The Middle Arm Circumference in Practice: fast way of detecting malnutrition

Home, East Bajac Bajac Health Center – After reading through Treatment of Diarrhea, a WHO manual, I was able to find a nifty tool at the appendixes. It was an instruction on how to make and use a mid-arm circumference tape to detect severe and moderate malnutrition. Having worked in a barangay health center for over a year now, I was able to see a minimum of twenty patients in a single day. At best, that number rises to one hundred and forty! I only had three hours to see those patients. It was easy to overlook malnutrition and other conventional methods of measuring weight and charting are cumbersome. This method seems to be promising and something I have never used before until now that I have tried it in practice.

Color coding was not needed, as long as I knew what the marks meant. I used a pink gel pen to mark moderate dehydration. The marks above showed how many centimeters for documentation. I designed my own MAC tape and I knew how to use it. Other health workers can fashion their own and/or use the instructions provided on the manual.
The incredible thing is the ease of use. It takes only 10 seconds to use and document. The following is an example showing a well nourished child. She was given further sick visit prescriptions and was advised to continue present diet.

The next is an example of why this method was invented. A severely malnourished child with pneumonia presented in an out-patient setting. The mother was apprehensive and this was their 3rd consult with different doctors. She was looking for free medications. It was important that the child be admitted. I was adamant that the baby be brought to the hospital. The MAC strip helped. It gave the mother a visual evidence of how malnourished the child is. Medicating the child at home carries the risk that the child will die if improper nutrition was given. Meds just won’t do. The malnutrition could be caused by some absorptive gut problem. The mother was teary-eyed when I told her that the child could die. I have to convince her further. I told him about social welfare and various financial options they could take to save the child. Proper referral was given and the mother affirmed that she will be bringing the child to the hospital by signing the child’s chart.

The patient was two years old. The mortality of under five babies is so high around the world and most are malnutrition related. Giving individualized care to prevent a single death is hard for physicians in rural health who are pressed for time to see each and every patient. This beautiful method presented here can be applied to peds 6 months to 5 years old. It’s a great visual tool that can be understood by mothers and health workers. Use it in your practice, it can affect how you manage your patients greatly!

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