Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score

Sheila Isanaka,Kerstin Hanson,Amy S Labar,Celine Langendorf,Benjamin Guesdon,Rebecca F Grais,Claudio Romero Farias Marinho

doi:10.1371/journal.pone.0137606

Abstract

ObjectivesDebate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics.MethodsUsing secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes.ResultsWe found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program.ConclusionsA single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.

Highlights

It is estimated that 34 million children under the age of 5 each year are affected by severe acute malnutrition (SAM), a condition associated with significant increased risks of mortality and morbidity [1, 2]
Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of mid-upper arm circumference (MUAC)< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion
We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program

Summary

Introduction

It is estimated that 34 million children under the age of 5 each year are affected by severe acute malnutrition (SAM), a condition associated with significant increased risks of mortality and morbidity [1, 2]. In 2007, a joint United Nations statement endorsed a new model for the management of SAM that combines outpatient treatment with ready-to-use therapeutic foods (RUTF) for uncomplicated cases and inpatient treatment for complicated cases [3]. This model has been shown to be both effective [4, 5] and cost-effective [6,7,8], with the potential to bring life-saving treatment to millions of children. Up to 63–79% of children currently recommended for therapeutic feeding with WHZ < -3 and/or MUAC < 115 mm would not be eligible if using MUAC < 115 mm alone for admission [10, 17, 18]

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Conclusion