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Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Addis Continental Inst Publ Hlth, Dept Publ Hlth Sci, POB 26751-1000, Addis Ababa, Ethiopia..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Addis Continental Inst Publ Hlth, Dept Publ Hlth Sci, POB 26751-1000, Addis Ababa, Ethiopia..ORCID iD: 0000-0002-2030-5309
Addis Continental Inst Publ Hlth, Dept Publ Hlth Sci, POB 26751-1000, Addis Ababa, Ethiopia..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2017 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 9, no 3, article id 267Article in journal (Refereed) Published
Abstract [en]

Weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) are two independent anthropometric indicators for diagnosing and admitting children with severe acute malnutrition (SAM) for treatment. While severely wasted children are at high risk of mortality, MUAC and WHZ do not always identify the same population of children as having SAM. Understanding how this discrepancy relates to age and sex may provide valuable information for care programmes for children with SAM. Age and sex distribution for differences between children identified as SAM by MUAC and WHZ were examined and the degree of agreement calculated. Children (n = 4297) aged 6-59 months with validated anthropometric measures were recruited from a population-based survey conducted in rural southern Ethiopia. MUAC < 115 mm and WHZ < 3 were used to define severe wasting as per the World Health Organization (WHO) classification. The kappa coefficient (kappa) was calculated. There was fair agreement between the MUAC and WHZ definitions of severe wasting in boys (kappa = 0.37) and children younger than 24 months (kappa = 0.32) but poor agreement in girls (kappa = 0.15) and children aged 24 months and above (kappa = 0.13). More research is needed on response to treatment and prediction of mortality using different anthropometric measurements in relation to ages and sex of children.

Place, publisher, year, edition, pages
MDPI AG , 2017. Vol. 9, no 3, article id 267
Keywords [en]
MUAC, WHZ, severe acute malnutrition, agreement, age, sex and children
National Category
Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-320872DOI: 10.3390/nu9030267ISI: 000397023600086OAI: oai:DiVA.org:uu-320872DiVA, id: diva2:1091161
Funder
Sida - Swedish International Development Cooperation Agency, SWE-2010-179Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2018-04-08Bibliographically approved
In thesis
1. Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
Open this publication in new window or tab >>Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The current recommended standard management for all children with severe acute malnutrition (SAM) is Community-based Management of Acute Malnutrition (CMAM). CMAM has a community-based outpatient therapeutic program (OTP) to treat uncomplicated SAM and has been scaled-up and integrated with government health services in low-resource settings. How-ever, the context in which such large-scale programs are implemented modifies their effective-ness. This study aims at assessing factors of importance for the effectiveness of management of SAM in the community.

A population-based survey of households with children aged under five years and a longitu-dinal study among children admitted to the integrated OTPs of rural Southern Ethiopia was undertaken. For Study I, children aged 6-59 months (n=4,297) from randomly selected house-holds were examined for differences between children identified as SAM by MUAC and WHZ. For Study II, subsets of 1,048 children admitted to OTPs were analyzed for program outcome and nutritional status at discharge (n=759) and 14 weeks after admission (n=991). For Study III, non-oedematous children (n=661) admitted to OTPs were analyzed for gains in anthropo-metric measures after 4 weeks of treatment. For Study IV, children with SAM (n=788) were studied in terms of factors of importance for their recovery. Home-visits were used to collect data and anthropometry was measured following standardized World Health Organization (WHO) techniques.

The degree of agreement between the two anthropometric indicators of severe wasting dif-fered depending on the sex and age of the children. The indicators’ response to treatment varied according to the indicator used to define SAM at admission. While 32.7% achieved the program’s recovery criteria at discharge, 29.6% had SAM at discharge and 72.1% of children were acutely malnourished at the end of 14 weeks of follow-up. Despite low recovery rate, children of caregivers with the highest decision-making autonomy recovered faster from SAM than children of caregivers with lower autonomy.

The poor agreement between MUAC and WHZ in diagnosing SAM within different groups of children indicates each anthropometric indicator may select different set of children for treatment. Our study provided empirical evidence that supports the current recommendation to use MUAC and WHZ independently for the management of SAM. Linking CMAM to other com-plementary programmes may improve the effectiveness of integrated large-scale nutrition programmes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1457
Keywords
Severe acute malnutrition, children, anthropometric indicators, integrated outpatient therapeutic programme, recovery, Ethiopia
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-347845 (URN)978-91-513-0316-1 (ISBN)
Public defence
2018-05-29, Rosénsalen, Ing 95/96, Akademiska sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-08 Created: 2018-04-08 Last updated: 2018-05-08

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