evidence-based blog of Filippo Dibari

Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

In Under-nutrition on April 13, 2013 at 8:03 am

Engy Alia, Rony Zachariaha, Zubair Shamsb, Lieven Vernaeveb, Petra Aldersc, Flavio Saliob,  Marcel Manzia, Malik Allaounac, Bertrand Draguezc, Pascale Delchevaleriec and Anthony D. Harries

Trans R Soc Trop Med Hyg (2013)


Objectives Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<–3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.

Methods Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored.

Results Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <–3. Cough was less frequent among those whose nutritional status improved.

Conclusions It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.

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