","author":"Reynaldo and Amanda","year":"2012","journal-title":"Paediatric and Perinatal Epidemiology"},{"issue":"7","key":"pone.0273634.ref028","doi-asserted-by":"crossref","first-page":"e101159","DOI":"10.1371\/journal.pone.0101159","article-title":"Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups","volume":"9","author":"A. 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