Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

Bliss, Jessica; Lelijveld, Natasha; Briend, André; Kerac, Marko; Manary, Mark J.; McGrath, Marie; Prinzo, Zita Weise; Shepherd, Susan; Zagré, Noël Marie; Woodhead, Sophie; Guerrero, Saúl; Mayberry, Amy

doi:10.9745/ghsp-d-18-00105

Cited by 48 publications

(50 citation statements)

References 27 publications

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“…The MUAC measurement was used over weight-for height below − 3 SD of the WHO standards because both of these measures give almost similar prevalence of SAM [3]. MUAC is regarded as a costeffective and easiest method to early detect SAM in children with minimal risk and many potential benefits [34]. We found that only 5.8% of children admitted to the OCCTs were severely malnourished.…”

Section: Discussionmentioning

confidence: 99%

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Ghimire¹,

Aryal²,

Gupta³

et al. 2020

BMC Pediatr

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Background Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal. Methods We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant. Results Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23–12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88–10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06–71.09) children (0–12 vs. 24–59 months). Conclusions The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.

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Section: Discussionmentioning

confidence: 99%

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Ghimire¹,

Aryal²,

Gupta³

et al. 2020

BMC Pediatr

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“…MUAC is clearly an easier and quicker screening tool at community level than weight-for-height. Mothers and health volunteers have shown their capacity of detecting SAM [5] in several countries of Africa with good sensitivity and accuracy [30,31]. Acute malnutrition screening should not be reduced to mortality risk screening but also to prevent morbidity, impaired physical, cognitive development, and associated micronutrient deficiencies [32].…”

Section: Plos Onementioning

confidence: 99%

“…In the latest 2013 guideline for the management of severe acute malnutrition, the World Health Organization (WHO) recommends using Mid Upper Arm Circumference (MUAC) at community level to screen for SAM [4]. A recent meta-analysis published in 2018 [5] supports this recommendation that communities through different platforms could perform routine screenings of young children with MUAC and improve thereby detection of SAM cases. However, over the last years, several papers have highlighted that the current practice to identify children with acute malnutrition, at least in a non-emergency context, can be improved considerably by increasing the current WHO recommended cut-offs for MUAC [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Routinely MUAC screening for severe acute malnutrition should consider the gender and age group bias in the Ethiopian non-emergency context

et al. 2020

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Early identification of children <5 years with severe acute malnutrition (SAM) is a high priority to reduce child mortality and improved health outcomes. Current WHO guidelines for community screening for SAM recommend a Mid-Upper-Arm Circumference (MUAC) of less than 115 mm to identify children with SAM, but this cutoff does not identify a significant number of children with a weight-for-height Z-score <-3. To establish new specific MUAC cutoffs , pooled data was obtained for 25,755 children from 49 SMART recent surveys in Ethiopia (2016-2019). Sensitivity, proportion of false positive, and areas under receiver-operator characteristic curves (AUC) were calculated. MUAC below 115mm alone identified 55% of children with SAM identified with both methodologies. MUAC was worse in identifying older children (21%), those from a pastoral region (42%) and boys (41%). Using current WHO cutoffs , the sensitivity (Se) of MUAC below 115mm to identify the children severly malnourished screened through Weight-for-height below-3 was 16%. Analysing the ROC curve and Youden Index, Se and Specificity (Sp) were maximal at a MUAC < 133 mm cutoff to identify SAM (respectively Se 61.1%, Sp 81.4%). However, given the high proportion of false-positive children, according to gender, region and age groups, a cutoff around 125 mm to screen SAM could be the optimal one. In Ethiopia, implementation of a MUAC-only screening program for the identification of severe acute malnutrition with the actual cutoff of 115 mm would be unethical as it will lead to many children remaining undiagnosed and untreated. In addition, future study on implementation challenge on screening children with a higher cutoff or gender/age sensitive ones should be assessed with the collection of mortality and morbidity data to ensure that the most in need are being taking care of.

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“…The MUAC measurement was used over weight-for height below -3 SD of the WHO standards because both of these measures give almost similar prevalence of SAM [3]. MUAC is regarded as a cost-effective and easiest method to early detect SAM in children with minimal risk and many potential bene ts [34]. We found that only 5.…”

Section: Discussionmentioning

confidence: 97%

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Ghimire¹,

Aryal²,

Gupta³

et al. 2020

Preprint

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Background: Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6-59 months in the two districts of Nepal. Methods: We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centres (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value <0.05 was considered as significant. Results: Out of 398 children, 5.8 percent were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23 - 12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06 - 71.09) children (0 - 12 vs. 24 - 59 months). . Conclusions: The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.

show abstract

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

Abstract: Limited studies suggest that with robust program inputs caregivers and CHWs can correctly use mid-upper arm circumference to detect severe acute malnutrition (SAM) and that properly trained and supported CHWs can treat uncomplicated SAM in communities.

Cited by 48 publications

References 27 publications

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Routinely MUAC screening for severe acute malnutrition should consider the gender and age group bias in the Ethiopian non-emergency context

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

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