Abstract : Severe malnutrition in children under 5 years is a global health problem due to higher morbidity and mortality. Mid-upper arm circumference (MUAC) and weight-for-height z-score (WHZ) were assessed to detect severe malnutrition. We compared WHZ and MUAC cut off to identify waste among children under 5 years, and WHZ was the gold standard. A cross-sectional study was conducted on pediatric inpatients and outpatients. A total of 99 children ages 6-59 months were recruited. A trained doctor performed anthropometric measurements. Statistical analysis was done by SPSS; results with p values <0,05 is significant. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), Likelihood Ratio (LR) were determined by 2x2 tables. We also used the receiver operator curve (ROC). The mean age of subjects was 2.0 years. The majority of subjects were born by section Caesarea (78,8%). Subjects were diagnosed with cardiovascular disease (29,3%), infection (20,2%), endocrine disturbance (18,2%), operative (9,1%), and other (6,1%). The prevalence of severe malnutrition based on MUAC <11.5 cm was 49,5% and 34.3% based on WHZ <−3. While moderate malnutrition based on MUAC 11.5 – 12.5 cm was 27,3% and 24.4% based on WHZ (-2) – (-3) SD. Sensitivity, specificity, PPV, NPV, LR (+), LR (-) of MUAC <11,5 cm were 59%, 90%, 85%, 69%, respectively. The total area of the ROC curve was 0.765 with accuracy 74%. The MUAC compared to WHZ has good accuracy to identify severe malnutrition in children under five years. A higher cut-off could improve case identification.