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Comparative Study
. 2019 Aug 6;14(8):e0219745.
doi: 10.1371/journal.pone.0219745. eCollection 2019.

Severe acute malnutrition and mortality in children in the community: Comparison of indicators in a multi-country pooled analysis

Catherine Schwinger  1 , Michael H Golden  2 , Emmanuel Grellety  3 , Dominique Roberfroid  4 , Benjamin Guesdon  5
Affiliations
Comparative Study

Severe acute malnutrition and mortality in children in the community: Comparison of indicators in a multi-country pooled analysis

Catherine Schwinger et al. PLoS One. .

Abstract

Objectives: This study aims to describe the mortality risk of children in the community who had severe acute malnutrition (SAM) defined by either a mid-upper arm circumference (MUAC) <115mm, a low weight-for-height Z-score (WHZ) <-3 or both criteria.

Methods: We pooled individual-level data from children aged 6-59 months enrolled in 3 community-based studies in the Democratic Republic of the Congo (DRC), Senegal and Nepal. We estimate the mortality hazard using Cox proportional hazard models in groups defined by either anthropometric indicator.

Results: In total, we had 49,001 time points provided by 15,060 children available for analysis, summing to a total of 143,512 person-months. We found an increasing death rate with a deteriorating nutritional status for all anthropometrical indicators. Children identified as SAM only by a low MUAC (<115mm) and those identified only by a low WHZ (Z-score <-3) had a similar mortality hazard which was about 4 times higher than those without an anthropometric deficit. Having both a low MUAC and a low WHZ was associated with an 8 times higher hazard of dying compared to children within the normal range. The 2 indicators identified a different set of children; the proportion of children identified by both indicators independently ranged from 7% in the DRC cohort, to 35% and 37% in the Senegal and the Nepal cohort respectively.

Conclusion: In the light of an increasing popularity of using MUAC as the sole indicator to identify SAM children, we show that children who have a low WHZ, but a MUAC above the cut-off would be omitted from diagnosis and treatment despite having a similar risk of death.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of children defined as SAM by MUAC-only (solid light grey area), WHZ-only (solid dark grey area) and both MUAC and WHZ (striped area) for (A) the combined data, (B) the DRC cohort, (C) the Senegal cohort, and (D) the Nepal cohort.
Fig 2
Fig 2. Hazard ratios with 95% CI resulting from Cox proportional hazard regression models for all measurements in children aged 6–59 months combined.
The reference categories are ≥135 mm for MUAC; ≥-1 Z-scores for WHZ; and MUAC ≥115 and WHZ ≥-3 for the combination of indicators.
Fig 3
Fig 3. Hazard ratios with 95% CI resulting from Cox proportional hazard regression models separately for each of the three original studies.
The reference categories are ≥135 mm for MUAC; ≥-1 Z-scores for WHZ; and MUAC ≥115 and WHZ ≥-3 for the combination of indicators.
Fig 4
Fig 4. Hazard ratios with 95% CI resulting from Cox proportional hazard regression models according to age group.
The reference categories are ≥135 mm for MUAC; ≥-1 Z-scores for WHZ; and MUAC ≥115 and WHZ ≥-3 for the combination of indicators.
See this image and copyright information in PMC

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References

    1. WHO/UNICEF. WHO child growth standards and the identification of severe acute malnutition in infants and children. Geneva / New york: World Health Organization and UNICEF, 2009. - PubMed
    1. Fernandez MA, Delchevalerie P, Van Herp M. Accuracy of MUAC in the detection of severe wasting with the new WHO growth standards. Pediatrics. 2010;126(1):e195–201. Epub 2010/07/01. 10.1542/peds.2009-2175 . - DOI - PubMed
    1. Laillou A, Prak S, Groot R, Whitney S, Conkle J, Horton L. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups. PLoS One. 2014;9 10.1371/journal.pone.0101159 - DOI - PMC - PubMed
    1. Dasgupta R, Sinha D, Jain SK, Prasad V. Screening for SAM in the community: Is MUAC a ‘Simple Tool’? Indian Pediatrics. 2013;50(1):154–5. 10.1007/s13312-013-0032-1 - DOI - PubMed
    1. Roberfroid D, Huybregts L, Lachat C, Vrijens F, Kolsteren P, Guesdon B. Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference: contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh. Nutrition journal. 2015;14 10.1186/s12937-015-0074-4 - DOI - PMC - PubMed

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The authors received no specific funding for this work.