Mid-upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia

Mwangome, Martha; Fegan, Greg; Fulford, Tony; Prentice, Andrew M.; Berkley, James A.

doi:10.2471/blt.12.109009

Cited by 77 publications

(100 citation statements)

References 39 publications

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“…Our findings contradict the previous suggestion that the MUAC measures body-composition components more directly than does the WLZ (7,32). This contradiction was unlikely to be explained by the younger age of our sample but could have been attributed to the importance of adjusting for length in the analysis as was previously FIGURE 2 Comparison of standardized regression coefficients for predicting the MUAC or WLZ in infants aged 0-6 mo.…”

Section: Discussioncontrasting

confidence: 84%

Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants

Grijalva-Eternod

Wells²,

Girma³

et al. 2015

The American Journal of Clinical Nutrition

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Section: Discussioncontrasting

confidence: 84%

Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants

Grijalva-Eternod

Wells²,

Girma³

et al. 2015

The American Journal of Clinical Nutrition

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“…These results were not changed by the introduction of the 2006 WHO child growth standards [13,14]. This has also been confirmed in children less than 6 months old at the time of vaccination who are in a very narrow age range suggesting the association with mortality is not entirely due to an age effect [15]. The relative utility of MUAC compared to WHZ has been demonstrated in settings as diverse as Bangladesh (in two separate studies) [16,17] Uganda [18] Senegal [13], Democratic Republic of Congo [19] and the Gambia [15].…”

Section: Introductionmentioning

confidence: 67%

Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

et al. 2016

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Background: Severe acute malnutrition (SAM) is currently defined by the WHO as either a low mid-upper arm circumference (i.e. MUAC <115 mm), a low weight-for-height z-score (i.e. WHZ <− 3), or bilateral pitting oedema. MUAC and WHZ do not always identify the same children as having SAM. This has generated broad debate, as illustrated by the recent article by Grellety & Golden (BMC Nutr. 2016;2:10). Discussion: Regional variations in the proportion of children selected by each index seem mostly related to differences in body shape, including stuntedness. However, the practical implications of these variations in relation to nutritional status and also to outcome are not clear. All studies that have examined the relationship between anthropometry and mortality in representative population samples in Africa and in Asia have consistently showed that MUAC is more sensitive at high specificity levels than WHZ for identifying children at high risk of death. Children identified as SAM cases by low MUAC gain both weight and MUAC in response to treatment. The widespread use of MUAC has brought enormous benefits in terms of the coverage and efficiency of programs. As a large high-risk group responding to treatment, children with low MUAC should be regarded as a public health priority independently of their WHZ. Conclusion: While a better understanding of the mechanism behind the discrepancy between MUAC and WHZ is desirable, research in this area should not delay the implementation of programs aiming at effectively reducing malnutrition-related deaths by prioritising the detection and treatment of children with low MUAC.

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“…4 For any given anthropometric measure, a z-score indicates how many standard deviations below or above a reference median an individual value is found. 5 Currently under-nutrition is defined as a z-score of < -2 using the weight-for-height index of the 2006 WHO multicentre growth reference standards, while overweight and obesity is defined as a z-score > 2 either by the weight and height index or the body mass index (BMI) for children 6-59 months in age. 6 Severe acute malnutrition is defined using either WHZ < -3 or MUAC < 11.5 cm, or presence of nutritional oedema irrespective of either criteria.…”

Section: Introductionmentioning

confidence: 99%

Does mid upper arm circumference identify all acute malnourished 6–59 month old children, in field and clinical settings in Nigeria?

Casken

Ocheke

Diala

et al. 2016

South African Journal of Clinical Nutrition

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Objectives:To determine the utility of mid-upper arm circumference (MUAC) in identifying acutely malnourished children compared with weight-for-height (WHZ), body mass index (BMI) for age (BAZ) and MUAC z-score (MUACZ) in clinical and field practice. Design: Cross-sectional study. Setting: Children from immunisation and paediatric outpatient clinics of Jos University Teaching Hospital and two schools in Jos, Plateau state, Nigeria. Subjects: Children 6-59 months with parental consent, and no chronic medical condition or pedal oedema. Outcome measures: MUAC, height and weight were measured. The WHZ, BAZ and MUACZ were determined using the World Health Organisation (WHO) Anthro software 3.0. Prevalence of acute malnutrition was compared between these data and those given by MUAC. The World Health Organisation (WHO) z-score cut-off of < -3 and < -2 and MUAC of ≤ 11.5 cm and 11.6 -12.5 cm was used to define severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. Stata 12SE was used to determine frequency distribution, means and significance. Results: The mean age of subjects was 22.4 ± 15.5 months. The mean MUAC was 14.7 ± 1.5 cm. The MUAC differed between males and females in the age-groups of 6-11 (p = 0.02) and 36-47 (p = 0.006) months. The prevalence of SAM by WHZ was 3.4%, MUAC was 1.5%, BAZ was 4.3% and MUACZ was 1.0%. When compared, WHZ and BAZ were concordant in 77.8% (p = 0.001) of SAM subjects. MUAC and MUACZ indicated that none of the subjects were classified as SAM by WHZ and BAZ. Conclusion: Neither WHZ or MUAC as a single parameter identifies all children with acute malnutrition. A re-definition of MUAC criteria for malnutrition or consistent application of both parameters is required.

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Mid-upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia

Cited by 77 publications

References 39 publications

Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants

Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants

Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

Does mid upper arm circumference identify all acute malnourished 6–59 month old children, in field and clinical settings in Nigeria?

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