Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children

Abstract

The World Health Organization and UNICEF define non-oedematous severe acute malnutrition (SAM) either by a mid-upper arm circumference (MUAC) less than 115 mm or by a weight-for-height z-score (WHZ) less than -3. The objective of this study was to assess whether there was any benefit to identify malnourished children with a high risk of death to combine these two diagnostic criteria. Data of a longitudinal study examining the relationship between anthropometry and mortality in rural Senegal and predating the development of community-based management of SAM were used for this study. First, the receiver operating characteristic (ROC) curves of MUAC and of WHZ to predict mortality were drawn, and then the points corresponding to WHZ less than -3 and/or MUAC less than 115 mm were positioned in relation to these curves. MUAC had the highest ROC curve, which indicates that it identifies high-risk children better than WHZ. Both points representing WHZ less than -3 and/or MUAC less than 115 mm were below the MUAC ROC curve. It is concluded that to identify high-risk malnourished children, there is no benefit in using both WHZ less than -3 and/or MUAC less than 115 mm, and that using MUAC alone is preferable.

Figure 1

Receiver operating characteristic curves of MUAC and WHZ and combinations of WHZ ≤−3 and/or MUAC <115 mm. The two vertical dotted lines represent WHZ = −3 (left) and MUAC = 115 mm (right). MUAC, mid‐upper arm circumference; WHZ, weight‐for‐height z‐score.