Victor M Aguayo1, Satinder Aneja2, Nina Badgaiyan1, Karanveer Singh3. 1. 1United Nations Children's Fund (UNICEF),Regional Office for South Asia,PO Box 5815,Lekhnath Marg,Kathmandu,Nepal. 2. 2Department of Pediatrics,Lady Hardinge Medical College,New Delhi,India. 3. 3Child Development and Nutrition Programme,UNICEF,New Delhi,India.
Abstract
OBJECTIVE: To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India. DESIGN: The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics. SETTING: States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India. SUBJECTS: Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission. RESULTS: Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm. CONCLUSIONS: In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old.
OBJECTIVE: To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India. DESIGN: The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics. SETTING: States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India. SUBJECTS:Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission. RESULTS:Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm. CONCLUSIONS: In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old.
Entities:
Keywords:
India; Mid upper-arm circumference; Severe acute malnutrition; Severe wasting
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