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

Area of Science:

• Pediatrics
• Global Health
• Nutritional Epidemiology

Background:

• Severe acute malnutrition (SAM) is a critical global health issue affecting children worldwide.
• Current diagnostic criteria for non-oedematous SAM include mid-upper arm circumference (MUAC) < 115 mm or weight-for-height z-score (WHZ) < -3.
• Accurate identification of SAM cases at high risk of mortality is crucial for timely intervention.

Purpose of the Study:

• To evaluate the diagnostic accuracy of combining MUAC and WHZ criteria for predicting mortality in children with SAM.
• To determine if using both MUAC and WHZ offers additional benefit over using either criterion alone in identifying high-risk children.

Main Methods:

• Utilized data from a longitudinal study in rural Senegal on anthropometry and mortality.
• Constructed receiver operating characteristic (ROC) curves for MUAC and WHZ to assess their predictive ability for mortality.
• Positioned the diagnostic thresholds (MUAC < 115 mm and WHZ < -3) on the ROC curves to compare their performance.

Main Results:

• Mid-upper arm circumference (MUAC) demonstrated superior predictive accuracy for mortality compared to weight-for-height z-score (WHZ), as indicated by its higher ROC curve.
• The combined criteria (WHZ < -3 and/or MUAC < 115 mm) did not improve mortality prediction compared to MUAC alone.
• Both diagnostic thresholds fell below the MUAC ROC curve, suggesting MUAC is a more sensitive indicator of mortality risk.

Conclusions:

• There is no added benefit in combining WHZ < -3 and MUAC < 115 mm for identifying children with SAM at high risk of death.
• Utilizing MUAC < 115 mm alone is a preferable and more effective diagnostic criterion for identifying high-risk SAM cases.
• Simplifying diagnostic criteria using MUAC can enhance the identification and management of severely malnourished children.