Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2014 Jul 1;9(7):e101159.
doi: 10.1371/journal.pone.0101159. eCollection 2014.

Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

Arnaud Laillou  1 , Sophonneary Prak  2 , Richard de Groot  3 , Sophie Whitney  4 , Joel Conkle  1 , Lindsey Horton  5 , Sam Oeurn Un  1 , Marjoleine A Dijkhuizen  6 , Frank T Wieringa  7
Affiliations
Practice Guideline

Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

Arnaud Laillou et al. PLoS One. .

Abstract

Background: Timely treatment of acute malnutrition in children <5 years of age could prevent >500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm Circumference (MUAC) of <115 mm to identify severe acute malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ).

Methods: Secondary data from >11,000 Cambodian children, obtained by different surveys between 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ.

Findings: The secondary analysis showed that using the current WHO cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score (WHZ) <-3 would have been missed. Reversely, WHZ<-3 missed 80% of the children with a MUAC<115 mm.

Conclusions: The current WHO cut-off for screening for SAM should be changed upwards from the current 115 mm. In the Cambodian data-set, a cut-off of 133 mm would allow inclusion of >65% of children with a WHZ<-3. Importantly, MUAC and WHZ identified different sub-groups of children with acute malnutrition, therefore these 2 indicators should be regarded as independent from each other. We suggest a 2-step model with MUAC used a screening at community level, followed by MUAC and WHZ measured at a primary health care unit, with both indicators used independently to diagnose severe acute malnutrition. Current guidelines should be changed to reflect this, with treatment initiated when either MUAC <115 mm or WHZ<-3.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. ROC curve of the MUAC score in against WHZ<-2SD.
Figure 2
Figure 2. ROC curve of the MUAC score in against WHZ<-3SD.
Figure 3
Figure 3. Two-step screening procedure for severe acute malnutrition at community level.
Figure 4
Figure 4. MUAC-for-Age Z-scores according to the gender (boys and girl) from WHO anthropometric database in comparison to a single cut-off of 13.3 cm.
See this image and copyright information in PMC

References

    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382 (9890): 427–51. - PubMed
    1. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382 (9890): 452–77. - PubMed
    1. WHO (2013) Guideline: updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization. - PubMed
    1. Collins S, Dent N, Binns P, Bahwere P, Sadler K, et al. (2006) Management of severe acute malnutrition in children. Lancet 368 (9551): 1992–2000. - PubMed
    1. Briend A, Maire B, Fontaine O, Garenne M (2012) Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children. Matern Child Nutr 8(1): 130–3. - PMC - PubMed

Publication types