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. 2020 Feb 10:6:5.
doi: 10.1186/s40795-019-0328-1. eCollection 2020.

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

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Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Benjamin Guesdon et al. BMC Nutr. .

Abstract

Background: Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the "expanded MUAC-only" approach, with Mid Upper Arm Circumference (MUAC) < 125 mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115 mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this "expanded MUAC-only" program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance.

Methods: We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach.

Results: We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the "expanded MUAC-only" scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target.

Conclusions: This empirical evidence suggests that adoption of "expanded MUAC-only" programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

Keywords: Humanitarian; MUAC; Nutrition; RUTF; Survey; WHZ; Wasting.

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Conflict of interest statement

Competing interestsAll authors declare that they have no competing interests; no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Overlap of the SAM and GAM categories of children defined either by WHZ or MUAC criteria based on the aggregated totals presented in Table 1 SAM severe acute malnutrition, GAM global acute malnutrition, RUTF ready-to-use therapeutic food, WHZ weight-for-height z-score, MUAC mid-upper arm circumference Categories represented by colors are as follows: GAM by WHZ (red), SAM by WHZ (orange), SAM by MUAC (blue), and GAM by MUAC (green)
Fig. 2
Fig. 2
Distribution of SAM (a) and MAM (b) children among the categories defined based on “expanded MUAC-only” admission criteria, by region SAM severe acute malnutrition, MAM moderate acute malnutrition, RUTF ready-to-use therapeutic food, DRC Democratic Republic of Congo Categories represented by colors in a are as follows: Correctly Detected (green), Ignored Risk (yellow), Underestimated (orange), and Excluded (red). Categories represented by colors in b are as follows: Included MAM (green) and Excluded MAM (red)
Fig. 3
Fig. 3
Distribution of SAM (a) and MAM (b) children among the categories defined based on “expanded MUAC-only” admission criteria in individual surveys, grouped by region SAM severe acute malnutrition, MAM moderate acute malnutrition, RUTF ready-to-use therapeutic food, DRC Democratic Republic of Congo Categories represented by colors in a are as follows: Correctly Detected (green), Ignored Risk (yellow), Underestimated (orange), and Excluded (red). Categories represented by colors in b are as follows: Included MAM (green) and Excluded MAM (red)

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