Abstract
As anaesthetists we have to learn to recognize malnourished children. The implications for fluid management, cardiac function, weaning and nutrition are important. Mid-upper arm circumference (MUAC) is the most useful anthropometric parameter for severely debilitated patients. We observed that the measuring tape is frequently missing or out of stock. In order to overcome this challenge we searched for an always available, easy to understand method with acceptable accuracy which is free. We conducted a study of 262 volunteers in four professional groups. In a deliberately short training session of 5–10 min we provided them with gauze bandages and asked them to measure the circumference with their own fingers, nails and interphalangeal crests. Later we showed them bandages (substitutes for upper arms) of different sizes and asked them to determine whether these were bigger or smaller than the original or the same size. Of the 1048 decisions, 91.2% were taken correctly and 97.2% were acceptable for the identification of a malnourished patient. Two hundred and thirty-five of the 262 participants (89.7%) would have been able to identify a severely malnourished child. The best subgroup recognized all children in danger and even the non-medical subgroup diagnosed 80.6%. The child who was not in need of special resources was recognized by all 262 participants (100%). Only two (0.76%) made decisions which were contradictory. A semiquantitative measurement of MUAC is possible. Our method is sufficiently exact, needs minimal training, alerts the anaesthetist and is free. We should train all professionals working in developing countries with malnourished children in the ‘one grip’ measurement of MUAC.
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