Factors associated with mid upper arm circumference in pregnant women in Banke, Nepal
Authors: Ghosh Shibani , Trevino Johanna Andrews , Davis Dale , Shrestha Robin , Bhattarai Abhiygna , Anusree KC , Pokharel Ashish , Dulal Bishnu , Gurung Sabi , Paudel Krishna , Baral Kedar , Webb Patrick 
Published: November 2023

Background

Rates of weight gain in pregnancy are associated with infant weight for age, length for age and weight for length and are predictive of postnatal growth at 6 months of age. The study examines factors linked with low mid upper arm circumference (MUAC) in pregnant women in Banke Nepal.

Objective

The objectives of this analysis are to examine the MUAC status of pregnant women enrolled in a longitudinal birth cohort and understand the factors associated with low MUAC.

Methods

Data for these analyses are from a rolling pregnancy cohort (n=1675) being conducted in 17 Village Development Committees (VDCs) in the Banke District of Nepal. At recruitment (pregnancy), one venous blood sample was collected from each pregnant woman along with anthropometry (weight, height, mid upper arm circumference), health measurements (hemoglobin, blood pressure, recent illness), information on maternal education and socio‐economic status. A wealth index was constructed using principal components analysis. A cut‐off of 23 cm or less was used to define low MUAC. Descriptive statistics and bivariate correlation analysis were conducted. Multivariate linear regression analyses were conducted. All analyses were conducted with Stata® SE version 14.

Results

Key demographic characteristics included mean years of schooling ± SD (4.77± 4.94) and age (23.6 ± 4.77) with 20% under the age of 20. At recruitment 66% were in their second trimester while 19% and 14% were in their first and third trimesters, respectively. The mean MUAC was 24.2 ± 2.55 cm, while prevalence of low MUAC was 33.4%. Bivariate Pearson correlations showed significant positive relationships between MUAC and age (p=0.000), wealth (p=0.000), years of schooling (p=0.0003) attending ante natal visits (p=0.01), access to improved toilets (p=0.000), first pregnancy (p=0.0000), consumption of dairy (p=0.0054), meat (p=0.0054) and vitamin A rich fruits and vegetables (p=0.01). Besides these co‐variates, the linear regression model included geographic location (VDC), marital status, religion (and ethnicity), trimester, access to iron supplementation, received deworming, improved water source and household food security with mean MUAC as a dependent. Age, education and wealth were significantly associated with better MUAC. Women in the richest category had significantly higher MUAC (cm) than women in the poorest category (β=0.581, p=0.017) while women with primary (β=0.69, p=0.000), secondary (β=0.64, p=0.001) or greater than secondary education (β=0.67, p=0.013) had significantly higher MUAC. Women under 20 had significantly lower MUAC compared to all the other age groups.

Conclusion

In Nepal, wealth, age and women's education were associated with a higher mean MUAC in pregnancy. Location and ethnicity interaction was significant and strongly correlated. MUAC in women was not found to be associated with other individual or household level factors.

Support or Funding Information

This study is supported by the USAID Feed the Future Innovation Lab on Nutrition, USAID Bureau of Food Security and USAID Nepal Mission.