The optimal mid-upper-arm circumference cutoffs to screen severe acute malnutrition in Vietnamese children

Hai, Tran Thi; Bardosono, Saptawati; Wiradnyani, Luh Ade Ari; Hop, Le Thi; Hoang, N.T.D.; Phuong, Huynh Nam

doi:10.3934/publichealth.2020016

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…In Vietnam, a study involving 4764 infants aged 6-59 months without medical issues found that the ideal MUAC cut-off point was less than 135 mm. This cut-off point had a sensitivity of 65% and specificity of 72%, with an AUC (area under the curve) value of 0.72 27 .…”

Section: Discussionmentioning

confidence: 99%

Akurasi Mid Upper Arm Circumference (MUAC) dalam Mendeteksi Malnutrisi Akut pada Anak di bawah 5 Tahun : A Literature Review

Ariza,

Nadhiroh,

Willmart

2023

AMNT

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Latar Belakang: Deteksi awal kasus malnutrisi akut secara akurat, penting untuk mencegah kematian. Penggunaan Mid Upper Arm Circumference (MUAC) dapat menjadi alternatif, namun keakuratannya masih terus digali sebab ditemukan banyak perbedaan hasil penelitian. Tujuan: Penulisan literature review ini bertujuan untuk mengidentifikasi akurasi (sensitivitas dan spesifisitas) serta cut-off optimal MUAC dalam mendeteksi malnutrisi akut pada anak di bawah 5 tahun. Metode: Pencarian artikel menggunakan dua pangkalan data elektronik yaitu Google Scholar dan Pubmed dengan kata kunci “MUAC” “children” “acute malnutrition”. Penyeleksian dilakukan berbasis pertanyaan “Bagaimana sensitivitas dan spesifisitas MUAC dalam mendeteksi malnutrisi akut pada anak dibawah 5 tahun” dengan kriteria inklusi yaitu artikel 10 tahun terakhir (2013-2023), dapat diakses penuh serta tidak berbayar, lalu mengecualikan artikel tidak Bahasa Inggris dan jenis review article. Berdasarkan hasil pencarian didapatkan 6 artikel yang layak untuk dilakukan tinjauan lebih lanjut Ulasan: Nilai sensitivitas indikator MUAC yang telah ditetapkan oleh organisasi kesehatan dunia untuk mendeteksi malnutrisi akut lebih kecil dibanding nilai spesifisitasnya. Sensitivitas MUAC terendah dalam mendeteksi malnutrisi akut berat (<11,5cm) maupun sedang (11,5-12,5 cm) ialah di Nepal, yaitu masing-masing 13,6% dan 21%. Berdasarkan hasil analisis menggunakan ROC curve pada masing-masing artikel, ditemukan cut-off optimal MUAC yang bervariasi dalam mendeteksi kasus malnutrisi akut. Kesimpulan: Akurasi cut-off MUAC yang direkomendasikan oleh organisasi kesehatan dunia belum optimal untuk mengidentifikasi malnutrisi akut pada anak dibawah 5 tahun. Oleh karena itu, diperlukan studi lebih lanjut pada setiap negara untuk menetapkan cut-off optimal di wilayahnya sesuai kelompok umur maupun klasifikasi masalah.

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Section: Discussionmentioning

confidence: 99%

Akurasi Mid Upper Arm Circumference (MUAC) dalam Mendeteksi Malnutrisi Akut pada Anak di bawah 5 Tahun : A Literature Review

Ariza,

Nadhiroh,

Willmart

2023

AMNT

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Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children ages 6 to 59 months: Systematic review and meta-analysis

Lambebo¹,

Mezemir²,

Tamiru³

et al. 2023

Nutrition

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Improving case-detection of severe wasting among under-five-year-old children in Timor Leste: A secondary analysis of data from the 2020 national cross-sectional food and nutrition survey

Mutunga,

Chiwile,

de Araujo Moniz

et al. 2024

PLoS ONE

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The World Health Organization recommends using weight-for-height Z-score (WHZ) <-3 or Mid-Upper Arm Circumference (MUAC) <115 mm as independent criteria for diagnosing severe wasting. However, there are several challenges in using the WHZ criterion. As a result, the MUAC (and edema)-only approach for identifying children needing treatment for severe wasting has been developed and is being rapidly scaled-up globally, including in Timor-Leste. But previous studies reported that MUAC<115 mm has poor diagnostic accuracy for detecting children with WHZ<-3. The two options being explored globally for improving the identification of these children in MUAC (and edema)-only programming contexts include expanding MUAC cut-off and the combination of the indicators MUAC and Weight-for-Age Z-score (WAZ). This study explored the accuracy for diagnosing severe wasting (WHZ<-3) of these two options in Timor-Leste. We conducted a secondary analysis of data from the 2020 national Timor-Leste Food and Nutrition Survey. We tested the accuracy of various MUAC cut-offs, and predefined case definitions in five age groups (0–5 months, 6–23 months, 24–59 months, 6–59 months, and 0–59 months). We calculated the standard diagnostic test parameters (sensitivity, specificity, Youden Index, and others) and used the Youden Index as the principal criterion for rating the overall level of accuracy. The sample analyzed comprised 11,056 children with complete information on our key variables (anthropometric data, age, and sex), of whom 52.2% were boys. The age groups 0 to 5 months, 6 to 23 months, and 24 to 59 months represented 9.0%, 33.7%, and 57.3% of the sample, respectively. We found that the optimal diagnostic MUAC cut-off varied across the age groups between 117 mm and 142 mm, with the Youden Index remaining < 55% in all the age groups considered. The use of case definitions combing MUAC and WAZ optimized the identification of children with WHZ<-3. The case definition MUAC<130 mm or WAZ<-3 Z-score had the best diagnostic accuracy in all the age groups except for the 0 to 5 months age group for which the case definition MUAC<110 mm or WAZ<-2 Z-score had the highest Youden Index. Our findings show that it is challenging to significantly improve diagnostic accuracy for identifying children with WHZ<-3 by only expanding the MUAC cut-off in under five Timorese children. However, In settings facing challenges in using WHZ, the combination of MUAC and WAZ indicators offers a promising approach. Further research is needed to confirm the effectiveness of the proposed combination of MUAC and WAZ indicators case definitions in a programmatic context in Timor-Leste, and other similar contexts.

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The optimal mid-upper-arm circumference cutoffs to screen severe acute malnutrition in Vietnamese children

Cited by 4 publications

References 16 publications

Akurasi Mid Upper Arm Circumference (MUAC) dalam Mendeteksi Malnutrisi Akut pada Anak di bawah 5 Tahun : A Literature Review

Akurasi Mid Upper Arm Circumference (MUAC) dalam Mendeteksi Malnutrisi Akut pada Anak di bawah 5 Tahun : A Literature Review

Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children ages 6 to 59 months: Systematic review and meta-analysis

Improving case-detection of severe wasting among under-five-year-old children in Timor Leste: A secondary analysis of data from the 2020 national cross-sectional food and nutrition survey

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