## Description

Mid-upper arm circumference (MUAC) at admission measures timeliness of admissions. This measure assesses either how early / late beneficiaries seek care for acute malnutrition or how early / late the program is able to find cases of acute malnutrition. Late admissions or those children who are admitted to the program only after they have met admission criteria for a considerable period of time are of particular interest.

## Data requirements

Data on admission MUAC can be collected from the outpatient care treatment cards and recorded using a tally sheet.

## Analysis of data

Plotting MUAC at admission is the most informative approach to analysing timeliness of admissions. A bar plot can be created either by hand or using a computer. If done by hand, tabulation of MUAC at admission data from beneficiary cards can be done using a tally sheet approach which also presents the data graphically. The tally sheet is basically a table with the MUAC values in descending order starting from the program’s MUAC admission criteria (generally 115 mm but can be lower for certain country programs). The second column will be the tally column which is filled out using hash counts based on the MUAC at admission data that is indicated in the beneficiary cards. Figure 1 is an example of how to collect, tabulate and plot MUAC at admission data by hand. An example and template tally sheet can be found here.

Figure 1: Admission MUAC tabulated/plotted by hand using a tally sheet for a CMAM program admitting on MUAC < 115 mm

From FANTA technical reference page 19

Using a computer, the tabulated data can be entered into a spreadsheet or a statistical package and a bar plot created with the MUAC values at the x-axis and the frequencies or counts at the y-axis. A template spreadsheet to create admission MUAC bar plots can be found here. Figure 2 is the same data used in Figure 1 but done using a computer.

Figure 2: Admission MUAC tabulated/plotted by hand using a tally sheet for a CMAM program admitting on MUAC < 115 mm

## Interpretation

A plot of admission MUAC from a program with high coverage is likely to have a very large number of admissions close to the program admission criteria, as in the example using dummy data in Figure 1, Figure 2 and Figure 3. Plots that differ markedly from this (e.g., as in Figure 4) are indicative of problems with case-finding and recruitment and low program coverage.

Figure 3: Admission MUAC of a high coverage program

From FANTA technical reference page 21

Figure 4: Admission MUAC of a low coverage program

From FANTA technical reference page 21

The interpretation of plots of admission MUAC should take into account the phase of the program being investigated. For example, during the start-up phase of a program, the plots of admission MUAC will usually look something like Figure 4. This is because, in the first few months of program operation, both prevalent cases (i.e., cases that have been SAM for some time and may have very low MUACs) and incident cases (i.e., cases that have only recently developed SAM and have MUACs close to the program admission criteria) are found and admitted. When investigating the coverage of an established program, it is often useful, therefore, to plot admission MUAC for recent program admissions only (e.g., admissions occurring in the previous 6 months).

Updated: