Prevalence of Low MUAC Among Women

Impact

% of women aged 15–49 years in the specified target group with MUAC below the cut-off defined for that group and context

The indicator measures the proportion of women in a defined target group whose mid-upper arm circumference (MUAC) is below the cut-off used by the programme. It can help programmes assess undernutrition risk, inform screening and referral where MUAC is used for programme eligibility, and monitor changes in the proportion of women with low MUAC over time. The target group and MUAC cut-off should always be reported with the result, as there is no single internationally accepted MUAC cut-off for all women.

First define the group of women the indicator will cover and the MUAC cut-off that will be used, based on the programme objective and relevant national or response-level guidance. Examples include pregnant women, breastfeeding women, non-pregnant and non-breastfeeding women, or all women aged 15–49 years. If different cut-offs apply to different groups, calculate and report the indicator separately for each group.

MUAC can be collected through a project baseline or endline survey, periodic monitoring, mass screening or routine programme screening. Measure MUAC using an appropriate MUAC tape and a standardised procedure, and record the exact measurement in millimetres whenever possible.

Calculate the indicator as: number of women in the specified target group with MUAC below the defined cut-off ÷ total number of women in that target group with a valid MUAC measurement × 100.

Clearly state the target group and cut-off whenever reporting the result. If routine programme or facility screening reaches only part of the target population, report the result as the proportion of screened women with low MUAC rather than assuming that it represents prevalence among all women in the programme area.

This data can be disaggregated by pregnancy and breastfeeding status and age group, and, if relevant and feasible, also by geographic area, disability status and displacement status.

1) MUAC cut-offs depend on the population and programme context. For pregnant and breastfeeding women in humanitarian settings, UNICEF and the Global Nutrition Cluster currently recommend MUAC <23 cm as an interim threshold for identifying women at risk of undernutrition and for referral or admission to nutritional recovery programmes. National or response-level protocols should nevertheless be followed where they specify another cut-off. Some programmes continue to use <21 cm; UNICEF currently supplies maternal MUAC tapes with both 21 cm and 23 cm cut-offs. For non-pregnant and non-breastfeeding women, there is no internationally agreed MUAC cut-off, so use an applicable national or programme-specific threshold and state it clearly. Do not compare or combine prevalence estimates calculated using different cut-offs as if they measured the same thing.

   

2) Decide which groups of women to include according to the programme's objectives. Record pregnancy and breastfeeding status so that results can be interpreted and, where useful, reported separately for pregnant, breastfeeding and non-pregnant/non-breastfeeding women. Do not pool groups into a single low-MUAC prevalence estimate when different cut-offs have been applied. For pregnant and breastfeeding adolescent girls, be careful not to use the MUAC cut-off as an automatic exclusion criterion for nutrition support. In humanitarian settings, UNICEF/GNC recommends that all pregnant and breastfeeding adolescent girls are considered for contextually appropriate interventions regardless of their MUAC measurement.

   

3) Low MUAC prevalence can change because of seasonal and contextual factors. When comparing baseline and endline results, collect data at similar points in the seasonal calendar where feasible, and consider important changes in food security, disease, displacement and humanitarian assistance when interpreting trends.

    

4) Do not automatically attribute a change in low MUAC prevalence to the programme. Changes in the population measured, programme coverage, displacement, shocks or other assistance may also affect the result. In routine screening data, for example, increased outreach to more nutritionally vulnerable women may increase the proportion with low MUAC even when programme reach has improved.

5) Ensure that staff measuring MUAC receive practical training and supervision and follow a standardised measurement procedure. If the assessment uses sampling or results will inform important programme decisions, seek appropriate nutrition or MEAL support for the assessment design and data-quality checks.

Also consider using the following indicators:

• Minimum Dietary Diversity - Women (adds information on women's diet quality, an important determinant of nutritional status)

• Household Hunger Scale (helps interpret low MUAC alongside severe household food deprivation)