Reading a MUAC band: what green, yellow and red mean
A MUAC band is a strip of plastic tape that measures around a child's upper arm, and the colour it stops on tells you how much muscle and fat that arm still carries. Measure the left arm at the point halfway between the tip of the shoulder and the tip of the elbow, with the arm hanging loose and relaxed at the child's side, and read the colour with the band flat against the skin and not denting it. Green means the child is not acutely malnourished today, yellow means the child is thinning and needs a health worker told as well as more and thicker food, and red means acute malnutrition that needs a health worker the same day.
- Measure the left arm, midway between the point of the shoulder and the point of the elbow, with the arm hanging loose.
- Green is a pass for today only. Malnutrition can arrive between one harvest and the next, so measure again next month.
- Yellow means two things at once: tell your village health team member or go to the facility, and start feeding the child more often and more thickly at home.
- Red means going to the health facility that day, not at the weekend and not after the garden work is finished.
- Always press both feet as well. A swollen child can measure green and still be seriously ill.
General information, not medical advice. If you are worried about a mother or a child, go to your nearest health facility or speak to your village health team.
What the band is actually measuring
When a child is not getting enough to eat, the body burns the fat and then the muscle on the limbs before it touches anything it needs more. The upper arm loses that flesh early and visibly, which is why a simple strip of tape around it works as a warning.
Weight on its own is harder to read. A child who has grown taller and lost flesh can weigh the same as last month, and a scale tells you little without a chart and a birth date the household may not have. The arm needs neither.
The band is used for children from about six months old until they are around five. Below six months the arm is too small for the reading to mean much, and a baby that age should be assessed a different way.
How to measure an arm so the reading is honest
Most wrong readings come from a band pulled too tight, a band left too loose, or the wrong point on the arm. Take the extra thirty seconds. A false green sends a sick child home.
Work through it in this order every time, on every child, so it becomes something your hands do without thinking.
- 01Sit the child on the lap of whoever brought them, facing sideways so the left arm is free.
- 02Push the sleeve right up. A jumper sleeve rolled once will still add a false centimetre.
- 03Bend the arm to a right angle and find the halfway point between the bony tip of the shoulder and the tip of the elbow. Mark it with a thumb.
- 04Let the arm hang straight and loose down the side of the body. A held-up arm tenses the muscle and reads high.
- 05Wrap the band round at the mark, flat against the skin, all the way round with no twist.
- 06Pull until the tape sits against the skin without denting it, then read the colour in the window while the band is still on the arm.
- 07Say the colour out loud to the person holding the child, and write it down before you move to the next child.
What green means, and why you measure again anyway
Green means this child does not have acute malnutrition today. It does not mean the child is well fed, and it does not mean you can skip the next screening.
A child can go from green to red inside two months if the household runs out of food, if a mother is ill, or if a bout of diarrhoea keeps the child off food for a week. The gap between harvests is the usual time it happens.
So a green child gets the same next step as everyone else: come back to the parish screening next month. If the household has other worries, a father who has gone, a mother expecting again, a child who is off food, say so at the screening rather than waiting for the arm to change colour.
What yellow means, and what to do the same week
Yellow is moderate acute malnutrition. The child is thinning, and thinning is not something a household watches on its own. A yellow reading means telling your village health team member or taking the child to the health facility, and it means changing how the child is fed at home. It is both of those, not one instead of the other, and neither of them waits for next month.
Tell the health worker first because the band cannot see what they can. An untreated infection, swelling, a mother too ill to feed properly, or a child who is not receiving their share at home will all keep a child in the yellow however good the cooking is, and all of them are found by somebody asking questions and looking at the child. The health worker also decides whether this child needs treatment now or a closer eye, and says when the arm should be measured again.
The feeding work alongside that is more meals and thicker ones, not different food. A child of this age needs to eat more often than an adult, and a thin porridge fills a small stomach with water rather than food. Our guide on building a balanced plate from food that grows nearby sets out the cheapest things to stir into a pot you are already cooking.
Go back sooner than whatever date you were given if the child stops eating, falls ill, or the band drops to red. A yellow child who is still yellow at the next measurement is not a household that has failed. It is a child who needs somebody to look harder, and that is a reason to be seen again rather than to try the same month over.
What red means, and why the same day matters
Red is severe acute malnutrition. A child in the red has very little reserve left, and the ordinary illnesses of a village, malaria, diarrhoea, a chest infection, are far more dangerous to them than to the child next door.
Red means going to the health centre that day. Field officers hear the same answer often, that the household will bring the child after the weekend, and the weekend is where children in the red are lost.
The reason is almost never that the household does not care. It is the fare, or no rider, or nobody free to make the journey, and each of those has somebody who can help with it. Start with your village health team member, because that is the person who knows what exists near you and who can get word to the facility that a child is coming. If the fare is the problem and you are in a savings group, this is exactly what the social fund is kept for, a child who needs a boda to the health centre at an awkward hour. If the group is not yours, the LC1 chairperson is the next person to ask, and after that a neighbour with a vehicle or a rider who lives in your village.
Ask out loud rather than deciding privately that it cannot be done, and say plainly what the matter is: the child's arm has measured red and the child has to be seen today. People find money and a ride much faster when they know what is being asked and why.
At the facility a health worker will measure the arm again, weigh and measure the child, check for swelling and for danger signs, and usually offer a small taste of therapeutic food to see whether the child still has an appetite. What happens next depends on that. A child who is eating and has no complications is normally treated from home with weekly checks. A child who refuses food, or who is also sick, is referred for inpatient care.
Why the arm can lie: checking for swelling
There is one form of severe malnutrition where the child looks fuller rather than thinner. Fluid collects in the body, the face rounds out and the feet puff up, and the arm can measure green while the child is seriously ill.
The check takes ten seconds. Press a thumb firmly on the top of both feet and hold it there while you count slowly to three, then lift. If a dent stays behind in the skin on both feet, that is the sign. One foot alone can be an injury or an insect bite. Both feet together is different.
A child with that sign goes to the health facility the same day whatever the band said. Do not wait to see if it goes down overnight.
Where screening happens, and who does it
Our teams run mid-upper arm circumference screening at parish level each month, alongside the village health team members who already know which households have young children. It is deliberately close to home, because a screening that needs a boda fare is a screening half the parish misses.
Village health team members carry bands and can measure a child between sessions. So can a parent. There is nothing clinical about the measurement itself, and a mother who measures her own children at the start of each month will find a change earlier than a screening that comes round every thirty days.
What a band cannot do is treat anybody. The value of measuring at home is that it turns a vague worry into a colour you can take to a health worker, and it gives you a date to compare against.
What usually goes wrong on a screening day
Rain empties a screening. In the wet season, a parish site that is a twenty-minute walk in March becomes an hour in April with a child on your back, and the households furthest out are the ones with the thinnest children. If your village is far, ask the village health team member to carry a band and measure at home.
Children cry and pull the arm away, and a tired screener starts reading fast. If a child is fighting, feed them or let them settle on the mother's lap for a minute rather than forcing an arm straight. A struggling child gives a tight, false reading.
The last common problem is a green reading that nobody believes. If the band says green and the child looks unwell, thin around the ribs, listless, off food, trust your eyes and take the child to be seen. The band is a screening tool, not a verdict.
This guide describes what generally happens, not what will happen at your facility or your school. Costs, timetables and rules differ between districts and they change. Check anything that matters with your health worker, the head teacher, or your district office. If something here is wrong or out of date, tell us and we will correct it.
Questions people ask
- My child measured green but is clearly thin. What now?
- Take the child to a health worker anyway. The band only catches one kind of problem, and a child who is thin, slow, off food or swollen needs to be looked at properly. Mention the reading and the date when you go, because it is still useful information.
- Can I measure a baby under six months with the band?
- No. The arm is too small for the reading to be reliable at that age. A baby who is not gaining weight, not feeding well or not producing wet nappies should be seen at the health facility, and the health worker will assess them a different way.
- Does a fat arm mean my child is eating well?
- Not on its own. The band tells you the child is not acutely malnourished, which is not the same as well fed. A child living mostly on cassava or matoke can measure green and still be short for their age and often ill, because energy is not the only thing a growing body needs.
- We only have one band in the village. Is that a problem?
- One band is enough for a village if people take turns with it. Wipe it between children, keep it out of the sun, and replace it when the printing wears or the plastic cracks, because a stretched or faded band gives false readings. Ask your village health team member where to get another.
- My child was treated last year and is now yellow again. Why?
- Relapse is common, and it usually means the household situation that caused it the first time has not changed, not that the treatment failed. Take the reading to a health worker and tell them the child was treated before, because that sentence changes how quickly the child is seen. A child who has been treated once should be watched more closely, not less.