Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia

Abstract

Weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) are two independent anthropometric indicators for diagnosing and admitting children with severe acute malnutrition (SAM) for treatment. While severely wasted children are at high risk of mortality, MUAC and WHZ do not always identify the same population of children as having SAM. Understanding how this discrepancy relates to age and sex may provide valuable information for care programmes for children with SAM. Age and sex distribution for differences between children identified as SAM by MUAC and WHZ were examined and the degree of agreement calculated. Children (n = 4297) aged 6–59 months with validated anthropometric measures were recruited from a population-based survey conducted in rural southern Ethiopia. MUAC < 115 mm and WHZ < −3 were used to define severe wasting as per the World Health Organization (WHO) classification. The kappa coefficient (κ) was calculated. There was fair agreement between the MUAC and WHZ definitions of severe wasting in boys (κ = 0.37) and children younger than 24 months (κ = 0.32) but poor agreement in girls (κ = 0.15) and children aged 24 months and above (κ = 0.13). More research is needed on response to treatment and prediction of mortality using different anthropometric measurements in relation to ages and sex of children.

Routinely MUAC screening for severe acute malnutrition should consider the gender and age group bias in the Ethiopian non-emergency context

“…It is accepted and highlighted in the WHO guidelines [14] that MUAC and WHZ indicators identify different categories of malnutrition and therefore different groups of acutely malnourished children. The present study confirms an earlier study from Southern Ethiopia [15] and studies in several other countries [9] that MUAC and WHZ identify different sub-sets of children. Also, our large sample from Ethiopia is highlighting similar findings from Tadess et al [14] in that MUAC characterised a larger proportion of girls and young children as severely malnourished as compared to WHZ.…”

Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

“…MAM is currently defined by two criteria: weight‐for‐height z score (WHZ) between −2 and −3 and/or a mid‐upper arm circumference (MUAC) between 115 and 125 mm (WHO, UNICEF, WFP and UNHCR, ). Whether WHZ‐ or MUAC‐based criteria are more suitable for identifying children in need of treatment is still under debate (Briend et al, ; Grellety & Golden, ; Hossain et al, ; Tadesse, Tadesse, Berhane, & Ekström, ), but children falling under each of the categories have not yet been well characterised, including with regard to their motor and language development. The association of linear and ponderal growth with child development has been reported from several low‐ and middle‐income settings (Adair et al, ; Prado et al, ; Worku et al, ).…”

Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson’s paradox

“…Although the prevalence of SAM (and moderate acute malnutrition - MAM), is about the same in nutritional surveys when diagnosed by MUAC and WHZ, different children are identified by the two criteria with a considerable discordance in individual countries [ 24 – 41 ]. We previously collected data from representative community surveys of children from 47 countries to assess the degree of overlap for SAM and MAM by the two anthropometric criteria, to examine the external validity, the scale and direction of discordance and how it varied by country [ 42 ].…”