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

Abstract

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

Severely malnourished children with a low weight-for-height have similar mortality to those with a low mid-upper-arm-circumference: II. Systematic literature review and meta-analysis

“…The 21 datasets’ characteristics are shown in Table 1 and the derived mortality data in Table 2 [ 16 , 36 , 39 – 41 , 44 – 58 ]. A brief description and comments on each study are given in Additional file 2 .…”

Mid-Arm Circumference and All-Cause, Cardiovascular, and Cancer Mortality among Obese and Non-Obese US Adults: the National Health and Nutrition Examination Survey III

“…demonstrated that arm muscles have better insulin sensitivity and higher insulin-mediated glucose clearance than leg muscles 28 . Thirdly, diminished nutrition or severe malnourishment, which is directly proportional to MAC, can be linked to an increase in the risk of mortality among infants and children 29–31 . Therefore, it is important to detect malnutrition early, and MAC may be an efficacious and non-invasive tool to assess nutritional status and identify subjects with a high risk of death.…”

Effectiveness of Albendazole for Hookworm Varies Widely by Community and Correlates with Nutritional Factors: A Cross-Sectional Study of School-Age Children in Ghana

“…38 Mid-upper arm circumference (MUAC) was measured for all participants to the nearest 0.1 cm at the midpoint of the left arm using a standardized tape ribbon. 39,40 Hookworm diagnosis and treatment. Children were asked to provide a fresh, morning fecal sample in a previously provided clean plastic cup.…”