Abstract
Anthropometric surveys of children are used to assess the nutritional status of a population. World Health Organization (WHO) recommends that either mid-upper-arm circumference (MUAC) or weight-for-height Z-scores (WHZ) are used to assess acute malnutrition prevalence. However, there are reports from several countries that the two criteria identify different children. In order to examine the external validity of these observations we have compared the direction and degree of discrepancy across countries. Anonymous data were collected from 1832 anthropometric surveys from 47 countries with measured children aged from 6 to 59 months and at least 75 malnourished subjects. The prevalence of total acute malnutrition and severe acute malnutrition was calculated using either absolute-MUAC or WHZ (WHO2006 standards). For each country, the total number of children diagnosed as acutely malnourished by either criterion alone or by both criteria were summed from all the surveys conducted in that country. In all countries a minority of children were diagnosed as malnourished by both criteria. Both the magnitude and direction of the discrepancy varied dramatically between countries with some having most children diagnosed as malnourished by MUAC and others where nearly all the children were diagnosed by WHZ alone. Eight additional countries with insufficient malnourished children were also analysed and they support the conclusions. For all countries examined the discrepancy was not adequately explained by any single hypothesis, such as variation in relative leg to body length. The perceived need for humanitarian intervention can be affected by the measurement chosen to assess the prevalence of malnutrition which will vary from region to region. It is recommended that MUAC measurement be included in all anthropometric surveys and that the two criteria are not alternative measures of the loss of body tissue leading to an increased risk of death, but complementary variables that should both be used independently to guide admission for treatment of malnourished children.
Highlights
Anthropometric surveys of children are used to assess the nutritional status of a population
Overall 16.3 % of children were identified as global acute malnutrition (GAM) by either weight-for-height Z-scores (WHZ) < -2SD or mid-upper-arm circumference (MUAC) < 125 mm and Surveys No Total children Age % 26.5 months Height % 88.5 cm
The move towards using MUAC as the single criterion to admit severely malnourished children for treatment is partly based upon statistical analysis of anthropometric indices against all-cause mortality in community studies over many ensuing months. These analyses show that MUAC has a better sensitivity and specificity than WHZ in predicting subsequent all-cause mortality of the individual child [37]
Summary
Anthropometric surveys of children are used to assess the nutritional status of a population. World Health Organization (WHO) recommends that either mid-upper-arm circumference (MUAC) or weight-for-height Z-scores (WHZ) are used to assess acute malnutrition prevalence. The current definitions of acute malnutrition are based either upon a weight-for-height Z-score (WHZ) below -2 standard deviations of the international reference population (World Health Organization 2006 Growth Standards) or a mid-upper arm circumference (MUAC) lower than 125 mm [7]. These indicators are used independently to define the sum of moderate and severe acute malnutrition, commonly referred to as global acute malnutrition (GAM). The MUAC cut-off points were selected from statistical analysis of nutritional surveys to approximately correspond to the WHZ cut-off points so that the same prevalence of acute malnutrition would be found with each criterion
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