Abstract
Background: There is an increasing recognition of malnutrition among infants under 6 mo of age (U6M). Current diagnosis criteria use weight-for-length z scores (WLZs), but the 2006 WHO standards exclude infants shorter than 45 cm. In older children, midupper arm circumference (MUAC) predicts mortality better than does WLZ. Outcomes may also be influenced by exposure to HIV and size or gestational age at birth. Diagnostic thresholds for WLZ, MUAC, and other indexes have not been fully evaluated against mortality risk among U6M infants.Objective: The aim was to determine the association of anthropometric indexes with risks of inpatient and postdischarge mortality among U6M infants recruited at the time of hospitalization.Design: We analyzed data from a cohort of U6M infants admitted to Kilifi County Hospital (2007–2013), Kenya. The primary outcomes were inpatient death and death during follow-up over 1 y after discharge. We calculated adjusted RRs for inpatient mortality and HRs for postdischarge mortality for different anthropometric measures and thresholds. Discriminatory value was assessed by using receiver operating characteristic curves.Results: A total of 2882 infants were admitted: 140 (4.9%) died in the hospital and 1405 infants were followed up after discharge. Of these, 75 (5.3%) died within 1 y during 1318 child-years of observation. MUAC and weight-for-age z score (WAZ) predicted inpatient and postdischarge mortality better than did WLZ (P < 0.0001). A single MUAC threshold of <11.0 cm performed similarly to MUAC thresholds that varied with age (all P > 0.05) and performed better than WLZ <−3 for both inpatient and postdischarge mortality (both P < 0.001). Reported small size at birth did not reduce the risk of death associated with anthropometric indexes.Conclusions: U6M infants at the highest risk of death are best targeted by using MUAC or WAZ. Further research into the effectiveness of potential interventions is required.
Highlights
Infancy represents a period of transition from neonatal life to childhood during which there is rapid growth, neurological and immunologic development, and changes in the mode of feeding
332 were missing data on $1 anthropometric measurements: 320 were missing weight-for-length z scores (WLZs), 249 were missing length-for-age z score (LAZ), 106 were missing midupper arm circumference (MUAC), and 63 were missing weight-for-age z score (WAZ), often because infants were too sick to measure at admission
Adjusted for age and HIV, the RRs of inpatient mortality associated with missing anthropometric indexes were as follows: 3.04, 5.02, 3.11, and 3.56 for WLZ, WAZ, LAZ, and MUAC, respectively
Summary
Infancy represents a period of transition from neonatal life to childhood during which there is rapid growth, neurological and immunologic development, and changes in the mode of feeding. The diagnosis of SAM in this age group is based on WLZ, with the use of the same thresholds as for older children. Anthropometric criteria for SAM are traditionally based on the association with the risk of subsequent mortality, ideally in an untreated population [10]. Midupper arm circumference (MUAC) is more discriminatory for mortality than is WLZ [11]. Midupper arm circumference (MUAC) predicts mortality better than does WLZ. Diagnostic thresholds for WLZ, MUAC, and other indexes have not been fully evaluated against mortality risk among U6M infants. Objective: The aim was to determine the association of anthropometric indexes with risks of inpatient and postdischarge mortality among U6M infants recruited at the time of hospitalization. MUAC and weight-for-age z score (WAZ) predicted inpatient and postdischarge mortality better than did WLZ (P , 0.0001).
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