Berkley et al identified screening criteria for identifying malnourished children at significant risk for inpatient mortality. This demonstrated that the mid upper arm circumference can be a useful screening tool in areas with limited heath resources. The authors are from Kenya Medical Institute Centre for Geographic Medicine Research in Kilifi, the University of Oxford, the Institute of Child Health (London) and Imperial College (London).


Patient selection: children from 12 to 59 months of age


Parameters from multivariate logistic regression analysis:

(1) mid upper arm circumference in cm (MUAC)

(2) weight for height z score (WHZ) for age and gender

(3) gross physical appearance of wasting (wasting of the gluteal area; presence of bony prominence over the chest wall)




mid upper arm circumference

> 11.5 cm



<= 11.5 cm


weight for height z score

> -3.0



<= -3.0


physical wasting

none to moderate






total number of risk factors =

= SUM(points for all 3 factors)



• minimum number of risk factors: 0

• maximum number of risk factors: 3

• The presence of risk factors is associated with an increased risk for inpatient mortality.



• The tests depend on appropriate training of the observer(s). The mid-upper arm circumference must be taken at a standard point with a nonstretchable tape.

• The sensitivity of MUAC for inpatient mortality was 46% with specificity of 91%. The adjusted odds ratio was 1.8.

• The sensitivity of WHZ for inpatient mortality was 42% with specificity of 92%. The adjusted odds ratio was 2.6.

• The sensitivity of severe wasting for inpatient mortality was 47% with specificity of 93%. The adjusted odds ratio was 4.8.


To read more or access our algorithms and calculators, please log in or register.