Nutritional status of children: validity of mid-upper arm circumference for screening undernutrition.

OBJECTIVES: To determine the nutritional status and validity of mid upper arm circumference (MAC) in diagnosing malnutrition among preschool children. DESIGN: Cross-sectional household survey. SETTING: 47 villages in District Ambala, Haryana. SUBJECTS: 3747 children aged less than six years. METHODOLOGY: Trained field workers recorded age, weight, length/ height and MAC of children. Prevalence of underweight, stunting, and wasting were calculated in reference to National Centre for Health Statistics (NCHS) standards. Sensitivity and specificity of MAC for detecting underweight, wasting and stunting among children aged 1 to 4 years were determined. RESULTS: At the cut-off level of < -2.00 SD of Z-scores, 48.8% children were stunted, 49.6% were underweight and 9.1% were wasted whereas 47.6% children had neither wasting nor stunting. Prevalence of severe stunting, underweight, and wasting (Z-score < -3 SD) was 18.1%, 11.5% and 0.6%, respectively. Undernutrition showed a significant rise after 12 months of age (p < 0.0001). Stunting and underweight were significantly more among girls compared to boys (p < 0.01) but wasting was not significantly different in them. Compared to the conventional MAC cut off levels of < 13.5 cm and < 12.5 cm, sensitivity and specificity in our setting were optimum at < 13.5 cm for detection of wasting and < 14.0 cm for diagnosis of underweight and stunting, and < 13.0 cm for detection of severe wasting and < 13.5 cm for diagnosis of severe underweight and severe stunting. CONCLUSIONS: Almost every second child was undernourished. Optimum cut off level of MAC in our setting were higher than the conventional cut off points for detection of undernutrition among children.

Participation of health workers, school teachers and pupils in the control of rheumatic fever: evaluation of a training programme.

In a rural community block of north India we initiated a programme for control of rheumatic fever and rheumatic heart disease (RF/RHD). This included a training campaign for all 74 health workers, 773 school teachers and 12,500 older pupils (class V to X) to enable them to suspect and refer cases of RF/RHD and counsel them about secondary prophylaxis. Training material was used by project staff, medical officers and teachers to convey that this serious disease with onset between 5 and 15 years can be recognized by four simple criteria: fever with joint pain or swelling; breathlessness and fatigue; involuntary face and limb movements. One year later we evaluated awareness generated by training by administering a questionnaire to random samples in the intervention area and in a noncontiguous control area. Health workers, teachers and pupils of the intervention block were significantly better aware of the nature, severity and presentation of the disease and reported having recognized cases whom they had referred for diagnosis, prophylaxis and counselled for follow up. We conclude that a training protocol incorporating simple messages can effectively create practical awareness for RF/RHD control among teachers, health workers and pupils in a rural community.