Accuracy of caregiver-performed MUAC measurements: a community-based study in a humanitarian context in Amhara, Ethiopia

BACKGROUND AND OBJECTIVES

The Family MUAC approach empowers caregivers to assess their children and detect malnutrition early. While the strategy is increasingly adopted, its accuracy and associated determinants remain under-explored, particularly in conflict contexts. Therefore, this study aims to assess the accuracy of MUAC measurements performed by caregivers and to investigate the factors that are associated with accurate measurements.

METHODS/STUDY DESIGN

A community-based cross-sectional study was conducted from November 27 to December 5, 2024, in conflict-affected areas of Ethiopia. A total of 241 mothers/caregivers trained in Family MUAC, each with a child aged 6–59 months and a MUAC tape at home, participated. Each caregiver measured their child’s MUAC, followed by a measurement by a trained data collector serving as the gold standard. Accuracy was assessed using sensitivity, specificity, Cohen’s Kappa, and area under the ROC curve (AUC). Logistic regression identified factors associated with accurate caregiver classification.

RESULTS/EXPECTED RESULTS

Caregivers demonstrated high performance, with a sensitivity of 93.7% and specificity of 98.0% for detecting acute malnutrition. Agreement between caregiver and expert measurement was excellent (Cohen’s Kappa = 0.91; 95% CI: 0.85–0.96), and the AUC was 95.8% (95% CI: 93.4–98.3). However, sensitivity for detecting severe acute malnutrition (SAM) was lower at 71.4%. Factors significantly associated with accurate classification included younger child age (<24 months: adjusted odds ratio (AOR) = 12.03; p = 0.002), participation in food assistance programs (AOR = 2.62; p = 0.003), weekly follow-up by health workers (AOR = 3.67; p = 0.016), and higher caregiver literacy (AOR = 5.37; p = 0.001).

CONCLUSIONS/DISCUSSION

Caregiver-performed MUAC measurement demonstrated high accuracy and strong agreement with expert assessment, supporting the utility of the Family MUAC approach in humanitarian settings. Enhanced caregiver training and routine follow-up are recommended. These findings support the scale-up of Family MUAC to strengthen community-based malnutrition screening where health system access is limited.