Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

AbstractObjectiveTo investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic criteria are needed to identify children with a high risk of death and in need of treatment.DesignCommunity-based cohort study, following 5751 children through time. Each child was visited up to four times at 6-month intervals. Anthropometric measurements were taken at each visit. Survival was monitored using a demographic surveillance system operating in the study villages.SettingNiakhar, a rural area of the Fatick region of central Senegal.ParticipantsChildren aged 6–59 months living in thirty villages in the study area.ResultsWeight-for-age Z-score (WAZ) and mid-upper arm circumference (MUAC) were independently associated with near-term mortality. The lowest WAZ threshold that, in combination with MUAC, detected all deaths associated with severe wasting or concurrent wasting and stunting was WAZ <−2·8. Performance for detecting deaths was best when only WAZ and MUAC were used. Additional criteria did not improve performance. Risk ratios for near-term death in children identified using WAZ and MUAC suggest that children identified by WAZ <−2·8 but with MUAC≥115 mm may require lower-intensity treatment than children identified using MUAC <115 mm.ConclusionsA combination of MUAC and WAZ detected all near-term deaths associated with severe anthropometric deficits including concurrent wasting and stunting. Therapeutic feeding programmes may achieve higher impact if WAZ and MUAC admission criteria are used.

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Mid-upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia

Bulletin of the World Health Organization ◽

10.2471/blt.12.109009 ◽

2012 ◽

Vol 90 (12) ◽

pp. 887-894 ◽

Cited By ~ 40

Author(s):

Martha K Mwangome ◽

Greg Fegan ◽

Tony Fulford ◽

Andrew M Prentice ◽

James A Berkley

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Elevated Risk ◽

Upper Arm ◽

Infant Vaccination ◽

Risk Of Death ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Routine Infant

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Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Public Health Nutrition ◽

10.1017/s1368980015000737 ◽

2015 ◽

Vol 18 (14) ◽

pp. 2575-2581 ◽

Cited By ~ 20

Author(s):

Emmanuel Grellety ◽

L Kendall Krause ◽

Manal Shams Eldin ◽

Klaudia Porten ◽

Sheila Isanaka

Keyword(s):

Severe Acute Malnutrition ◽

South Sudan ◽

Patient Characteristics ◽

Acute Malnutrition ◽

Upper Arm ◽

Risk Of Death ◽

Risk Of Mortality ◽

Admission Criterion ◽

Arm Circumference ◽

Mid Upper Arm Circumference

AbstractObjectiveThe present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.DesignWe performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6–59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<−3 and MUAC≥115 mm.ResultsOf 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<−3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<−3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<−3 alone and 100 % by MUAC<130 mm.ConclusionsThe study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.

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Using Mid-Upper Arm Circumference to Detect High-Risk Malnourished Patients in Need of Treatment

Handbook of Famine, Starvation, and Nutrient Deprivation ◽

10.1007/978-3-319-40007-5_11-1 ◽

2017 ◽

pp. 1-17 ◽

Cited By ~ 1

Author(s):

André Briend ◽

Martha K. Mwangome ◽

James A. Berkley

Keyword(s):

High Risk ◽

Upper Arm ◽

Arm Circumference ◽

Mid Upper Arm Circumference

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Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age

Public Health Nutrition ◽

10.1017/s1368980016000719 ◽

2016 ◽

Vol 19 (14) ◽

pp. 2513-2520 ◽

Cited By ~ 17

Author(s):

Sakshi Sachdeva ◽

Pooja Dewan ◽

Dheeraj Shah ◽

Rajeev Kumar Malhotra ◽

Piyush Gupta

Keyword(s):

Test Accuracy ◽

Hospitalized Children ◽

Index Test ◽

Care Hospital ◽

Inpatient Mortality ◽

Upper Arm ◽

Risk Of Death ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Children Under 5

AbstractObjectiveTo compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age.DesignDiagnostic test accuracy study.SettingPaediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India.SubjectsHospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome.ResultsOne hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<−3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<−3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually.ConclusionMUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<−3. It should be measured in all emergency settings to identify the children at higher risk of death.

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Nutritional Status and Disease Profile of Under Five Children in a Selected Rural Area

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v12i1.39977 ◽

2016 ◽

Vol 12 (1) ◽

pp. 94-99

Author(s):

Nasrin Sultana ◽

Sumon Chandra Debnath ◽

Rifat Sultana ◽

Shamina Akter ◽

Dewan Shahida Banu ◽

...

Keyword(s):

Nutritional Status ◽

Rural Area ◽

Acute Malnutrition ◽

Z Score ◽

Upper Arm ◽

Under Five ◽

Under Five Children ◽

Risk Of Death ◽

Arm Circumference ◽

Mid Upper Arm Circumference

Introduction: Malnutrition is referred to as the greatest single threat to the world’s public health, especially for the developing countries. Childhood malnutrition is linked to slower cognitive development and serious health impairments later in life that reduce the quality of life of individuals. Nutritional status is determined anthropometrically and is a significant determinant of various types of morbidity and is associated with an increased risk of death from acute respiratory infection, diarrhoea, measles and few other infectious diseases. Objective: To assess nutritional status and disease profile of under five children in a rural area of Bangladesh. Materials and Methods: This cross-sectional study was conducted among 205 children with age between 1 to 59 months who were selected purposively. Two hundred five data were collected by interviewing the mothers of the children and also by reviewing the documents using a pretested semi-structured questionnaire and checklist. Nutritional status was assessed using WHO recommended Z-score category and Mid Upper Arm Circumference measurement. Results: Out of 205 children, more than half (57.6%) were girls and the rest of them were boys. About two-third of the children were aged between 25 and 59 months. Maximum (40.5%) mothers of the children had a background of secondary educational status and most of them (90.2%) were housewives. More than one-third (36.1%) of the respondents belong to families haveing monthly income between Tk. 5001 and 10,000 and the average income was Tk.14,544. About onethird (33.5%) of the children were stunted in Height for Age Z score. While 9.7% were moderately wasted and 1.5% were severely wasted in Weight for Height Z score. 3.8% of the children were severely underweight and 70.8% of the children’s weight was within the normal limit for their age. By Mid Upper Arm Circumference (MUAC) measurement, about 20.0% were of moderate acute malnutrition (MAM) and 1.1% were of severe acute malnutrition (SAM). Among the associated morbidities, diarrhoeal disease had highest prevalence (45%) followed by respiratory tract infection (38%) and pneumonia (18%). Conclusion: Under five children are the vulnerable segment of the population. The result demonstrates a high prevalence of malnutrition (especially stunting) among under five children in the study area. Considering the acute and long-term consequences of malnutrition, interventions aiming at reducing child malnutrition in such a population should focus on all the children of less than 5 years of age. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 94-99

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Mid upper arm circumference as an alternative measure to assess the nutritional status of adolescents: a study in India based on NFHS-4 data

Journal of Biosocial Science ◽

10.1017/s0021932021000298 ◽

2021 ◽

pp. 1-12

Author(s):

Aparna Roy ◽

T. V. Sekher

Keyword(s):

Nutritional Status ◽

Sensitivity And Specificity ◽

Measurement Data ◽

Anthropometric Measurement ◽

Alternative Measure ◽

Upper Arm ◽

Male Adolescents ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

The Relationship

Abstract Use of body mass index (BMI) to assess the nutritional status of adolescents requires many resources, especially for country-level assessment. This study aimed to determine the relationship between BMI and mid upper arm circumference (MUAC) among adolescent males and females in India and to examine whether MUAC effectively represents the nutritional status of adolescents. The study utilized anthropometric measurement data collected by India’s National Family Health Survey-4 (2015–16). The weighted sample for analysis included 91,315 female and 14,893 male adolescents. The BMI and MUAC measurements showed a positive correlation in both female and male adolescents. Using BMI-for-age Z-score classifications, 12.7% of the adolescents were undernourished. Using MUAC (in cm) as per NACS (Nutrition Assessment, Counselling, and Support) guidelines and Mramba et al. (2017) classified 22.9% and 3.7% of the adolescents as undernourished respectively. Finally, using the MUAC-for-age Z-score classification, 98.4% of adolescents were determined to be normal and 1.7% undernourished. Sensitivity and specificity tests of the MUAC cut-offs, in comparison with BMI cut-offs, showed that all three MUAC cut-off classifications had high specificity (NACS cut-off: 81.3%; Mramba et al. cut-off (cm): 97.7%; Mramba et al. cut-off (Z-score): 99.1%). The NACS cut-off had moderately high sensitivity (52.2%) but the Mramba et al. cut-offs had low sensitivity (13.3% for the centimetre cut-off and 6.6% for the Z-score cut-off). Sensitivity and specificity tests proved the relationship between BMI and MUAC, and that MUAC represents adolescent nutritional status with considerable efficiency. With further research, it may be established that MUAC is a better and promising measure of adolescent nutrition, having the advantage of needing fewer resources for data collection. The MUAC has the potential to offer a simple and low-resource alternative to BMI to assess nutritional status among adolescents in poor countries.

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