Mid‐upper arm circumference and weight‐for‐height to identify high‐risk malnourished under‐five children

Briend, André; Maire, Bernard; Fontaine, Olivier; Garenne, Michel

doi:10.1111/j.1740-8709.2011.00340.x

Cited by 159 publications

(164 citation statements)

References 7 publications

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“…However, the researchers in this study found that of the children with MAM, an acceptable MUAC measurement of > 12.5 cm was found in a large proportion of the sample, despite a WHZ lower than −2 SD having been recorded. This is in line with other international studies which, in conflict with the recommendations by Briend et al 17 and Goossens et al, 18 showed a poor correlation between WHZ and MUAC. 19,20 Thus, the sensitivity of MUAC in screening for MAM in South African populations with high levels of moderate and severe stunting should be questioned.…”

Section: Discussion and Recommendationscontrasting

confidence: 56%

“…However, it was demonstrated from recent data that nurses in the Western Cape had inadequate knowledge of the use of available nutritional status interpretation tools in the Road to Health booklets. 16 Simplifying nutritional screening by using MUAC alone to identify high-risk, malnourished children has been described by Briend et al 17 They found MUAC to be an acceptable screening tool in identifying children with severe acute malnutrition, with no benefit using WHZ in combination with MUAC or MUAC alone. MUAC has also been described by Goossens et al 18 to have many advantages over the use of WHZ.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

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Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Steenkamp

Lategan

Raubenheimer

2016

South African Journal of Clinical Nutrition

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Objectives: The objective of the study was to describe wasting and stunting in children aged 12-60 months, admitted to targeted supplementary feeding programmes for the treatment of moderate acute malnutrition (MAM) in South Africa.Design: A cross-sectional, descriptive study was performed.Subjects and setting: Children with MAM, managed as outpatients at primary healthcare facilities in three provinces, were included in the study conducted between September 2012 and August 2013.Outcome measures: Weight, height and mid-upper-arm circumference (MUAC) measurements were collected to classify the children as moderately or severely stunted or wasted.Results: Of the total sample (n = 225), 13% (n = 30) were diagnosed as wasted, 58% (n = 131) as stunted, and 21% (n = 47) as both wasted and stunted. MUAC was significantly associated with wasting. However, an association was not found between MUAC and stunting. Of the sample, 32% (n = 72) presented with severe stunting, and 29% (n = 65) with moderate wasting. Food insecurity was associated with wasting, but not with stunting. Conclusion:A low weight-for-age z-score resulted more from stunting than from wasting in this study. Severe stunting presented as a greater health concern than moderate wasting. Without scrutinising wasting and stunting, healthcare professionals may remain unaware of the drivers of underweight for age in children treated at South African primary healthcare facilities. Following this study's outcomes, the sensitivity of MUAC in screening for moderate malnutrition in South African settings with a high prevalence of stunting is questionable. It is recommended that current nutritional interventions are revisited to explore the efficacy of treating children with wasting, stunting or both.Peer reviewed.

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Section: Discussion and Recommendationscontrasting

confidence: 56%

Section: Discussion and Recommendationsmentioning

confidence: 99%

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Steenkamp

Lategan

Raubenheimer

2016

South African Journal of Clinical Nutrition

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“…The MUAC cut-off value having the same specificity for predicting death as a combination criterion of either MUAC < 11.5 cm or WHZ below −3 yielded a greater sensitivity. These findings concur with those of a recent secondary analysis of the risk of dying in a community-based data set in rural Senegal 16 and provide further evidence from a different setting that measuring both WHZ and MUAC does not result in improved identification of undernourished children at high risk of dying. Measurement of MUAC only could therefore replace the use of both MUAC and WHZ, depending on the MUAC cut-off value chosen.…”

Section: Discussionsupporting

confidence: 80%

Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya

Mogeni¹,

Twahir²,

Bandika³

et al. 2011

Bull World Health Org

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“…Besides the simplicity of the use of MUAC and the ability to allow for high coverage, these reviews emphasize its superior effectiveness to identify children at high risk of death; they also indicate that there is no benefit in using WHZ < −3 in addition to MUAC < 115 mm as MUAC identifies high-risk children better than WHZ < −3 (12,13) . Moreover, the new global guidance by WHO indicating that MUAC ≥ 125 mm (without oedema for at least two weeks) should be used as discharge criterion for children admitted with MUAC < 115 mm can significantly simplify national protocols, the training and supervision of the staff involved in identifying and treating children, and the overall performance of programmes for the management of SAM (14) .…”

Section: Discussionmentioning

confidence: 99%

Mid upper-arm circumference is an effective tool to identify infants and young children with severe acute malnutrition in India

Aguayo¹,

Aneja

Badgaiyan³

et al. 2015

Public Health Nutr.

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Objective: To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India. Design: The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009)(2010)(2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics. Setting: States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India. Subjects: Children aged 6-59 months with bilateral pitting oedema or weight-forheight Z-score (WHZ) < −3 or MUAC < 115 mm at admission. Results: Children aged 6-23 months represented~80 % of the admissions. Among them, the proportion with WHZ < −3 was similar to that with MUAC < 115 mm (85·7 % v. 81·8 %); the proportion with MUAC < 115 mm whose WHZ was < −3 was 82·6 %; and the proportion with WHZ < −3 whose MUAC < 115 mm was 78·8 %. MUAC < 115 mm was as effective as WHZ < −3 in identifying 6-59-monthold children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC < 115 mm were higher than in children with WHZ < −3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedemafree children were deaths of children with MUAC < 115 mm. Conclusions: In populations similar to those included in our analysis, MUAC < 115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old. Keywords Severe acute malnutritionSevere wasting Mid upper-arm circumference IndiaSevere acute malnutrition (SAM) remains a major killer of children, as mortality rates in children with severe wasting -the most widespread form of SAM -are nine times higher than in well-nourished children (1) . Current global recommendations indicate that children aged 6-59 months with a mid upper-arm circumference (MUAC) <115 mm should be admitted to a programme for the management of SAM (2) . The latest data available indicate that at any point in time, an average of 8 million Indian under-5s (i.e. an estimated 6·4 % of children 0-59 months old) are severely wasted (3,4) . This is the largest pool of severely wasted children worldwide.In this context, India's Ministry of Health has endorsed the use of MUAC < 115 mm as a screening and admission criterion for the management of children with SAM (5) .However, some argue that this cut-off may not be appropriate for Indian children (6) . The objective of our analysis was to assess the appropriateness of current MUAC cut-off values in identifying children with SAM in India in order to inform the future design and implementation of national and state programmes for the provision of care for children with SAM. MethodsOur analysis concerns 6307 children with SAM admitted to nutrition rehabilitation centres (NRC) in the states of Jharkhand, Madhya Pradesh and Uttar Pradesh between 1

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Mid‐upper arm circumference and weight‐for‐height to identify high‐risk malnourished under‐five children

Cited by 159 publications

References 7 publications

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya

Mid upper-arm circumference is an effective tool to identify infants and young children with severe acute malnutrition in India

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