Comparison of Weight-for-Height Z-score and mid-upper arm circumference to diagnose moderate and severe acute malnutrition in children aged 6-59 months

Abstract

Objective: To compare weight for height (WHZ) and mid upper arm circumference (MUAC) to diagnose malnutrition in children aged 6–59 months and to determine the association of various risk factors with the nutritional status of the children.
 Methods: Descriptive study conducted at the Department of Paediatric Medicine of The Children’s Hospital Lahore from May 2017 to April 2018. A total of 257 children 6 to 59 months of age having MUAC of <125mm were included. WHZ scoring was done and compared with MUAC.
 Results: There was slight male predominance 135 (52.5%). Mean age of children was 13.43 + 8.81 months (95% CI: 12.34-14.51). Mean MUAC was 103±13.5 mm (95%CI: 101-105mm). Exclusive breast feeding was present in 82 (32%). Maternal illiteracy was common in SAM (p = was 0.001). More children (73.2%) were identified as SAM by MUAC of <115 mm as compared to WHZ of <-3SD (70%). The ROC curve analysis for MUAC (cut-off value:103, 95%CI; AUC: 101-107 mm) showed it as an excellent predictor (p=<0.001) for children having SAM and WHZ <-3SD, with (AUC= 0.786 [95%CI; 0.725-0.848]).
 Conclusion: Both MUAC and WHZ showed fair degree of agreement to diagnose moderate and severe acute malnutrition among children aged 6–59 months. At the community level of resource limited countries, MUAC can be used as an appropriate rapid diagnostic method to identify malnourished children to be managed in nutritional rehabilitation programs.
 How to cite this:Bari A, Nazar M, Iftikhar A, Mehreen S. Comparison of Weight-for-Height Z-score and mid-upper arm circumference to diagnose moderate and severe acute malnutrition in children aged 6-59 months. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.45
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Patterns of maternal nutritional status based on mid upper arm circumference

“…Our two third mother were illiterate and our results are supported by a research from Pakistan in which 53% mothers were illiterate and this illiteracy had significant contribution in the nutritional status of child (p=0.01). 19 Similarly a study from Ethiopia showed that 63% of women had no formal school education. 20 It is not astonishing to see that illiteracy is prevalent in all resource poor countries as 58% mothers were illiterate shown in a study from Nigeria.…”

Concordance Between Indices of Malnutrition: Mid-Upper Arm Circumference V/S Weight for the Height Z Score in Different Age Groups in Karachi, Pakistan

“…On the contrary, this paper found literature with differing findings of AUC from the ROC curve of 0.94 and 0.95 in 6-12 months and 12-24 month infants showing excellent MUAC diagnostic ability [ 13 ]. One study from Lahore and one from India, with a value of AUC of 0.78 calculated under a ROC curve of MAUC <11.5 cm at age 6-60 months, showed good predictability [ 15 - 16 ].…”

“…A study in Southern Ethiopia found a fair agreement between MUAC and WHZ scores but results were varying in different age groups [ 21 ]. One study in Pakistan found MUAC as a more useful diagnostic tool as compared to WHZ [ 16 ]. A study conducted in Sudan gave opposite results, concluding that WHZ was a better method for the diagnosis of SAM [ 22 ].…”

Comparison of Mid-Upper-Arm Circumference and Weight-For-Height Z-Score in Identifying Severe Acute Malnutrition among Children Aged 6–59 Months in South Gondar Zone, Ethiopia

“…A study in Southern Ethiopia indicated a nonsignificant difference in the prevalence of SAM based on MUAC and WHZ [ 23 ]. However, a study in Pakistan identified more children with SAM by MUAC compared to WHZ [ 20 ]. Moreover, two studies in Niger reported that more cases were identified using MUAC than WHZ [ 24 , 40 ].…”

“…Even if both WFH and MUAC can identify children with SAM [2], there are arguments about which may identify more SAM cases. Some studies have reported that a relatively similar magnitude of acutely malnourished children are identified if MUAC or WHZ is used [2,[15][16][17][18][19][20], while other studies reported that more SAM cases are identified if WHZ is used than MUAC [21,22]. On the other hand, more SAM cases were reportedly detected if MUAC was used rather than WHZ [23].…”