Abstract
The World Health Organization (WHO) recommends the assessment of nutritional recovery using the same anthropometric indicator that was used to diagnose severe acute malnutrition (SAM) in children. However, related empirical evidence from low-income countries is lacking. Non-oedematous children (n = 661) aged 6–59 months admitted to a community-based outpatient therapeutic program for SAM in rural southern Ethiopia were studied. The response to treatment in children admitted to the program based on the mid-upper arm circumference (MUAC) measurement was defined by calculating the gains in average MUAC and weight during the first four weeks of treatment. The children showed significant anthropometric changes only when assessed with the same anthropometric indicator used to define SAM at admission. Children with the lowest MUAC at admission showed a significant gain in MUAC but not weight, and children with the lowest weight-for-height/length (WHZ) showed a significant gain in weight but not MUAC. The response to treatment was largest for children with the lowest anthropometric status at admission in either measurement. MUAC and weight gain are two independent anthropometric measures that can be used to monitor sufficient recovery in children treated for SAM. This study provides empirical evidence from a low-income country to support the recent World Health Organization recommendation.
Highlights
Of 1659 children admitted to the outpatient therapeutic program (OTP), 179 were excluded because ineligible and 355 because their nutritional status was not assessed within seven days of admission
We found that Severe acute malnutrition (SAM) children showed changes in both mid-upper arm circumference (MUAC) and weight measurements following treatment
An average MUAC gain of 0.17 mm/day and weight gain of 1.8 g/kg/day for the children in our cohort compared unfavorably to those reported by other community-based nutritional programs, where the average MUAC and weight gains for children recovering from acute malnutrition varied between 0.2 to 0.52 mm/day [17,33] and 3 to 6.8 g/kg/day [33,34], respectively
Summary
Lower than 115 mm or of weight-for-height/length (WHZ) below the −3 Z score of the WHO standard [2,3,6] as two independent anthropometric criteria for identifying children with SAM for treatment [7]. Both indicators are commonly used in nutritional rehabilitative programs, WHZ and MUAC were shown to identify different sets of children as having SAM [2,8,9,10].
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