Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6–24 months in Niger
Nutrition Research and Practice
;
: 247-255, 2019.
Article
in English
| WPRIM
| ID: wpr-760604
ABSTRACT
BACKGROUND/OBJECTIVES:
Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6–24 months with global (GAM) or severe acute malnutrition (SAM). SUBJECTS/METHODS:
Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < −2, MUAC < 12.5 cm) and SAM (WHZ < −3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion.RESULTS:
Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%).CONCLUSIONS:
The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < −3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Arm
/
Mass Screening
/
Global Health
/
ROC Curve
/
Mortality
/
Sensitivity and Specificity
/
Malnutrition
/
Diagnosis
/
Severe Acute Malnutrition
/
Niger
Type of study:
Diagnostic study
/
Practice guideline
/
Prevalence study
/
Prognostic study
/
Risk factors
/
Screening study
Limits:
Child
/
Humans
Country/Region as subject:
Africa
Language:
English
Journal:
Nutrition Research and Practice
Year:
2019
Type:
Article
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